instruction
stringclasses 1
value | input
stringlengths 4
18.4k
| output
stringclasses 40
values |
|---|---|---|
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:, Detox from heroin.,HISTORY OF PRESENT ILLNESS: , This is a 52-year-old gentleman with a long history of heroin abuse, who keeps relapsing, presents once again, trying to get off the heroin, last use shortly prior to arrival including cocaine. The patient does have a history of alcohol abuse, but mostly he is concerned about the heroin abuse.,PAST MEDICAL HISTORY: , Remarkable for chronic pain. He has had multiple stab wounds, gunshot wounds, and a variety of other injuries that resulted him having chronic pain and he states that is what triggers of him getting on heroin to try to get out of pain. He has previously been followed by ABC but has not seen him for several years.,REVIEW OF SYSTEMS: ,The patient states that he did use heroin as well as cocaine earlier today and feels under the influence. Denies any headache or visual complaints. No hallucinations. No chest pain, shortness of breath, abdominal pain or back pain. Denies any abscesses.,SOCIAL HISTORY: , The patient is a smoker. Admits to heroin use, alcohol abuse as well. Also admits today using cocaine.,FAMILY HISTORY:, Noncontributory.,MEDICATIONS: , He has previously been on analgesics and pain medications chronically. Apparently, he just recently got out of prison. He has previously also been on Klonopin and lithium. He was previously on codeine for this pain.,ALLERGIES: , NONE.,PHYSICAL EXAMINATION: , VITAL SIGNS: The patient is afebrile. He is markedly hypertensive, 175/104 and pulse 117 probably due to the cocaine onboard. His respiratory rate is normal at 18. GENERAL: The patient is a little jittery but lucid, alert, and oriented to person, place, time, and situation. HEENT: Unremarkable. Pupils are actually moderately dilated about 4 to 5 mm, but reactive. Extraoculars are intact. His oropharynx is clear. NECK: Supple. His trachea is midline. LUNGS: Clear. He has good breath sounds and no wheezing. No rales or rhonchi. Good air movement and no cough. CARDIAC: Without murmur. ABDOMEN: Soft and nontender. He has multiple track marks, multiple tattoos, but no abscesses. NEUROLOGIC: Nonfocal.,IMPRESSION: , MEDICAL EXAMINATION FOR THE PATIENT WHO WILL BE DETOXING FROM HEROIN.,ASSESSMENT AND PLAN: ,At this time, I think the patient can be followed up at XYZ. I have written a prescription of clonidine and Phenergan for symptomatic relief and this has been faxed to the pharmacy. I do not think he needs any further workup at this time. He is discharged otherwise in stable condition. | 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 PERFORMED: , Nissen fundoplication.,DESCRIPTION OF PROCEDURE: , After informed consent was obtained detailing the risks of infection, bleeding, esophageal perforation and death, the patient was brought to the operative suite and placed supine on the operating room table. General endotracheal anesthesia was induced without incident. The patient was then placed in a modified lithotomy position taking great care to pad all extremities. TEDs and Venodynes were placed as prophylaxis against deep venous thrombosis. Antibiotics were given for prophylaxis against surgical infection.,A 52-French bougie was placed in the proximal esophagus by Anesthesia, above the cardioesophageal junction. A 2 cm midline incision was made at the junction of the upper two-thirds and lower one-third between the umbilicus and the xiphoid process. The fascia was then cleared of subcutaneous tissue using a tonsil clamp. A 1-2 cm incision was then made in the fascia gaining entry into the abdominal cavity without incident. Two sutures of 0 Vicryl were then placed superiorly and inferiorly in the fascia, and then tied to the special 12 mm Hasson trocar fitted with a funnel-shaped adaptor in order to occlude the fascial opening. Pneumoperitoneum was then established using carbon dioxide insufflation to a steady state of pressure of 16 mmHg. A 30-degree laparoscope was inserted through this port and used to guide the remaining trocars.,The remaining trocars were then placed into the abdomen taking care to make the incisions along Langer's line, spreading the subcutaneous tissue with a tonsil clamp, and confirming the entry site by depressing the abdominal wall prior to insertion of the trocar. A total of 4 other 10/11 mm trocars were placed. Under direct vision 1 was inserted in the right upper quadrant at the midclavicular line, at a right supraumbilical position; another at the left upper quadrant at the midclavicular line, at a left supraumbilical position; 1 under the right costal margin in the anterior axillary line; and another laterally under the left costal margin on the anterior axillary line. All of the trocars were placed without difficulty. The patient was then placed in reverse Trendelenburg position.,The triangular ligament was taken down sharply, and the left lobe of the liver was retracted superolaterally using a fan retractor placed through the right lateral cannula. The gastrohepatic ligament was then identified and incised in an avascular plane. The dissection was carried anteromedially onto the phrenoesophageal membrane. The phrenoesophageal membrane was divided on the anterior aspect of the hiatal orifice. This incision was extended to the right to allow identification of the right crus. Then along the inner side of the crus, the right esophageal wall was freed by dissecting the cleavage plane.,The liberation of the posterior aspect of the esophagus was started by extending the dissection the length of the right diaphragmatic crus. The pars flaccida of the lesser omentum was opened, preserving the hepatic branches of the vagus nerve. This allowed free access to the crura, left and right, and the right posterior aspect of the esophagus, and the posterior vagus nerve.,Attention was next turned to the left anterolateral aspect of the esophagus. At its left border, the left crus was identified. The dissection plane between it and the left aspect of the esophagus was freed. The gastrophrenic ligament was incised, beginning the mobilization of the gastric pouch. By dissecting the intramediastinal portion of the esophagus, we elongated the intra-abdominal segment of the esophagus and reduced the hiatal hernia.,The next step consisted of mobilization of the gastric pouch. This required ligation and division of the gastrosplenic ligament and several short gastric vessels using the harmonic scalpel. This dissection started on the stomach at the point where the vessels of the greater curvature turned towards the spleen, away from the gastroepiploic arcade. The esophagus was lifted by a Babcock inserted through the left upper quadrant port. Careful dissection of the mesoesophagus and the left crus revealed a cleavage plane between the crus and the posterior gastric wall. Confirmation of having opened the correct plane was obtained by visualizing the spleen behind the esophagus. A one-half inch Penrose drain was inserted around the esophagus and sewn to itself in order to facilitate retraction of the distal esophagus. The retroesophageal channel was enlarged to allow easy passage of the antireflux valve.,The 52-French bougie was then carefully lowered into the proximal stomach, and the hiatal orifice was repaired. Two interrupted 0 silk sutures were placed in the diaphragmatic crura to close the orifice.,The last part of the operation consisted of the passage and fixation of the antireflux valve. With anterior retraction on the esophagus using the Penrose drain, a Babcock was passed behind the esophagus, from right to left. It was used to grab the gastric pouch to the left of the esophagus and to pull it behind, forming the wrap. The,52-French bougie was used to calibrate the external ring. Marcaine 0.5% was injected 1 fingerbreadth anterior to the anterior superior iliac spine and around the wound for postanesthetic pain control. The skin incision was approximated with skin staples. A dressing was then applied. All surgical counts were reported as correct.,Having tolerated the procedure well, the patient was subsequently taken to the recovery room in good and stable condition. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | Her axial back pain is greatly improved, but not completely eradicated. There is absolutely no surgery at this point in time that would be beneficial for her axial back pain due to her lumbar internal disc disruption.,PAST MEDICAL HISTORY:, Significant for anxiety disorder.,PAST SURGICAL HISTORY: , Foot surgery, abdominal surgery, and knee surgery.,CURRENT MEDICATIONS:, Lipitor and Lexapro.,ALLERGIES: , She is allergic to sulfa medications.,SOCIAL HISTORY: , She is married, retired. Denies tobacco or ethanol use.,FAMILY HISTORY:, Father died of mesothelioma. Mother gastric problems.,REVIEW OF SYSTEMS: , No recent history of night sweats, fevers, weight loss, visual changes, loss of consciousness, convulsion, or dysphagia. Otherwise, review of systems is unremarkable, and a detailed history can be found in the patient's chart.,PHYSICAL EXAMINATION:, Physical exam can be found in great detail in the patient's chart.,ASSESSMENT AND PLAN: ,The patient is suffering from multilevel lumbar internal disc disruption as well as an element of lumbar facet joint syndrome. Her lumbar facet joints were denervated approximately 6 months ago. The denervation procedure helped her axial back pain approximately 40% when standing. With extension and rotation it helped her axial back pain approximately 70%. She is now able to swing a golf club. She was unable to swing a golf club due to the rotational movements before her rhizotomy. She is currently playing golf. Her L4 radicular symptoms have resolved since her therapeutic transforaminal injection.,I am going to have her fitted with a low profile back brace and I am starting her on diclofenac 75 mg p.o. b.i.d. We will follow her up in 1 month's time., | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR REFERRAL: , Ms. A is a 60-year-old African-American female with 12 years of education who was referred for neuropsychological evaluation by Dr. X after she demonstrated mild cognitive deficits on a neuropsychological screening evaluation during a followup appointment with him for stroke in July. A comprehensive evaluation was requested to assess current cognitive functioning and assist with diagnostic decisions and treatment planning.,RELEVANT BACKGROUND INFORMATION:, Historical information was obtained from a review of available medical records and clinical interview with Ms. A. A summary of pertinent information is presented below. Please refer to the patient's medical chart for a more complete history.,HISTORY OF PRESENTING PROBLEM:, Ms. A presented to the ABC Hospital emergency department on 07/26/2009 reporting that after she had woken up that morning she noticed numbness and weakness in her left hand, slurred speech, and left facial droop. Neurological evaluation with Dr. X confirmed left hemiparesis. Brain CT showed no evidence of intracranial hemorrhage or mass effect and that she received TPA and had moderate improvement in left-sided weakness. These symptoms were thought to be due to a right middle cerebral artery stroke. She was transferred to the ICU for monitoring. Ultrasound of the carotids showed 20% to 30% stenosis of the right ICA and 0% to 19% stenosis of the left ICA. On 07/29/2009, she was admitted for acute inpatient rehabilitation for the treatment of residual functional deficits of her acute ischemic right MCA/CVA. At discharge on 08/06/2009, she was mainly on supervision for all ADLs and walking with a rolling walker, but tolerating increased ambulation with a cane. She was discharged home with recommendations for outpatient physical therapy. She returned to the Sinai ER on 08/2009/2009 due to reported left arm pain, numbness, and weakness, which lasted 10 to 15 minutes and she reported that it felt "just like the stroke." Brain CT on 08/2009/2009 was read as showing "mild chronic microvascular ischemic change of deep white matter," but no acute or significant interval change compared to her previous scan. Neurological examination with Dr. Y was within normal limits, but she was admitted for a more extensive workup. Due to left arm pain an ultrasound was completed on her left upper extremity, but it did not show deep vein thrombosis.,Followup CT on 08/10/2009 showed no significant interval change. MRI could not be completed due to the patient's weight. She was discharged on 08/11/2009 in stable condition after it was determined that this event was not neurological in origin; however, note that Ms. A referred to this as a second stroke.,Ms. A presented for a followup outpatient neurological evaluation with Dr. X on 09/22/2009, at which time a brief neuropsychological screening was also conducted. She demonstrated significant impairments in confrontation naming, abstract verbal reasoning, and visual and verbal memory and thus a more comprehensive evaluation was suggested due to her intent to return to her full-time work duty. During the current interview, Ms. A reported that she noticed mild memory problems including some difficultly remembering conversations, events, and at times forgetting to take her medications. She also reported mild difficulty finding words in conversation, solving novel problems and tasks (e.g. difficulty learning to use her camcorder), but overall denied significant cognitive deficits in attention, concentration, language or other areas of cognitive functioning. When asked about her return to work, she said that she was still on light duty due to limited physical activity because of residual left leg weakness. She reported that no one had indicated to her that she appeared less capable of performing her job duties, but said that she was also receiving fewer files to process and enter data into the computer at the Social Security Agency that she works at. Note also that she had some difficulty explaining exactly what her job involved. She also reported having problems falling asleep at work and that she is working full-time although on light duty.,OTHER MEDICAL HISTORY: ,As mentioned, Ms. A continues to have some residual left leg weakness and continues to use a rolling walker for ambulation, but she reported that her motor functioning had improved significantly. She was diagnosed with sleep apnea approximately two years ago and was recently counseled by Dr. X on the need to use her CPAP because she indicated she never used it at night. She reported that since her appointment with Dr. X, she has been using it "every other night." When asked about daytime fatigue, Ms. A initially denied that she was having any difficulties, but repeatedly indicated that she was falling asleep at work and thought that it was due to looking at a computer screen. She reported at times "snoring" and forgetting where she is at and said that a supervisor offered to give her coffee at one point. She receives approximately two to five hours of sleep per night. Other current untreated risk factors include obesity and hypercholesterolemia. Her medical history is also significant for hypertension, asthma, abdominal adenocarcinoma status post hysterectomy with bilateral salpingo-oophorectomy, colonic benign polyps status post resection, benign lesions of the breast status post lumpectomy, and deep vein thrombosis in the left lower extremity status post six months of anticoagulation (which she had discontinued just prior to her stroke).,CURRENT MEDICATIONS: , Aspirin 81 mg daily, Colace 100 mg b.i.d., Lipitor 80 mg daily, and albuterol MDI p.r.n.,SUBSTANCE USE:, Ms. A denied drinking alcohol or using illicit drugs. She used to smoke a pack of cigarettes per day, but quit five to six years ago.,FAMILY MEDICAL HISTORY: , Ms. A had difficulty providing information on familial medical history. She reported that her mother died three to four years ago from lung cancer. Her father has gout and blood clots. Siblings have reportedly been treated for asthma and GI tumors. She was unsure of familial history of other conditions such as hypertension, high cholesterol, stroke, etc.,SOCIAL HISTORY: , Ms. A completed high school degree. She reported that she primarily obtained B's and C's in school. She received some tutoring for algebra in middle school, but denied ever having been held back a grade failing any classes or having any problems with attention or hyperactivity.,She currently works for the Social Security Administration in data processing. As mentioned, she has returned to full-time work, but continues to perform only light duties due to her physical condition. She is now living on her own. She has never driven. She reported that she continues to perform ADLs independently such as cooking and cleaning. She lost her husband in 2005 and has three adult daughters. She previously reported some concerns that her children wanted her to move into assisted living, but she did not discuss that during this current evaluation. She also reported number of other family members who had recently passed away. She has returned to activities she enjoys such as quire, knitting, and cooking and plans to go on a cruise to the Bahamas at the end of October.,PSYCHIATRIC HISTORY: , Ms. A did not report a history of psychological or psychiatric treatment. She reported that her current mood was good, but did describe some anxiety and nervousness about various issues such as her return to work, her upcoming trip, and other events. She reported that this only "comes and goes.",TASKS ADMINISTERED:,Clinical Interview,Adult History Questionnaire,Wechsler Test of Adult Reading (WTAR),Mini Mental Status Exam (MMSE),Cognistat Neurobehavioral Cognitive Status Examination,Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Form XX),Mattis Dementia Rating Scale, 2nd Edition (DRS-2),Neuropsychological Assessment Battery (NAB),Wechsler Adult Intelligence Scale, Third Edition (WAIS-III),Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV),Wechsler Abbreviated Scale of Intelligence (WASI),Test of Variables of Attention (TOVA),Auditory Consonant Trigrams (ACT),Paced Auditory Serial Addition Test (PASAT),Ruff 2 & 7 Selective Attention Test,Symbol Digit Modalities Test (SDMT),Multilingual Aphasia Examination, Second Edition (MAE-II), Token Test, Sentence Repetition, Visual Naming, Controlled Oral Word Association, Spelling Test, Aural Comprehension, Reading Comprehension,Boston Naming Test, Second Edition (BNT-2),Animal Naming Test | 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: , History of polyps.,POSTOPERATIVE DIAGNOSES:,1. Normal colonoscopy, left colonic diverticular disease.,2. 3+ benign prostatic hypertrophy.,PROCEDURE PERFORMED: , Total colonoscopy and photography.,GROSS FINDINGS: , This is a 74-year-old white male here for recheck colonoscopy for a history of polyps. After signed informed consent, blood pressure monitoring, EKG monitoring, and pulse oximetry monitoring, he was brought to the Endoscopic Suite. He was given 100 mg of Demerol, 3 mg of Versed IV push slowly. Digital examination revealed a large prostate for which he is following up with his urologist. No nodules. 3+ BPH. Anorectal canal was within normal limits. No stricture tumor or ulcer. The Olympus CF 20L video endoscope was inserted per anus. The anorectal canal was visualized, was normal. The sigmoid, descending, splenic, and transverse showed scattered diverticula. The hepatic, ascending, cecum, and ileocecal valve was visualized and was normal. The colonoscope was removed. The air was aspirated. The patient was discharged with high-fiber, diverticular diet. Recheck colonoscopy three years. | 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 KUB.,REASON FOR EXAM: , Flank pain.,TECHNIQUE:, Noncontrast CT abdomen and pelvis per renal stone protocol.,Correlation is made with the prior examination dated 01/16/09.,FINDINGS: , There is no intrarenal stone or obstruction bilaterally. There is no hydronephrosis, ureteral dilatation. There are calcifications about the pelvis including one in the left upper pelvis, but these are stable from the prior study and there is no upstream ureteral dilatation, the findings therefore are favored to represent phleboliths. The bladder is nearly completely decompressed. There is no asymmetric renal enlargement or perinephric stranding as secondary evidence of obstruction.,The appendix is normal. There is no evidence for a pericolonic inflammatory process or small bowel obstruction.,Dedicated scan to the pelvis disclosed the aforementioned presumed phleboliths. There is no pelvic free fluid or adenopathy.,Lung bases appear clear. Given the lack of contrast, liver, spleen, adrenal glands, and the pancreas appear grossly unremarkable. The gallbladder has been resected. There is no abdominal free fluid or pathologic adenopathy.,IMPRESSION:,1. No renal stone or evidence of obstruction. Stable appearing pelvic calcifications likely indicate phleboliths.,2. Normal appendix. | Nephrology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | EARS, NOSE, MOUTH AND THROAT: , The nose is without any evidence of any deformity. The ears are with normal-appearing pinna. Examination of the canals is normal appearing bilaterally. There is no drainage or erythema noted. The tympanic membranes are normal appearing with pearly color, normal-appearing landmarks and normal light reflex. Hearing is grossly intact to finger rubbing and whisper. The nasal mucosa is moist. The septum is midline. There is no evidence of septal hematoma. The turbinates are without abnormality. No obvious abnormalities to the lips. The teeth are unremarkable. The gingivae are without any obvious evidence of infection. The oral mucosa is moist and pink. There are no obvious masses to the hard or soft palate. The uvula is midline. The salivary glands appear unremarkable. The tongue is midline. The posterior pharynx is without erythema or exudate. The tonsils are normal appearing. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT:, Bright red blood per rectum ,HISTORY OF PRESENT ILLNESS: ,This 73-year-old woman had a recent medical history significant for renal and bladder cancer, deep venous thrombosis of the right lower extremity, and anticoagulation therapy complicated by lower gastrointestinal bleeding. Colonoscopy during that admission showed internal hemorrhoids and diverticulosis, but a bleeding site was not identified. Five days after discharge to a nursing home, she again experienced bloody bowel movements and returned to the emergency department for evaluation. ,REVIEW OF SYMPTOMS: ,No chest pain, palpitations, abdominal pain or cramping, nausea, vomiting, or lightheadedness. Positive for generalized weakness and diarrhea the day of admission. ,PRIOR MEDICAL HISTORY:, Long-standing hypertension, intermittent atrial fibrillation, and hypercholesterolemia. Renal cell carcinoma and transitional cell bladder cancer status post left nephrectomy, radical cystectomy, and ileal loop diversion 6 weeks prior to presentation, postoperative course complicated by pneumonia, urinary tract infection, and retroperitoneal bleed. Deep venous thrombosis 2 weeks prior to presentation, management complicated by lower gastrointestinal bleeding, status post inferior vena cava filter placement. ,MEDICATIONS: ,Diltiazem 30 mg tid, pantoprazole 40 mg qd, epoetin alfa 40,000 units weekly, iron 325 mg bid, cholestyramine. Warfarin discontinued approximately 10 days earlier. ,ALLERGIES: ,Celecoxib (rash).,SOCIAL HISTORY:, Resided at nursing home. Denied alcohol, tobacco, and drug use. ,FAMILY HISTORY:, Non-contributory.,PHYSICAL EXAM: ,Temp = 38.3C BP =146/52 HR= 113 RR = 18 SaO2 = 98% room air ,General: Pale, ill-appearing elderly female. ,HEENT: Pale conjunctivae, oral mucous membranes moist. ,CVS: Irregularly irregular, tachycardia. ,Lungs: Decreased breath sounds at the bases. ,Abdomen: Positive bowel sounds, soft, nontender, nondistended, gross blood on rectal exam. ,Extremities: No cyanosis, clubbing, or edema. ,Skin: Warm, normal turgor. ,Neuro: Alert and oriented. Nonfocal. ,LABS: ,CBC: ,WBC count: 6,500 per mL ,Hemoglobin: 10.3 g/dL ,Hematocrit:31.8% ,Platelet count: 248 per mL ,Mean corpuscular volume: 86.5 fL ,RDW: 18% ,CHEM 7: ,Sodium: 131 mmol/L ,Potassium: 3.5 mmol/L ,Chloride: 98 mmol/L ,Bicarbonate: 23 mmol/L ,BUN: 11 mg/dL ,Creatinine: 1.1 mg/dL ,Glucose: 105 mg/dL ,COAGULATION STUDIES: ,PT 15.7 sec ,INR 1.6 ,PTT 29.5 sec ,HOSPITAL COURSE: ,The patient received 1 liter normal saline and diltiazem (a total of 20 mg intravenously and 30 mg orally) in the emergency department. Emergency department personnel made several attempts to place a nasogastric tube for gastric lavage, but were unsuccessful. During her evaluation, the patient was noted to desaturate to 80% on room air, with an increase in her respiratory rate to 34 breaths per minute. She was administered 50% oxygen by nonrebreadier mask, with improvement in her oxygen saturation to 89%. Computed tomographic angiography was negative for pulmonary embolism. | 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' | ADMISSION DIAGNOSIS: , Bilateral l5 spondylolysis with pars defects and spinal instability with radiculopathy.,SECONDARY DIAGNOSIS:, Chronic pain syndrome.,PRINCIPAL PROCEDURE: , L5 Gill procedure with interbody and posterolateral (360 degrees circumferential) arthrodesis using cages, bone graft, recombinant bone morphogenic protein, and pedicle fixation. This was performed by Dr. X on 01/08/08.,BRIEF HISTORY OF HOSPITAL COURSE: , The patient is a man with a history of longstanding back, buttock, and bilateral leg pain. He was evaluated and found to have bilateral pars defects at L5-S1 with spondylolysis and instability. He was admitted and underwent an uncomplicated surgical procedure as noted above. In the postoperative period, he was up and ambulatory. He was taking p.o. fluids and diet well. He was afebrile. His wounds were healing well. Subsequently, the patient was discharged home.,DISCHARGE MEDICATIONS: , Discharge medications included his usual preoperative pain medication as well as other medications.,FOLLOWUP: ,At this time, the patient will follow up with me in the office in six weeks' time. The patient understands discharge plans and is in agreement with the discharge plan. He will follow up as noted | 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' | REASON FOR RETURN VISIT: , Followup of left hand discomfort and systemic lupus erythematosus.,HISTORY OF PRESENT ILLNESS: , The patient is a 56-year-old female with a history of systemic lupus erythematosus, who was last seen in rheumatology clinic approximately 4 months ago for bilateral hand discomfort, left greater than right. The patient was seen on 10/30/07. She had the same complaint. She was given a trial of Elavil at bedtime because the thought was to see that represented ulnar or radial neuropathy. She was also given a prescription for Zostrix cream but was unable to get it filled because of insurance coverage. The patient reports some worsening of the symptoms especially involving at the dorsum of the left hand, and she points to the area that actually involves the dorsal aspect of the second, third, and fourth digits. The patient recently has developed what sounds like an upper respiratory problem with a nonproductive cough for 3 days, although she reports that she has had subjective fevers for the past 3 or 4 days, but has not actually taken the temperature. She has not had any night sweats or chills. She has had no recent problems with chest pain, chest discomfort, shortness of breath or problems with GU or GI complaints. She is returning today for routine followup evaluation.,CURRENT MEDICATIONS:,1. Plaquenil 200 mg twice a day.,2. Fosamax 170 mg once a week.,3. Calcium and vitamin D complex twice daily.,4. Folic acid 1 mg per day.,5. Trilisate 1000 mg a day.,6. K-Dur 20 mEq twice a day.,7. Hydrochlorothiazide 15 mg once a day.,8. Lopressor 50 mg one-half tablet twice a day.,9. Trazodone 100 mg at bedtime.,10. Prempro 0.625 mg per day.,11. Aspirin 325 mg once a day.,12. Lipitor 10 mg per day.,13. Pepcid 20 mg twice a day.,14. Reglan 10 mg before meals and at bedtime.,15. Celexa 20 mg per day.,REVIEW OF SYSTEMS: , Noncontributory except for what was noted in the HPI and the remainder or complete review of systems is unremarkable.,PHYSICAL EXAMINATION:,VITAL SIGNS: Blood pressure 155/84, pulse 87, weight 223 pounds, and temperature 99.2. GENERAL: She is a well-developed, well-nourished female appearing her staged age. She is alert, oriented, and cooperative. HEENT: Normocephalic and atraumatic. There is no facial rash. No oral lesions. LUNGS: Clear to auscultation. CARDIOVASCULAR: Regular rate and rhythm without murmurs, rubs or gallops. EXTREMITIES: No cyanosis or clubbing. Sensory examination of the upper extremity decreased to light touch on the distal tips of the left second and third digits compared to the fifth digit. Positive Tinel sign. Full range of motion of the wrist with no evidence of motor atrophy or muscle loss.,LABORATORY DATA: ,WBC 5100, hemoglobin 11.1, hematocrit 32.8, and platelets 200,000. Westergren sedimentation rate of 47. Urinalysis is negative for protein and blood. Lupus serology is pending.,ASSESSMENT:,1. Systemic lupus erythematosus that is chronically stable at this point.,2. Carpal tunnel involving the left wrist with sensory change, but no evidence of motor change.,3. Upper respiratory infection with cough, cold, and congestion.,RECOMMENDATIONS:,1. The patient will have a trial of a resting wrist splint at night for the next 4 to 6 weeks. If there is no improvement, the patient will return for corticosteroid injection of her carpal tunnel.,2. Azithromycin 5-day dose pack.,3. Robitussin Cough and Cold Flu to be taken twice a day.,4. Atarax 25 mg at bedtime for sleep.,5. The patient will return to the rheumatology clinic for a routine followup evaluation in 4 months. | 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' | PROCEDURES UNDERTAKEN,1. Left coronary system cineangiography.,2. Right coronary system cineangiography.,3. Cineangiography of SVG to OM.,4. Cineangiography of LIMA to LAD.,5. Left ventriculogram.,6. Aortogram.,7. Percutaneous intervention of the left circumflex and obtuse marginal branch with plano balloon angioplasty unable to pass stent.,NARRATIVE:, After all risks and benefits were explained to the patient, informed consent was obtained. The patient was brought to the cardiac catheterization suite. The right groin was prepped in the usual sterile fashion. Right common femoral artery was cannulated using a modified Seldinger technique and a long 6-French AO sheath was introduced secondary to tortuous aorta. Next, Judkins left catheter was used to engage the left coronary system. Cineangiography was recorded in multiple views. Next, Judkins right catheter was used to engage the right coronary system. Cineangiography was recorded in multiple views. Next, the Judkins right catheter was used to engage the SVG to OM. Cineangiography was recorded. Next, the Judkins right was advanced into the left subclavian and exchanged over a long exchange length J-wire for a 4-French left internal mammary artery which was used to engage the LIMA graft to LAD and cineangiography was recorded in multiple views. Next, an angled pigtail catheter was advanced into the left ventricular cavity. LV pressures were measured. LV gram was done and a pullback gradient across the aortic valve was done and recorded. Next, an aortogram was done and recorded. At this point, I decided to proceed with percutaneous intervention of the left circumflex. Therefore, AVA 3.5 guide was used to engage the left coronary artery. Angiomax bolus and drip was started. Universal wire was advanced past the lesion and a 2.5-balloon was advanced first to the proximal lesions and predilations were done at 14 atmospheres and then to the distal lesion and predilatation was done at 12 atmospheres. Next, we attempted to advance a 3.0 x 12 stent to the distal lesion; however, we were unable to pass the stent. Next, second dilatations were done again with the 2.5 balloon at 18 atmospheres; however, we are unable to break the lesion. We next attempted a cutting balloon. Again, we are unable to cross the lesion, therefore a buddy wire technique was used with a PT choice support wire. Again, we were unable to cross the lesion with the stent. We then try to cross with a noncompliant balloon, which we were unsuccessful. We also try to cutting balloon again, we were unsuccessful. Despite multiple dilatations, we were unable to cross anything beyond the noncompliant balloon across the lesion; therefore, finally the procedure was aborted. Final images showed no evidence of dissection, perforation, or further complication. The right groin was filled after taking an image to confirm sheath placement above the bifurcation with excellent results. The patient tolerated the procedure very well without complications, was taken off the operating table and transferred back to cardiac telemetry floor.,DIAGNOSTIC FINDINGS,1. The LV. LVEDP was 4. LVES is approximately 50%-55% with inferobasal hypokinesis. No significant MR. No gradient across the aortic valve.,2. Aortogram. The ascending aorta shows no significant dilatation or evidence of dissection. The valve shows no significant aortic insufficiencies. The abdominal aorta and distal aorta shows significant tortuosities.,3. The left main. The left main coronary artery is a large caliber vessel, bifurcating the LAD and left circumflex with some mild distal disease of about 10%-20%.,4. Left circumflex. The left circumflex vessel is a large caliber vessel gives off a distal branching obtuse marginal branch. The upper pole of the OM shows retrograde filling of the distal graft and also at that point approximately a 70%-80% stenosis. The mid left circumflex is a high-grade 80% diffuse tortuous stenosis.,5. LAD. The LAD is a totally 100% occluded vessel. The LIMA to LAD is patent with only a small-to-moderate caliber LAD. There is a large diagonal branch coming off the proximal portion of the LAD and that proximal LAD showed some diffuse disease upwards of 60%-70%. The diagonal shows proximal 80% stenosis.,6. The right coronary artery: The right coronary artery is 100% occluded. There are retrograde collaterals from left to right to the distal PDA and PLV branches. The SVG to OM is 100% occluded at its take off. The SVG to PDA is not found; however, presumed 100% occluded given that there is collateral flow to the distal right.,7. LIMA to LAD is widely patent.,ASSESSMENT AND PLAN: , Attempted intervention to the left circumflex system, only able to perform plano balloon angioplasty, unable to pass stents, noncompliant balloons or cutting balloon. Final images showed some improvement, however, continued residual stenosis. At this point, the patient will be transferred back to telemetry floor and monitored. We can attempt future intervention or continue aggressive medical management. The patient continues to have residual stenosis in the diagonal; however, due to the length of this procedure, I did not attempt intervention to that diagonal branch. Possible consideration would be a stress test as an outpatient depending on where patient shows ischemia, focus on treatment to that lesion. | 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: , Patient is a 21-year-old white woman who presented with a chief complaint of chest pain. She had been previously diagnosed with hyperthyroidism. Upon admission, she had complaints of constant left sided chest pain that radiated to her left arm. She had been experiencing palpitations and tachycardia. She had no diaphoresis, no nausea, vomiting, or dyspnea.,She had a significant TSH of 0.004 and a free T4 of 19.3. Normal ranges for TSH and free T4 are 0.5-4.7 µIU/mL and 0.8-1.8 ng/dL, respectively. Her symptoms started four months into her pregnancy as tremors, hot flashes, agitation, and emotional inconsistency. She gained 16 pounds during her pregnancy and has lost 80 pounds afterwards. She complained of sweating, but has experienced no diarrhea and no change in appetite. She was given isosorbide mononitrate and IV steroids in the ER.,FAMILY HISTORY:, Diabetes, Hypertension, Father had a Coronary Artery Bypass Graph (CABG) at age 34.,SOCIAL HISTORY:, She had a baby five months ago. She smokes a half pack a day. She denies alcohol and drug use.,MEDICATIONS:, Citalopram 10mg once daily for depression; low dose tramadol PRN pain.,PHYSICAL EXAMINATION: , Temperature 98.4; Pulse 123; Respiratory Rate 16; Blood Pressure 143/74.,HEENT: She has exophthalmos and could not close her lids completely.,Cardiovascular: tachycardia.,Neurologic: She had mild hyperreflexiveness.,LAB:, All labs within normal limits with the exception of Sodium 133, Creatinine 0.2, TSH 0.004, Free T4 19.3 EKG showed sinus tachycardia with a rate of 122. Urine pregnancy test was negative.,HOSPITAL COURSE: , After admission, she was given propranolol at 40mg daily and continued on telemetry. On the 2nd day of treatment, the patient still complained of chest pain. EKG again showed tachycardia. Propranolol was increased from 40mg daily to 60mg twice daily., A I-123 thyroid uptake scan demonstrated an increased thyroid uptake of 90% at 4 hours and 94% at 24 hours. The normal range for 4-hour uptake is 5-15% and 15-25% for 24-hour uptake. Endocrine consult recommended radioactive I-131 for treatment of Graves disease.,Two days later she received 15.5mCi of I-131. She was to return home after the iodine treatment. She was instructed to avoid contact with her baby for the next week and to cease breast feeding.,ASSESSMENT / PLAN:,1. Treatment of hyperthyroidism. Patient underwent radioactive iodine 131 ablation therapy.,2. Management of cardiac symptoms stemming from hyperthyroidism. Patient was discharged on propranolol 60mg, one tablet twice daily.,3. Monitor patient for complications of I-131 therapy such as hypothyroidism. She should return to Endocrine Clinic in six weeks to have thyroid function tests performed. Long-term follow-up includes thyroid function tests at 6-12 month intervals.,4. Prevention of pregnancy for one year post I-131 therapy. Patient was instructed to use 2 forms of birth control and was discharged an oral contraceptive, taken one tablet daily.,5. Monitor ocular health. Patient was given methylcellulose ophthalmic, one drop in each eye daily. She should follow up in 6 weeks with the Ophthalmology clinic.,6. Management of depression. Patient will be continued on citalopram 10 mg. | 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 DIAGNOSES:,1. Left spermatocele.,2. Family planning.,POSTOPERATIVE DIAGNOSES:,1. Left spermatocele.,2. Family planning.,PROCEDURE PERFORMED:,1. Left spermatocelectomy/epididymectomy.,2. Bilateral partial vasectomy.,ANESTHESIA: , General.,ESTIMATED BLOOD LOSS:, Minimal.,SPECIMEN: , Left-sided spermatocele, epididymis, and bilateral partial vasectomy.,DISPOSITION: ,To PACU in stable condition.,INDICATIONS AND FINDINGS: , This is a 48-year-old male with a history of a large left-sided spermatocele with significant discomfort. The patient also has family status complete and desired infertility. The patient was scheduled for elective left spermatocelectomy and bilateral partial vasectomy.,FINDINGS: , At this time of the surgery, significant left-sided spermatocele was noted encompassing almost the entirety of the left epididymis with only minimal amount of normal appearing epididymis remaining.,DESCRIPTION OF PROCEDURE:, After informed consent was obtained, the patient was moved to the operating room. A general anesthesia was induced by the Department of Anesthesia.,The patient was prepped and draped in the normal sterile fashion for a scrotal approach. A #15 blade was used to make a transverse incision on the left hemiscrotum. Electrocautery was used to carry the incision down into the tunica vaginalis and the testicle was delivered into the field. The left testicle was examined. A large spermatocele was noted. Metzenbaum scissors were used to dissect the tissue around the left spermatocele. Once the spermatocele was identified, as stated above, significant size was noted encompassing the entire left epididymis. Metzenbaum scissors as well as electrocautery was used to dissect free the spermatocele from its testicular attachments and spermatocelectomy and left epididymectomy was completed with electrocautery. Electrocautery was used to confirm excellent hemostasis. Attention was then turned to the more proximal aspect of the cord. The vas deferens was palpated and dissected free with Metzenbaum scissors. Hemostats were placed on the two aspects of the cord, approximately 1 cm segment of cord was removed with Metzenbaum scissors and electrocautery was used to cauterize the lumen of the both ends of vas deferens and silk ties used to ligate the cut ends. Testicle was placed back in the scrotum in appropriate anatomic position. The dartos tissue was closed with running #3-0 Vicryl and the skin was closed in a horizontal interrupted mattress fashion with #4-0 chromic. Attention was then turned to the right side. The vas was palpated in the scrotum. A small skin incision was made with a #15 blade and the vas was grasped with a small Allis clamp and brought into the surgical field. A scalpel was used to excise the vas sheath and vas was freed from its attachments and grasped again with a hemostat. Two ends were hemostated with hemostats and divided with Metzenbaum scissors. Lumen was coagulated with electrocautery. Silk ties used to ligate both cut ends of the vas deferens and placed back into the scrotum. A #4-0 chromic suture was used in simple fashion to reapproximate the skin incision. Scrotum was cleaned and bacitracin ointment, sterile dressing, fluffs, and supportive briefs applied. The patient was sent to Recovery in stable condition. He was given prescriptions for doxycycline 100 mg b.i.d., for five days and Vicodin ES 1 p.o. q.4h. p.r.n., pain, #30 for pain. The patient is to followup with Dr. X in seven days. | 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: , Right carpal tunnel syndrome.,POSTOPERATIVE DIAGNOSIS:, Right carpal tunnel syndrome.,PROCEDURE PERFORMED: , Right carpal tunnel release.,PROCEDURE NOTE: ,The right upper extremity was prepped and draped in the usual fashion. IV sedation was supplied by the anesthesiologist. A local block using 6 cc of 0.5% Marcaine was used at the transverse wrist crease using a 25 gauge needle, superficial to the transverse carpal ligament.,The upper extremity was exsanguinated with a 6 inch ace wrap.,Tourniquet time was less than 10 minutes at 250 mmHg.,An incision was used in line with the third web space just to the ulnar side of the thenar crease. It was carried sharply down to the transverse wrist crease. The transverse carpal ligament was identified and released under direct vision. Proximal to the transverse wrist crease it was released subcutaneously. During the entire procedure care was taken to avoid injury to the median nerve proper, the recurrent median, the palmar cutaneous branch, the ulnar neurovascular bundle and the superficial palmar arch. The nerve appeared to be mildly constricted. Closure was routine with running 5-0 nylon. A bulky hand dressing as well as a volar splint was applied and the patient was sent to the outpatient surgery area in good 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' | DESCRIPTION OF OPERATION:, The patient was brought to the operating room and appropriately identified. Local anesthesia was obtained with a 50/50 mixture of 2% lidocaine and 0.75% bupivacaine given as a peribulbar block. The patient was prepped and draped in the usual sterile fashion. A lid speculum was used to provide exposure to the right eye.,A limited conjunctival peritomy was created with Westcott scissors to expose the supranasal and, separately, the supratemporal and inferotemporal quadrants. Calipers were set at 3.5 mm and a mark was made 3.5 mm posterior to the limbus in the inferotemporal quadrant.,A 5-0 nylon suture was passed through partial-thickness sclera on either side of this mark. The MVR blade was used to make a sclerotomy between the pre-placed sutures. An 8-0 nylon suture was then pre-placed for later sclerotomy closure. The infusion cannula was inspected and found to be in good working order. The infusion cannula was placed in the vitreous cavity and secured with the pre-placed sutures. The tip of the infusion cannula was directly visualized and found to be free of any overlying tissue and the infusion was turned on.,Additional sclerotomies were made 3.5 mm posterior to the limbus in the supranasal and supratemporal quadrants. The light pipe and vitrectomy handpieces were then placed in the vitreous cavity and a vitrectomy was performed. There was moderately severe vitreous hemorrhage, which was removed. Once a view of the posterior pole could be obtained, there were some diabetic membranes emanating along the arcades. These were dissected with curved scissors and judicious use of the vitrectomy cutter. There was some bleeding from the inferotemporal frond. This was managed by raising the intraocular pressure and using intraocular cautery. The surgical view became cloudy and the corneal epithelium was removed with a beaver blade. This improved the view. There is an area suspicious for retinal break near where the severe traction was inferotemporally. The Endo laser was used to treat in a panretinal scatter fashion to areas that had not received previous treatment. The indirect ophthalmoscope was used to examine the retinal peripheral for 360 degrees and no tears, holes or dialyses were seen. There was some residual hemorrhagic vitreous skirt seen. The soft-tip cannula was then used to perform an air-fluid exchange. Additional laser was placed around the suspicious area inferotemporally. The sclerotomies were then closed with 8-0 nylon suture in an X-fashion, the infusion cannula was removed and it sclerotomy closed with the pre-existing 8-0 nylon suture.,The conjunctiva was closed with 6-0 plain gut. A subconjunctival injection of Ancef and Decadron were given and a drop of atropine was instilled over the eye. The lid speculum was removed. Maxitrol ointment was instilled over the eye and the eye was patched. The patient was brought to the recovery room in stable 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' | PROCEDURE:, Circumcision.,ANESTHESIA: , EMLA.,FINDINGS: , Normal penis. The foreskin was normal in appearance and measured 1.6 cm. There was no bleeding at the circumcision site.,PROCEDURE:, Patient was placed on the circumcision restraint board. EMLA had been applied approximately 90 minutes before. A time-out was completed satisfactorily per protocol. The area was prepped with Betadine. The foreskin was grasped with sterile clamps and was dissected away from the corona and the glans penis with blunt dissection. A Mogen clamp was applied to the cervix. The excess foreskin was excised with the scalpel. The clamp was removed. At this point, the procedure was terminated. Sterile Vaseline and gauze was applied to the glans penis. There were no complications. There was minimal blood loss. | Urology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT:, Intractable nausea and vomiting.,HISTORY OF PRESENT ILLNESS:, This is a 43-year-old black female who was recently admitted and discharged yesterday for the same complaint. She has a long history of gastroparesis dating back to 2000, diagnosed by gastroscopy. She also has had multiple endoscopies revealing gastritis and esophagitis. She has been noted in the past multiple times to be medically noncompliant with her medication regimen. She also has very poorly controlled hypertension, diabetes mellitus and she also underwent a laparoscopic right adrenalectomy due to an adrenal adenoma in January, 2006. She presents to the emergency room today with elevated blood pressure and extreme nausea and vomiting. She was discharged on Reglan and high-dose PPI yesterday, and was instructed to take all of her medications as prescribed. She states that she has been compliant, but her symptoms have not been controlled. It should be noted that on her hospital admission she would have times where she would feel extremely sick to her stomach, and then soon after she would be witnessed going outside to smoke.,PAST MEDICAL HISTORY:,1. Diabetes mellitus (poorly controlled).,2. Hypertension (poorly controlled).,3. Chronic renal insufficiency.,4. Adrenal mass.,5. Obstructive sleep apnea.,6. Arthritis.,7. Hyperlipidemia.,PAST SURGICAL HISTORY:,1. Removal of ovarian cyst.,2. Hysterectomy.,3. Multiple EGDs with biopsies over the last six years. Her last EGD was in June, 2005, which showed esophagitis and gastritis.,4. Colonoscopy in June, 2005, showing diverticular disease.,5. Cardiac catheterization in February, 2002, showing normal coronary arteries and no evidence of renal artery stenosis.,6. Laparoscopic adrenalectomy in January, 2006.,MEDICATIONS:,1. Reglan 10 mg orally every 6 hours.,2. Nexium 20 mg orally twice a day.,3. Labetalol.,4. Hydralazine.,5. Clonidine.,6. Lantus 20 units at bedtime.,7. Humalog 30 units before meals.,8. Prozac 40 mg orally daily.,SOCIAL HISTORY:, She has a 27 pack year smoking history. She denies any alcohol use. She does have a history of chronic marijuana use.,FAMILY HISTORY:, Significant for diabetes and hypertension.,ALLERGIES:, NO KNOWN DRUG ALLERGIES.,REVIEW OF SYSTEMS:,HEENT: See has had headaches, and some dizziness. She denies any vision changes.,CARDIAC: She denies any chest pain or palpitations.,RESPIRATORY: She denies any shortness of breath.,GI: She has had persistent nausea and vomiting. She denies diarrhea, melena or hematemesis.,NEUROLOGICAL: She denies any neurological deficits.,All other systems were reviewed and were negative unless otherwise mentioned in HPI.,PHYSICAL EXAMINATION:,VITAL SIGNS: Blood pressure: 220/130. Heart rate: 113. Respiratory rate: 18. Temperature: 98.,GENERAL: This is a 43-year-old obese African-American female who appears in no acute distress. She has a depressed mood and flat affect, and does not answer questions elaborately. She will simply state that she does not feel well.,HEENT: Normocephalic, atraumatic, anicteric. PERRLA. EOMI. Mucous membranes moist. Oropharynx is clear.,NECK: Supple. No JVD. No lymphadenopathy.,LUNGS: Clear to auscultation bilaterally, nonlabored.,HEART: Regular rate and rhythm. S1 and S2. No murmurs, rubs, or gallops. | 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: , Right sacral alar notch and sacroiliac joint/posterior rami radiofrequency thermocoagulation.,ANESTHESIA: ,Local sedation.,VITAL SIGNS: , See nurse's notes.,COMPLICATIONS: , None.,DETAILS OF PROCEDURE: , INT was placed. The patient was in the operating room in the prone position. The back prepped with Betadine. The patient was given sedation and monitored. Under fluoroscopy, the right sacral alar notch was identified. After placement of a 20-gauge, 10 cm SMK needle into the notch, a positive sensory, negative motor stimulation was obtained. Following negative aspiration, 5 cc of 0.5% of Marcaine and 20 mg of Depo-Medrol were injected. Coagulation was then carried out at 90oC for 90 seconds. The SMK needle was then moved to the mid-inferior third of the right sacroiliac joint. Again the steps dictated above were repeated.,The above was repeated for the posterior primary ramus branch right at S2 and S3 by stimulating along the superior lateral wall of the foramen; then followed by steroid injected and coagulation as above.,There were no complications. The patient was returned to outpatient recovery in stable condition. | 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: , The patient is a 48-year-old man who has had abdominal pain since October of last year associated with a 30-pound weight loss and then developed jaundice. He had epigastric pain and was admitted to the hospital. A thin-slice CT scan was performed, which revealed a 4 x 3 x 2 cm pancreatic mass with involved lymph nodes and ring enhancing lesions consistent with liver metastases. The patient, additionally, had a questionable pseudocyst in the tail of the pancreas. The patient underwent ERCP on 04/04/2007 with placement of a stent. This revealed a strictured pancreatic duct, as well as strictured bile duct. A 10-french x 9 cm stent was placed with good drainage. The next morning, the patient felt quite a bit more comfortable. He additionally had a modest drop in his bilirubin and other liver tests. Of note, the patient has been having quite a bit of nausea during his admission. This responded to Zofran. It did not, initially, respond well to Phenergan, though after stent placement, he was significantly more comfortable and had less nausea, and in fact, had better response to the Phenergan itself. At the time of discharge, the patient's white count was 9.4, hemoglobin 10.8, hematocrit 32 with a MCV of 79, platelet count of 585,000. His sodium was 132, potassium 4.1, chloride 95, CO2 27, BUN of 8 with a creatinine of 0.3. His bilirubin was 17.1, alk phos 273, AST 104, ALT 136, total protein 7.8 and albumin of 3.8. He was tolerating a regular diet. The patient had been on oral hypoglycemics as an outpatient, but in hospital, he was simply managed with an insulin sliding scale. The patient will be transferred back to Pelican Bay, under the care of Dr. X at the infirmary. He will be further managed for his diabetes there. The patient will additionally undergo potential end of life meetings. I discussed the potentials of chemotherapy with patient. Certainly, there are modest benefits, which can be obtained with chemotherapy in metastatic pancreatic cancer, though at some cost with morbidity. The patient will consider this and will discuss this further with Dr. X. ,DISCHARGE MEDICATIONS:,1. Phenergan 25 mg q.6. p.r.n.,2. Duragesic patch 100 mcg q.3.d.,3. Benadryl 25-50 mg p.o. q.i.d. for pruritus.,4. Sliding scale will be discontinued at the time of discharge and will be reinstituted on arrival at Pelican Bay Infirmary.,5. The patient had initially been on enalapril here. His hypertension will be managed by Dr. X as well. ,PLAN: , The patient should return for repeat ERCP if there are signs of stent occlusion such as fever, increased bilirubin, worsening pain. In the meantime, he will be kept on a regular diet and activity per Dr. X. | 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' | 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' | TITLE OF OPERATION: , Right suboccipital craniectomy for resection of tumor using the microscope modifier 22 and cranioplasty.,INDICATION FOR SURGERY: , The patient with a large 3.5 cm acoustic neuroma. The patient is having surgery for resection. There was significant cerebellar peduncle compression. The tumor was very difficult due to its size as well as its adherence to the brainstem and the nerve complex. The case took 12 hours. This was more difficult and took longer than the usual acoustic neuroma.,PREOP DIAGNOSIS: , Right acoustic neuroma.,POSTOP DIAGNOSIS: , Right acoustic neuroma.,PROCEDURE:, The patient was brought to the operating room. General anesthesia was induced in the usual fashion. After appropriate lines were placed, the patient was placed in Mayfield 3-point head fixation, hold into a right park bench position to expose the right suboccipital area. A time-out was settled with nursing and anesthesia, and the head was shaved, prescrubbed with chlorhexidine, prepped and draped in the usual fashion. The incision was made and cautery was used to expose the suboccipital bone. Once the suboccipital bone was exposed under the foramen magnum, the high speed drill was used to thin out the suboccipital bone and the craniectomy carried out with Leksell and insertion with Kerrison punches down to the rim of the foramen magnum as well as laterally to the edge of the sigmoid sinus and superiorly to the edge of the transverse sinus. The dura was then opened in a cruciate fashion, the cisterna magna was drained, which nicely relaxed the cerebellum. The dura leaves were held back with the 4-0 Nurolon. The microscope was then brought into the field, and under the microscope, the cerebellar hemisphere was elevated. Laterally, the arachnoid was very thick. This was opened with bipolar and microscissors and this allowed for the cerebellum to be further mobilized until the tumor was identified. The tumor was quite large and filled up the entire lateral aspect of the right posterior fossa. Initially two retractors were used, one on the tentorium and one inferiorly. The arachnoid was taken down off the tumor. There were multiple blood vessels on the surface, which were bipolared. The tumor surface was then opened with microscissors and the Cavitron was used to began debulking the lesion. This was a very difficult resection due to the extreme stickiness and adherence to the cerebellar peduncle and the lateral cerebellum; however, as the tumor was able to be debulked, the edge began to be mobilized. The redundant capsule was bipolared and cut out to get further access to the center of the tumor. Working inferiorly and then superiorly, the tumor was taken down off the tentorium as well as out the 9th, 10th or 11th nerve complex. It was very difficult to identify the 7th nerve complex. The brainstem was identified above the complex. Similarly, inferiorly the brainstem was able to be identified and cotton balls were placed to maintain this plain. Attention was then taken to try identify the 7th nerve complex. There were multitude of veins including the lateral pontine vein, which were coming right into this area. The lateral pontine vein was maintained. Microscissors and bipolar were used to develop the plain, and then working inferiorly, the 7th nerve was identified coming off the brainstem. A number 1 and number 2 microinstruments were then used to began to develop the plane. This then allowed for the further appropriate plane medially to be identified and cotton balls were then placed. A number 11 and number 1 microinstrument continued to be used to free up the tumor from the widely spread out 7th nerve. Cavitron was used to debulk the lesion and then further dissection was carried out. The nerve stimulated beautifully at the brainstem level throughout this. The tumor continued to be mobilized off the lateral pontine vein until it was completely off. The Cavitron was used to debulk the lesion out back laterally towards the area of the porus. The tumor was debulked and the capsule continued to be separated with number 11microinstrument as well as the number 1 microinstrument to roll the tumor laterally up towards the porus. At this point, the capsule was so redundant, it was felt to isolate the nerve in the porus. There was minimal bulk remaining intracranially. All the cotton balls were removed and the nerve again stimulated beautifully at the brainstem. Dr. X then came in and scrubbed into the case to drill out the porus and remove the piece of the tumor that was left in the porus and coming out of the porus.,I then scrubbed back into case once Dr. X had completed removing this portion of the tumor. There was no tumor remaining at this point. I placed some Norian in the porus to seal any air cells, although there were no palpated. An intradural space was then irrigated thoroughly. There was no bleeding. The nerve was attempted to be stimulated at the brainstem level, but it did not stimulate at this time. The dura was then closed with 4-0 Nurolons in interrupted fashion. A muscle plug was used over one area. Duragen was laid and strips over the suture line followed by Hemaseel. Gelfoam was set over this and then a titanium cranioplasty was carried out. The wound was then irrigated thoroughly. O Vicryls were used to close the deep muscle and fascia, 3-0 Vicryl for subcutaneous tissue, and 3-0 nylon on the skin.,The patient was extubated and taken to the ICU 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:, Right ankle sprain.,HISTORY OF PRESENT ILLNESS: , This is a 56-year-old female who fell on November 26, 2007 at 11:30 a.m. while at work. She did not recall the specifics of her injury but she thinks that her right foot inverted and subsequently noticed pain in the right ankle. She describes no other injury at this time.,PAST MEDICAL HISTORY: , Hypertension and anxiety.,PAST SURGICAL HISTORY: , None.,MEDICATIONS: , She takes Lexapro and a blood pressure pill, but does not know anything more about the names and the doses.,ALLERGIES:, No known drug allergies.,SOCIAL HISTORY: , The patient lives here locally. She does not report any significant alcohol or illicit drug use. She works full time.,FAMILY HISTORY:, Noncontributory.,REVIEW OF SYSTEMS:,Pulm: No cough, No wheezing, No shortness of breath,CV: No chest pain or palpitations,GI: No abdominal pain. No nausea, vomiting, or diarrhea.,PHYSICAL EXAM:,GENERAL APPEARANCE: No acute distress,VITAL SIGNS: Temperature 97.8, blood pressure 122/74, heart rate 76, respirations 24, weight 250 lbs, O2 sat 95% on R.A.,NECK: Supple. No lymphadenopathy. No thyromegaly.,CHEST: Clear to auscultation bilaterally.,HEART: Regular rate and rhythm. No murmurs.,ABDOMEN: Non-distended, nontender, normal active bowel sounds.,EXTREMITIES: No Clubbing, No Cyanosis, No edema.,MUSCULOSKELETAL: The spine is straight and there is no significant muscle spasm or tenderness there. Both knees appear to be non-traumatic with no deformity or significant tenderness. The right ankle has some swelling just below the right lateral malleolus and the dorsum of the foot is tender. There is decreased range of motion and some mild ecchymosis noted around the ankle.,DIAGNOSTIC DATA: , X-ray of the right ankle reveals no acute fracture by my observation. Radiologic interpretation is pending., ,IMPRESSION:, Right ankle sprain.,PLAN:,1. Motrin 800 mg t.i.d.,2. Tylenol 1 gm q.i.d. as needed.,3. Walking cast is prescribed.,4. I told the patient to call back if any problems. The next morning she called back complaining of worsening pain and I called in some Vicodin ES 1-2 p.o. q. 8 hours p.r.n. pain #60 with no refills. | Orthopedic |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Right inguinal hernia.,POSTOPERATIVE DIAGNOSIS: , Right inguinal hernia.,ANESTHESIA: , General.,PROCEDURE: ,Right inguinal hernia repair.,INDICATIONS: , The patient is a 4-year-old boy with a right inguinal bulge, which comes and goes with Valsalva standing and some increased physical activity. He had an inguinal hernia on physical exam in the Pediatric Surgery Clinic and is here now for elective repair. We met with his parents and explained the surgical technique, risks, and talked to them about trying to perform a diagnostic laparoscopic look at the contralateral side to rule out an occult hernia. All their questions have been answered and they agreed with the plan.,OPERATIVE FINDINGS: ,The patient had a well developed, but rather thin walled hernia sac on the right. The thinness of hernia sac made it difficult to safely cannulate through the sac for the laparoscopy. Therefore, high ligation was performed, and we aborted the plan for laparoscopic view of the left side.,DESCRIPTION OF PROCEDURE: , The patient came to operating room and had an uneventful induction of general anesthesia. Surgical time-out was conducted while we were preparing and draping his abdomen with chlorhexidine based prep solution. During our time-out, we reiterated the patient's name, medical record number, weight, allergies status, and planned operative procedure. I then infiltrated 0.25% Marcaine with dilute epinephrine in the soft tissues around the inguinal crease in the right lower abdomen chosen for hernia incision. An additional aliquot of Marcaine was injected deep to the external oblique fascia performing the ilioinguinal and iliohypogastric nerve block. A curvilinear incision was made with a scalpel and a combination of electrocautery and some blunt dissection and scissor dissection was used to clear the tissue layers through Scarpa fascia and expose the external oblique. After the oblique layers were opened, the cord structure were identified and elevated. The hernia sac was carefully separated from the spermatic cord structures and control of the sac was obtained. Dissection of the hernia sac back to the peritoneal reflection at the level of deep inguinal ring was performed. I attempted to gently pass a 3-mm trocar through the hernia sac, but it was rather difficult and I became fearful that the sac would be torn in proximal control and mass ligation would be less effective. I aborted the laparoscopic approach and performed a high ligation using transfixing and a simple mass ligature of 3-0 Vicryl. The excess sac was trimmed and the spermatic cord structures were replaced. The external oblique fascia and Scarpa layers were closed with interrupted 3-0 Vicryl and skin was closed with subcuticular 5-0 Monocryl and Steri-Strips. The patient tolerated the operation well. Blood loss was less than 5 mL. The hernia sac was submitted for specimen, and he was then taken to the recovery room in good condition. | 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' | TITLE OF OPERATION: , Youngswick osteotomy with internal screw fixation of the first right metatarsophalangeal joint of the right foot.,PREOPERATIVE DIAGNOSIS: , Hallux limitus deformity of the right foot.,POSTOPERATIVE DIAGNOSIS: , Hallux limitus deformity of the right foot.,ANESTHESIA:, Monitored anesthesia care with 15 mL of 1:1 mixture of 0.5% Marcaine and 1% lidocaine plain.,ESTIMATED BLOOD LOSS:, Less than 10 mL.,HEMOSTASIS:, Right ankle tourniquet set at 250 mmHg for 35 minutes.,MATERIALS USED: , 3-0 Vicryl, 4-0 Vicryl, and two partially threaded cannulated screws from 3.0 OsteoMed System for internal fixation.,INJECTABLES: ,Ancef 1 g IV 30 minutes preoperatively.,DESCRIPTION OF THE PROCEDURE: , The patient was brought to the operating room and placed on the operating table in the supine position. After adequate sedation was achieved by the anesthesia team, the above-mentioned anesthetic mixture was infiltrated directly into the patient's right foot to anesthetize the future surgical site. The right ankle was then covered with cast padding and an 18-inch ankle tourniquet was placed around the right ankle and set at 250 mmHg. The right ankle tourniquet was then inflated. The right foot was prepped, scrubbed, and draped in normal sterile technique. Attention was then directed on the dorsal aspect of the first right metatarsophalangeal joint where a 6-cm linear incision was placed just parallel and medial to the course of the extensor hallucis longus to the right great toe. The incision was deepened through the subcutaneous tissues. All the bleeders were identified, cut, clamped, and cauterized. The incision was deepened to the level of the capsule and the periosteum of the first right metatarsophalangeal joint. All the tendinous and neurovascular structures were identified and retracted from the site to be preserved. Using sharp and dull dissection, all the capsular and periosteal attachments were mobilized from the base of the proximal phalanx of the right great toe and head of the first right metatarsal. Once the base of the proximal phalanx of the right great toe and the first right metatarsal head were adequately exposed, multiple osteophytes were encountered. Gouty tophi were encountered both intraarticularly and periarticularly for the first right metatarsophalangeal joint, which were consistent with a medical history that is positive for gout for this patient.,Using sharp and dull dissection, all the ligamentous and soft tissue attachments were mobilized and the right first metatarsophalangeal joint was freed from all adhesions. Using the sagittal saw, all the osteophytes were removed from the dorsal, medial, and lateral aspect of the first right metatarsal head as well as the dorsal, medial, and lateral aspect of the base of the proximal phalanx of the right great toe. Although some improvement of the range of motion was encountered after the removal of the osteophytes, some tightness and restriction was still present. The decision was thus made to perform a Youngswick-type osteotomy on the head of the first right metatarsal. The osteotomy consistent of two dorsal cuts and a plantar cut in a V-pattern with the apex of the osteotomy distal and the base of the osteotomy proximal. The two dorsal cuts were longer than the plantar cut in order to accommodate for the future internal fixation. The wedge of bone that was formed between the two dorsal cuts was resected and passed off to Pathology for further examination. The head of the first right metatarsal was then impacted on the shaft of the first right metatarsal and provisionally stabilized with two wires from the OsteoMed System. The wires were inserted from a dorsal distal to plantar proximal direction through the dorsal osteotomy. The wires were also used as guidewires for the insertion of two 16-mm proximally threaded cannulated screws from the OsteoMed System. The 2 screws were inserted using AO technique. Upon insertion of the screws, the two wires were removed. Fixation of the osteotomy on the table was found to be excellent. The area was copiously flushed with saline and range of motion was reevaluated and was found to be much improved from the preoperative levels without any significant restriction. The cartilaginous surfaces on the base of the first right metatarsal and the base of the proximal phalanx were also fenestrated in order to induce some cartilaginous formation. The capsule and periosteal tissues were then reapproximated with 3-0 Vicryl suture material, 4-0 Vicryl was used to approximate the subcutaneous tissues. Steri-Strips were used to approximate and reinforce the skin edges. At this time, the right ankle tourniquet was deflated. Immediate hyperemia was noted in the entire right lower extremity upon deflation of the cuff. The patient's surgical site was then covered with Xeroform, copious amounts of fluff and Kling, stockinette, and Ace bandage. The patient's right foot was placed in a surgical shoe and the patient was then transferred to the recovery room under the care of the anesthesia team with her vital signs stable and neurovascular status at appropriate levels. The patient was given instructions and education on how to continue caring for her right foot surgery at home. The patient was also given pain medication instructions on how to control her postoperative pain. The patient was eventually discharged from Hospital according to nursing protocol and was advised to follow up with Dr. X's office in one week's time for her first postoperative appointment. | 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' | HISTORY OF PRESENT ILLNESS: ,A 67-year-old male with COPD and history of bronchospasm, who presents with a 3-day history of increased cough, respiratory secretions, wheezings, and shortness of breath. He was seen by me in the office on the day of admission and noted to be dyspneic with audible wheezing and he was admitted for acute asthmatic bronchitis, superimposed upon longstanding COPD. Unfortunately over the past few months he has returned to pipe smoking. At the time of admission, he denied fever, diaphoresis, nausea, chest pain or other systemic symptoms.,PAST MEDICAL HISTORY: , Status post artificial aortic valve implantation in summer of 2002 and is on chronic Coumadin therapy. COPD as described above, history of hypertension, and history of elevated cholesterol.,PHYSICAL EXAMINATION: , Heart tones regular with an easily audible mechanical click. Breath sounds are greatly diminished with rales and rhonchi over all lung fields.,LABORATORY STUDIES: ,Sodium 139, potassium 4.5, BUN 42, and creatinine 1.7. Hemoglobin 10.7 and hematocrit 31.7.,HOSPITAL COURSE: , He was started on intravenous antibiotics, vigorous respiratory therapy, intravenous Solu-Medrol. The patient improved on this regimen. Chest x-ray did not show any CHF. The cortisone was tapered. The patient's oxygenation improved and he was able to be discharged home.,DISCHARGE DIAGNOSES: ,Chronic obstructive pulmonary disease and acute asthmatic bronchitis.,COMPLICATIONS: , None.,DISCHARGE CONDITION: , Guarded.,DISCHARGE PLAN: , Prednisone 20 mg 3 times a day for 2 days, 2 times a day for 5 days and then one daily, Keflex 500 mg 3 times a day and to resume his other preadmission medication, can be given a pneumococcal vaccination before discharge. To follow up with me in the office in 4-5 days. | 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' | ADMISSION DIAGNOSES:,1. Menorrhagia.,2. Uterus enlargement.,3. Pelvic pain.,DISCHARGE DIAGNOSIS: , Status post vaginal hysterectomy.,COMPLICATIONS: , None.,BRIEF HISTORY OF PRESENT ILLNESS: , This is a 36-year-old, gravida 3, para 3 female who presented initially to the office with abnormal menstrual bleeding and increase in flow during her period. She also had symptoms of back pain, dysmenorrhea, and dysuria. The symptoms had been worsening over time. The patient was noted also to have increasing pelvic pain over the past 8 months and she was noted to have uterine enlargement upon examination.,PROCEDURE:, The patient underwent a total vaginal hysterectomy.,HOSPITAL COURSE: ,The patient was admitted on 09/04/2007 to undergo total vaginal hysterectomy. The procedure preceded as planned without complication. Uterus was sent for pathologic analysis. The patient was monitored in the hospital, 2 days postoperatively. She recovered quite well and vitals remained stable.,Laboratory studies, H&H were followed and appeared stable on 09/05/2007 with hemoglobin of 11.2 and hematocrit of 31.8.,The patient was ready for discharge on Monday morning of 09/06/2007.,LABORATORY FINDINGS: , Please see chart for full studies during admission.,DISPOSITION: ,The patient was discharged to home in stable condition. She was instructed to follow up in the office postoperatively. | 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 DIAGNOSES: , C5-C6 disc herniation with right arm radiculopathy.,POSTOPERATIVE DIAGNOSES: , C5-C6 disc herniation with right arm radiculopathy.,PROCEDURE:,1. C5-C6 arthrodesis, anterior interbody technique.,2. C5-C6 anterior cervical discectomy.,3. C5-C6 anterior instrumentation with a 23-mm Mystique plate and the 13-mm screws.,4. Implantation of machine bone implant.,5. Microsurgical technique.,ANESTHESIA: ,General endotracheal.,ESTIMATED BLOOD LOSS: , Less than 100 mL.,BACKGROUND INFORMATION AND SURGICAL INDICATIONS: ,The patient is a 45-year-old right-handed gentleman who presented with neck and right arm radicular pain. The pain has become more and more severe. It runs to the thumb and index finger of the right hand and it is accompanied by numbness. If he tilts his neck backwards, the pain shoots down the arm. If he is working with the computer, it is very difficult to use his mouse. He tried conservative measures and failed to respond, so he sought out surgery. Surgery was discussed with him in detail. A C5-C6 anterior cervical discectomy and fusion was recommended. He understood and wished to proceed with surgery. Thus, he was brought in same day for surgery on 07/03/2007.,DESCRIPTION OF PROCEDURE: , He was given Ancef 1 g intravenously for infection prophylaxis and then transported to the OR. There general endotracheal anesthesia was induced. He was positioned on the OR table with an IV bag between the scapulae. The neck was slightly extended and taped into position. A metal arch was placed across the neck and intraoperative x-ray was obtain to verify a good position for skin incision and the neck was prepped with Betadine and draped in the usual sterile fashion.,A linear incision was created in the neck beginning just to the right of the midline extending out across the anterior border of the sternocleidomastoid muscle. The incision was extended through skin, subcutaneous fat, and platysma. Hemostasis was assured with Bovie cautery. The anterior aspect of the sternocleidomastoid muscle was identified and dissection was carried medial to this down to the carotid sheath. The trachea and the esophagus were swept out of the way and dissection proceeded medial to the carotid sheath down between the two bellies of the longus colli muscle on to the anterior aspect of the spine. A Bovie cautery was used to mobilize the longus colli muscle around initially what turned out to be C6-C7 disk based on x-rays and then around the C5-C6 disk space. An intraoperative x-ray confirmed C5-C6 disk space had been localized and then the self-retained distraction system was inserted to maintain exposure. A 15-blade knife was used to incise the C5-C6 disk and remove disk material. and distraction pins were inserted into C5-C6 and distraction placed across the disk space. The operating microscope was then brought into the field and used throughout the case except for the closure. Various pituitaries, #15 blade knife, and curette were used to evacuate the disk as best as possible. Then, the Midas Rex drill was taken under the microscope and used to drill where the cartilaginous endplate driven back all the way into the posterior aspect of the vertebral body. A nerve hook was swept underneath the posterior longitudinal ligament and a fragment of disk was produced and was pulled up through the ligament. A Kerrison rongeur was used to open up the ligament in this opening and then to march out in the both neural foramina. A small amount of disk material was found at the right neural foramen. After a good decompression of both neural foramina was obtained and the thecal sac was exposed throughout the width of the exposure, the wound was thoroughly irrigated. A spacing mechanism was intact into the disk space and it was determined that a #7 spacer was appropriate. So, a #7 machine bone implant was taken and tapped into disk space and slightly counter sunk. The wound was thoroughly irrigated and inspected for hemostasis. A Mystique plate 23 mm in length was then inserted and anchored to the anterior aspect of C5-C6 to hold the bone into position and the wound was once again irrigated. The patient was valsalved. There was no further bleeding seen and intraoperative x-ray confirmed a good position near the bone, plate, and screws and the wound was enclosed in layers. The 3-0 Vicryl was used to approximate platysma and 3-0 Vicryl was used in inverted interrupted fashion to perform a subcuticular closure of the skin. The wound was cleaned.,Mastisol was placed on the skin, and Steri-strips were used to approximate skin margins. Sterile dressing was placed on the patient's neck. He was extubated in the OR and transported to the recovery room in stable condition. 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' | CHIEF COMPLAINT:, Itchy rash.,HISTORY OF PRESENT ILLNESS: , This 34-year-old gentleman awoke this morning noting some itchiness to his back and then within very a short period of time realized that he had an itchy rash all over his torso and arms. No facial swelling. No tongue or lip swelling. No shortness of breath, wheezing, or other associated symptoms. He cannot think of anything that could have triggered this off. There have been no changes in his foods, medications, or other exposures as far as he knows. He states a couple of days ago he did work and was removing some insulation but does not remember feeling itchy that day.,PAST MEDICAL HISTORY: , Negative for chronic medical problems. No local physician. Has had previous back surgery and appendectomy, otherwise generally healthy.,REVIEW OF SYSTEMS: , As mentioned denies any oropharyngeal swelling. No lip or tongue swelling. No wheezing or shortness of breath. No headache. No nausea. Notes itchy rash, especially on his torso and upper arms.,SOCIAL HISTORY: , The patient is accompanied with his wife.,FAMILY HISTORY: , Negative.,MEDICATIONS: , None.,ALLERGIES: , TORADOL, MORPHINE, PENICILLIN, AND AMPICILLIN.,PHYSICAL EXAMINATION: , VITAL SIGNS: The patient was afebrile. He is slightly tachycardic, 105, but stable blood pressure and respiratory rate. GENERAL: The patient is in no distress. Sitting quietly on the gurney. HEENT: Unremarkable. His oral mucosa is moist and well hydrated. Lips and tongue look normal. Posterior pharynx is clear. NECK: Supple. His trachea is midline. There is no stridor. LUNGS: Very clear with good breath sounds in all fields. There is no wheezing. Good air movement in all lung fields. CARDIAC: Without murmur. Slight tachycardia. ABDOMEN: Soft, nontender. SKIN: Notable for a confluence erythematous, blanching rash on the torso as well as more of a blotchy papular, macular rash on the upper arms. He noted some on his buttocks as well. Remaining of the exam is unremarkable.,ED COURSE: , The patient was treated with epinephrine 1:1000, 0.3 mL subcutaneously along with 50 mg of Benadryl intramuscularly. After about 15-20 minutes he states that itching started to feel better. The rash has started to fade a little bit and feeling a lot more comfortable.,IMPRESSION:, ACUTE ALLERGIC REACTION WITH URTICARIA AND PRURITUS.,ASSESSMENT AND PLAN: , The patient has what looks to be some type of allergic reaction, although the underlying cause is difficult to assess. He will make sure he goes home to look around to see if there is in fact anything that changed recently that could have triggered this off. In the meantime, I think he can be managed with some antihistamine over-the-counter. He is responding already to Benadryl and the epinephrine that we gave him here. He is told that if he develops any respiratory complaints, shortness of breath, wheezing, or tongue or lip swelling he will return immediately for evaluation. He is discharged in stable condition. | 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' | GENERAL:, Negative weakness, negative fatigue, native malaise, negative chills, negative fever, negative night sweats, negative allergies.,INTEGUMENTARY: , Negative rash, negative jaundice.,HEMATOPOIETIC: , Negative bleeding, negative lymph node enlargement, negative bruisability.,NEUROLOGIC: , Negative headaches, negative syncope, negative seizures, negative weakness, negative tremor. No history of strokes, no history of other neurologic conditions.,EYES:, Negative visual changes, negative diplopia, negative scotomata, negative impaired vision.,EARS: , Negative tinnitus, negative vertigo, negative hearing impairment.,NOSE AND THROAT: ,Negative postnasal drip, negative sore throat.,CARDIOVASCULAR: , Negative chest pain, negative dyspnea on exertion, negative palpations, negative edema. No history of heart attack, no history of arrhythmias, no history of hypertension.,RESPIRATORY:, No history of shortness of breath, no history of asthma, no history of chronic obstructive pulmonary disease, no history of obstructive sleep apnea.,GASTROINTESTINAL: , Negative dysphagia, negative nausea, negative vomiting, negative hematemesis, negative abdominal pain.,GENITOURINARY: , Negative frequency, negative urgency, negative dysuria, negative incontinence. No history of STDs.,MUSCULOSKELETAL:, Negative myalgia, negative joint pain, negative stiffness, negative weakness, negative back pain.,PSYCHIATRIC: , See psychiatric evaluation.,ENDOCRINE: , No history of diabetes mellitus, no history of thyroid problems, no history of endocrinologic abnormalities. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR CONSULTATION: , Syncope.,HISTORY OF PRESENT ILLNESS: ,The patient is a 69-year-old gentleman, a good historian, who relates that he was brought in the Emergency Room following an episode of syncope. The patient relates that he may have had a seizure activity prior to that. Prior to the episode, he denies having any symptoms of chest pain or shortness of breath. No palpitation. Presently, he is comfortable, lying in the bed. As per the patient, no prior cardiac history.,CORONARY RISK FACTORS: , History of hypertension. No history of diabetes mellitus. Nonsmoker. Cholesterol status is borderline elevated. No history of established coronary artery disease. Family history noncontributory.,PAST MEDICAL HISTORY: ,Hypertension, hyperlipidemia, recently diagnosed with Parkinson's, as a Parkinson's tremor, admitted for syncopal evaluation.,PAST SURGICAL HISTORY: ,Back surgery, shoulder surgery, and appendicectomy.,FAMILY HISTORY: , Nonsignificant.,MEDICATIONS:,1. Pain medications.,2. Thyroid supplementation.,3. Lovastatin 20 mg daily.,4. Propranolol 20 b.i.d.,5. Protonix.,6. Flomax.,ALLERGIES:, None.,PERSONAL HISTORY:, He is married. Nonsmoker. Does not consume alcohol. No history of recreational drug use.,REVIEW OF SYSTEMS,CONSTITUTIONAL: No weakness, fatigue, or tiredness.,HEENT: No history of cataract or glaucoma.,CARDIOVASCULAR: No congestive heart failure. No arrhythmias.,RESPIRATORY: No history of pneumonia or valley fever.,GASTROINTESTINAL: No nausea, vomiting, hematemesis, or melena.,UROLOGICAL: No frequency or urgency.,MUSCULOSKELETAL: Arthritis and muscle weakness.,SKIN: Nonsignificant.,NEUROLOGIC: No TIA or CVA. No seizure disorder.,ENDOCRINE/HEMATOLOGIC: Nonsignificant.,PHYSICAL EXAMINATION,VITAL SIGNS: Pulse of 93, blood pressure of 158/93, afebrile, and respiratory rate 16 per minute.,HEENT: Atraumatic and normocephalic.,NECK: Neck veins are flat. No significant carotid bruits.,LUNGS: Air entry is bilaterally decreased.,HEART: PMI is displaced. S1 and S2 are regular.,ABDOMEN: Soft and nontender. Bowel sounds are present.,EXTREMITIES: No edema. Pulses are palpable. No clubbing or cyanosis. The patient is moving all extremities; however, the patient has tremors.,RADIOLOGICAL DATA: , EKG reveals normal sinus rhythm with underlying nonspecific ST-T changes secondary to tremors.,LABORATORY DATA: , H&H stable. White count of 14. BUN and creatinine are within normal limits. Cardiac enzyme profile is negative. Ammonia level is elevated at 69. CT angiogram of the chest, no evidence of pulmonary embolism. Chest x-ray is negative for acute changes. CT of the head, unremarkable, chronic skin changes. Liver enzymes are within normal limits.,IMPRESSION:,1. The patient is a 69-year-old gentleman, admitted with syncopal episode and possible seizure disorder. | 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. Neck pain with bilateral upper extremity radiculopathy, left more than the right.,2. Cervical spondylosis with herniated nucleus pulposus, C5-C6.,POSTOPERATIVE DIAGNOSES,1. Neck pain with bilateral upper extremity radiculopathy, left more than the right.,2. Cervical spondylosis with herniated nucleus pulposus, C5-C6.,OPERATIVE PROCEDURES,1. Anterior cervical discectomy with decompression, C5-C6.,2. Arthrodesis with anterior interbody fusion, C5-C6.,3. Spinal instrumentation, C5-C6 using Pioneer 18-mm plate and four 14 x 4.0 mm screws (all titanium).,4. Implant using PEEK 7 mm.,5. Allograft using Vitoss.,DRAINS: , Round French 10 JP drain.,FLUIDS: ,1200 cc of crystalloids.,URINE OUTPUT: , No Foley catheter.,SPECIMENS: , None.,COMPLICATIONS: , None.,ANESTHESIA: , General endotracheal anesthesia.,ESTIMATED BLOOD LOSS: , Less than 50 cc.,INDICATIONS FOR THE OPERATION:, This is a case of a very pleasant 38-year-old Caucasian female who has been complaining over the last eight years of neck pain and shoulder pain radiating down across the top of her left shoulder and also across her shoulder blades to the right side, but predominantly down the left upper extremity into the wrist. The patient has been diagnosed with fibromyalgia and subsequently, has been treated with pain medications, anti-inflammatories and muscle relaxants. The patient's symptoms continued to persist and subsequently, an MRI of the C-spine was done, which showed disc desiccation, spondylosis and herniated disk at C5-C6, an EMG and CV revealed a presence of mild-to-moderate carpal tunnel syndrome. The patient is now being recommended to undergo decompression and spinal instrumentation and fusion at C5-C6. The patient understood the risks and benefits of the surgery. Risks include but not exclusive of bleeding and infection. Bleeding can be in the form of soft tissue bleeding, which may compromise airway for which she can be brought emergently back to the operating room for emergent evacuation of the hematoma as this may cause weakness of all four extremities, numbness of all four extremities, as well as impairment of bowel and bladder function. This could also result in dural tear with its attendant symptoms of headache, nausea, vomiting, photophobia, and posterior neck pain as well as the development of pseudomeningocele. Should the symptoms be severe or the pseudomeningocele be large, she can be brought back to the operating room for repair of the CSF leak and evacuation of the pseudomeningocele. There is also the risk of pseudoarthrosis and nonfusion, for which she may require redo surgery at this level. There is also the possibility of nonimprovement of her symptoms in about 10% of cases. The patient understands this risk on top of the potential injury to the esophagus and trachea as well as the carotid artery. There is also the risk of stroke, should an undiagnosed plaque be propelled into the right cerebral circulation. The patient also understands that there could be hoarseness of the voice secondary to injury to the recurrent laryngeal nerve. She understood these risks on top of the risks of anesthesia and gave her consent for the procedure.,DESCRIPTION OF PROCEDURE: ,The patient was brought to the operating room, awake, alert and not in any form of distress. After smooth induction and intubation, the patient was positioned supine on the operating table with the neck placed on hyperextension and the head supported on a foam doughnut. A marker was placed. This verified the level to be at the C5-C6 level and incision was then marked in a transverse fashion starting from the midline extending about 5 mm beyond the anterior border of the sternocleidomastoid muscle. The area was then prepped with DuraPrep after the head was turned 45 degrees to the left.,After sterile drapes were laid out, an incision was made using a scalpel blade #10. Wound edge bleeders were carefully controlled with bipolar coagulation and the platysma was cut using a hot knife in a transverse fashion. Dissection was then carried underneath the platysma superiorly inferiorly. The anterior border of the sternocleidomastoid was identified and dissection was carried out lateral to the esophagus to trachea as well as medial to the carotid sheath in the sternocleidomastoid muscle. The prevertebral fascia was noted to be taken her case with a lot of fat deposition. Bipolar coagulation of bleeders was done; however, branch of the superior thyroid artery was ligated with Hemoclips x4. After this was completed, a localizing x-ray verified the marker to be at the C6-C7 level. We proceeded to strip the longus colli muscles off the vertebral body of the C5 and C6. Self-retaining retractor was then laid down. An anterior osteophyte was carefully drilled using a Midas 5-mm bur and the disk together with the inferior endplate of C5 and the superior endplate of C6 was also drilled down with the Midas 5-mm bur. This was later followed with a 3-mm bur and the disk together with posterior longitudinal ligament was removed using Kerrison's ranging from 1 to 4 mm. The herniation was noted on the right. However, there was significant neuroforaminal stenosis on the left. Decompression on both sides was done and after this was completed, a Valsalva maneuver showed no evidence of any CSF leakage. The area was then irrigated with saline with bacitracin solution. A 7 mm implant with its inferior packed with Vitoss was then laid down and secured in place with four 14 x 4.0 mm screws and plate 18 mm, all of which were titanium. X-ray after this placement showed excellent position of all these implants and screws and _____ and the patient's area was also irrigated with saline with bacitracin solution. A round French 10 JP drain was then laid down and exteriorized through a separate stab incision on the patient's right inferiorly. The catheter was then anchored to the skin with a nylon 3-0 stitch and connected to a sterile draining system. The wound was then closed in layers with Vicryl 3-0 inverted interrupted sutures for the platysma, Vicryl subcuticular 4-0 Stitch for the dermis, and the wound was reinforced with Dermabond. Dressing was placed only at the exit site of the catheter. C-collar was placed. The patient was extubated and transferred to recovery. | 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: , Degenerative arthritis of left knee.,POSTOPERATIVE DIAGNOSIS:, Degenerative arthritis of left knee.,PROCEDURE PERFORMED: , NexGen left total knee replacement.,ANESTHESIA: , Spinal.,TOURNIQUET TIME: Approximately 66 minutes.,COMPLICATIONS:, None.,ESTIMATED BLOOD LOSS: , Approximately 50 cc.,COMPONENTS: , A NexGen stemmed tibial component size 5 was used, 10 mm cruciate retaining polyethylene surface, a NexGen cruciate retaining size E femoral component, and a size 38 9.5 mm thickness All-Poly Patella.,BRIEF HISTORY:, The patient is a 72-year-old female with a history of bilateral knee pain for years progressively worse and decreasing quality of life and ADLs. She wishes to proceed with arthroplasty at this time.,PROCEDURE: ,The patient was taken to the Operative Suite at ABCD General Hospital on 09/11/03. She was placed on the operating table. Department of Anesthesia administered a spinal anesthetic. Once adequately anesthetized, the left lower extremity was prepped and draped in the usual sterile fashion. An Esmarch was applied and a tourniquet was inflated to 325 mmHg on the left thigh. A longitudinal incision was made over the anterior portion of the knee and this was taken down through the subcutaneous tissue to the level of the patella retinaculum. A medial peripatellar arthrotomy was then made and taken down to the level of the tibial tubercle. Care was then ensured that the patellar tendon was not violated. The proximal tibia was then skeletonized both medially and laterally to the level of the axis through the joint line. Again care was ensured that the patellar tendon was not avulsed from the insertion on the tibia. The intramedullary canal was then opened using a drill and the anterior sizing guide was then placed. Rongeur was used to take out any osteophytes and the size of approximately size E. At this point, the epicondyle axis guide was then inserted and aligned in a proper orientation. The anterior cutting guide was then placed. Care was checked for the amount of resection that the femur would be notched and the oscillating saw was used to cut the anterior portion of the femur. After this was performed, this was removed and the distal femoral cutting guide was then placed. The left knee placed in 5 degrees of valgus, guide was then placed, and a standard distal cut was then taken. After the cuts were ensured further to be leveled and they were, and we proceeded to place the finishing guide size E and distal femur. This was placed slightly in lateral position and secured in position with spring tense and head lift tense. Once adequately secured and placed in the appropriate orientation, the alignment was again verified with the epicondyle axis and appeared to be externally rotated appropriately. The chamfer cuts and anterior and posterior cuts were then made as well as the notch cut using the reciprocating and oscillating saws. After this was performed, the guide was removed and all bony fragments were then removed. Attention was then directed to the tibia. The external tibial alignment guide was then placed and pinned to the proximal tibia in a proper position. Care was ensured if it is was a varus or valgus and the appropriate. The femur gauge was then used to provide us appropriate amount of bony resection. This was then pinned and secured into place. Ligament retractors were used to protect the collateral ligaments and the tip proximal tibial cut was then made. This bony portion was then removed and remaining meniscal fragments were removed as well as the ACL till adequate exposure was obtained. Trial components were then inserted into position and taken the range of motion and found to have good and full excellent range of motion stability. The trial components were then removed. The tibia was then stemmed in standard fashion after the tibial plate was placed in some degree of external rotation with appropriate alignment. After it was stemmed and broached, these were removed and the patella was then incised, a size 41 patella reamer blade was then used and was taken down, a size 38 patella button was then placed intact. Again the trial components were placed back into position. Patella button was placed and the tracking was evaluated. They tracked centrally with no touch technique. Again, all components were now removed and the knee was then copiously irrigated and suctioned dry. Once adequately suctioned dry, the tibial portion was cemented and packed into place. Also excess cement was removed. The femoral component was then cemented into position. All excess cement was removed. A size 12 poly was then inserted in trial to provide compression at cement adhered. The patella was then cemented and held into place. All components were held under compression until cement had adequately adhered all excess cement was then removed. The knee was then taken through range of motion and size 12 felt to be slightly too big, this was removed and the size 10 trial was replaced, and again had excellent varus and valgus stability with full range of motion and felt to be the articulate surface of choice. The knee was again copiously irrigated and suctioned dry. One last check in the posterior aspect of the knee for any loose bony fragments or osteophytes was performed, there were none found and a final articulating surface was impacted and locked into place. After this, the knee was taken again for final range of motion and found to have excellent position, stability, and good alignment of the components. The knee was once again copiously irrigated, and the tourniquet was deflated. Bovie cautery was used to cauterize the knee bleeding that was seen until good hemostasis obtained. A drain was then placed deep to the retinaculum and the retinaculum repair was performed using #2-0 Ethibond and oversewn with a #1 Vicryl. This was flexed and the repair was found held securely. At this point, the knee was again copiously irrigated and suctioned dry. The subcutaneous tissue was closed with #2-0 Vicryl, and the skin was approximated with skin staples. Sterile dressing with Adaptic, 4x4s, ABDs, and Kerlix rolls was then applied. The patient was then transferred back to the gurney in a supine position.,DISPOSITION: , The patient tolerated well with no complications, to PACU in satisfactory 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 (1/1):, This 62 year old female presents today for evaluation of angina.,Associated signs and symptoms: Associated signs and symptoms include chest pain, nausea, pain radiating to the arm and pain radiating to the jaw.,Context: The patient has had no previous treatments for this condition.,Duration: Condition has existed for 5 hours.,Quality: Quality of the pain is described by the patient as crushing.,Severity: Severity of condition is severe and unchanged.,Timing (onset/frequency): Onset was sudden and with exercise. Patient has the following coronary risk factors: smoking 1 packs/day for 40 years and elevated cholesterol for 5 years. Patient's elevated cholesterol is not being treated with medication. Menopause occurred at age 53.,ALLERGIES:, No known medical allergies.,MEDICATION HISTORY:, Patient is currently taking Estraderm 0.05 mg/day transdermal patch.,PMH:, Past medical history unremarkable.,PSH:, No previous surgeries.,SOCIAL HISTORY:, Patient admits tobacco use She relates a smoking history of 40 pack years.,FAMILY HISTORY:, Patient admits a family history of heart attack associated with father (deceased).,ROS:, Unremarkable with exception of chief complaint.,PHYSICAL EXAMINATION:,General: Patient is a 62 year old female who appears pleasant, her given age, well developed,,oriented, well nourished, alert and moderately overweight.,Vital Signs: BP Sitting: 174/92 Resp: 28 HR: 88 Temp: 98.6 Height: 5 ft. 2 in. Weight: 150 lbs.,HEENT: Inspection of head and face shows head that is normocephalic, atraumatic, without any gross or neck masses. Ocular motility exam reveals muscles are intact. Pupil exam reveals round and equally reactive to light and accommodation. There is no conjunctival inflammation nor icterus. Inspection of nose reveals no abnormalities. Inspection of oral mucosa and tongue reveals no pallor or cyanosis. Inspection of the tongue reveals normal color, good motility and midline position. Examination of oropharynx reveals the uvula rises in the midline. Inspection of lips, teeth, gums, and palate reveals healthy teeth, healthy gums, no gingival,hypertrophy, no pyorrhea and no abnormalities.,Neck: Neck exam reveals neck supple and trachea that is midline, without adenopathy or crepitance palpable.,Thyroid examination reveals smooth and symmetric gland with no enlargement, tenderness or masses noted.,Carotid pulses are palpated bilaterally, are symmetric and no bruits auscultated over the carotid and vertebral arteries. Jugular veins examination reveals no distention or abnormal waves were noted. Neck lymph nodes are not noted.,Back: Examination of the back reveals no vertebral or costovertebral angle tenderness and no kyphosis or scoliosis noted.,Chest: Chest inspection reveals intercostal interspaces are not widened, no splinting, chest contours are normal and normal expansion. Chest palpation reveals no abnormal tactile fremitus.,Lungs: Chest percussion reveals resonance. Assessment of respiratory effort reveals even respirations without use of accessory muscles and diaphragmatic movement normal. Auscultation of lungs reveal diminished breath sounds bibasilar.,Heart: The apical impulse on heart palpation is located in the left border of cardiac dullness in the midclavicular line, in the left fourth intercostal space in the midclavicular line and no thrill noted. Heart auscultation reveals rhythm is regular, normal S1 and S2, no murmurs, gallop, rubs or clicks and no abnormal splitting of the second heart sound which moves normally with respiration. Right leg and left leg shows evidence of edema +6.,Abdomen: Abdomen soft, nontender, bowel sounds present x 4 without palpable masses. Palpation of liver reveals no abnormalities with respect to size, tenderness or masses. Palpation of spleen reveals no abnormalities with respect to size, tenderness or masses. Examination of abdominal aorta shows normal size without presence of systolic bruit.,Extremities: Right thumb and left thumb reveals clubbing.,Pulses: The femoral, popliteal, dorsalis, pedis and posterior tibial pulses in the lower extremities are equal and normal. The brachial, radial and ulnar pulses in the upper extremities are equal and normal. Examination of peripheral vascular system reveals varicosities absent, extremities warm to touch, edema present - pitting and pulses are full to palpation. Femoral pulses are 2 /4, bilateral. Pedal pulses are 2 /4, bilateral.,Neurological: Testing of cranial nerves reveals nerves intact. Oriented to person, place and time. Mood and affect normal and appropriate to situation.Deep tendon reflexes normal. Touch, pin, vibratory and proprioception sensations are normal. Babinski reflex is absent. Coordination is normal. Speech is not aphasic. Musculoskeletal: Muscle strength is 5/5 for all groups tested. Gait and station examination reveals midposition without abnormalities.,Skin: No skin rash, subcutaneous nodules, lesions or ulcers observed. Skin is warm and dry with normal turgor and there is no icterus.,Lymphatics: No lymphadenopathy noted.,IMPRESSION:, Angina pectoris, other and unspecified.,PLAN:, ,DIAGNOSTIC & LAB ORDERS:, Ordered serum creatine kinase isoenzymes (CK isoenzymes). Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report. The following cardiac risk factor modifications are recommended: quit smoking and reduce LDL cholesterol to below 120 mg/dl.,PATIENT INSTRUCTIONS: | 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' | FINAL DIAGNOSES:,1. Cardiac arrest.,2. Severe congestive heart failure.,3. Acute on chronic respiratory failure.,4. Osteoporosis.,5. Depression.,HISTORY OF PRESENT ILLNESS: , This 92-year-old lady with history of depression and chronic low back pain, osteoporosis, and congestive heart failure, was diagnosed having pneumonia approximately for at least 10 days prior to admission. In the ER, she was given oral antibiotics. She also saw me few days before admission coming for a followup. She was doing fairly well. She was thought to have congestive heart failure and she was advised to continue with her diuretics. For the last few days, the patient started to have anorexia, she did not eat well, and she did not drink well. Her family could not take care of her. So, she was brought to the emergency room, where she was found to have rapid heart rate with a sinus tachycardia around 112 to 130s. The ________ was found to be dry. She was given 1 L of IV fluids and she was subsequently admitted in the hospital for further management.,COURSE IN THE HOSPITAL: , The patient stayed in the telemetry. The patient had significant shortness of breath secondary to congestive heart failure with bilateral basilar crackles. She was continued on IV antibiotics and general IV hydration was started initially because of low blood pressure and low perfusion status. On subsequently improved and stopped and Lasix was started; Dr. X, cardiologist was also placed. The patient's family wanted her to be a DNR and DNI. They were allowing us to treat her aggressively medically for pneumonia and congestive heart failure. However, the patient became extremely weak, mostly unresponsive. At this time, the patient's family wanted a Hospice consult, which was requested. By the time the Hospice could evaluate her, the patient's condition got deteriorated, she went into more bradycardiac and hypertension and subsequently expired. Please see the hospital notes for complete details. | Discharge Summary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | EXAM:, Lexiscan Nuclear Myocardial Perfusion Scan.,INDICATION:, Chest pain.,TYPE OF TEST: ,Lexiscan, unable to walk on a treadmill.,INTERPRETATION: , Resting heart rate of 96, blood pressure of 141/76. EKG, normal sinus rhythm, nonspecific ST-T changes, left bundle branch block. Post Lexiscan 0.4 mg injected intravenously by standard protocol. Peak heart rate was 105, blood pressure of 135/72. EKG remains the same. No symptoms are noted.,SUMMARY:,1. Nondiagnostic Lexiscan.,2. Nuclear interpretation as below.,NUCLEAR MYOCARDIAL PERFUSION SCAN WITH STANDARD PROTOCOL:, Resting and stress images were obtained with 10.4, 32.5 mCi of tetrofosmin injected intravenously by standard protocol. Myocardial perfusion scan demonstrates homogeneous and uniform distribution of the tracer uptake. There is no evidence of reversible or fixed defect. Gated SPECT revealed mild global hypokinesis, more pronounced in the septal wall possibly secondary to prior surgery. Ejection fraction calculated at 41%. End-diastolic volume of 115, end-systolic volume of 68.,IMPRESSION:,1. Normal nuclear myocardial perfusion scan.,2. Ejection fraction 41% by gated SPECT. | 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' | NAME OF PROCEDURE,1. Selective coronary angiography.,2. Placement of overlapping 3.0 x 18 and 3.0 x 8 mm Xience stents in the proximal right coronary artery.,3. Abdominal aortography.,INDICATIONS: ,The patient is a 65-year-old gentleman with a history of exertional dyspnea and a cramping-like chest pain. Thallium scan has been negative. He is undergoing angiography to determine if his symptoms are due to coronary artery disease.,NARRATIVE: ,The right groin was sterilely prepped and draped in the usual fashion and the area of the right coronary artery anesthetized with 2% lidocaine. Constant sedation was obtained using Versed 1 mg and fentanyl 50 mcg. Received additional Versed and fentanyl during the procedure. Please refer to the nurses' notes for dosages and timing.,The right femoral artery was entered and a 4-French sheath was placed. Advancement of the guidewire demonstrated some obstruction at the level of abdominal aorta. Via the right Judkins catheter, the guidewire was easily infiltrated to the thoracic aorta and over aortic arch. The right Judkins catheter was advanced to the origin of the right coronary artery where selective angiograms were performed. This revealed a very high-grade lesion at the proximal right coronary artery. This catheter was exchanged for a left #4 Judkins catheter which was advanced to the ostium of the left main coronary artery where selective angiograms were performed.,The patient was found to have the above mentioned high-grade lesion in the right coronary artery and a coronary intervention was performed. A 6-French sheath and a right Judkins guide was placed. The patient was started on bivalarudin. A BMW wire was easily placed across the lesion and into the distal right coronary artery. A 3.0 x 15 mm Voyager balloon was placed and deployed at 10 atmospheres. The intermediate result was improved with TIMI-3 flow to the terminus of the vessel. Following this, a 3.0 x 18 mm Xience stent was placed across the lesion and deployed at 17 atmospheres. This revealed excellent result however at the very distal of the stent there was an area of haziness but no definite dissection. This was stented with a 3.0 x 8 mm Xience stent deployed again at 17 atmospheres. Final angiograms revealed excellent result with TIMI-3 flow at the terminus of the right coronary artery and approximately 10% residual stenosis at the worst point of the narrowing. The guiding catheter was withdrawn over wire and a pigtail was placed. This was advanced to the abdominal aorta at the area of obstruction and small injection of contrast was given demonstrating that there was a small aneurysm versus a small retrograde dissection in that area with some dye hang up after injection. The catheter was removed. The bivalarudin was stopped at the termination of procedure. A small injection of contrast given through arterial sheath and Angio-Seal was placed without incident.,It should also be noted that an 8-French sheath was placed in the right femoral vein. This was placed initially as the patient was going to have a right heart catheterization as well because of the dyspnea.,Total contrast media, 205 mL, total fluoroscopy time was 7.5 minutes, X-ray dose, 2666 milligray.,HEMODYNAMICS: , Rhythm was sinus throughout the procedure. Aortic pressure was 170/81 mmHg.,The right coronary artery is a dominant vessel. This vessel gives rise to conus branch and two small RV free wall branches and PDA and a small left ventricular branch. It should be noted that there was competitive flow in the posterior left ventricular branch and that the distal right coronary artery fills via left sided collaterals. In the proximal right coronary artery, there is a large ulcerative plaque followed immediately by a severe stenosis that is subtotal in severity. After intervention, there is TIMI-3 flow to the terminus of the right coronary with better fill into the distal right coronary artery and loss of competitive flow. There was approximately 10% residual stenosis at the worst part of the previous stenosis.,The left main is without disease and trifurcates into a moderate-sized ramus intermedius, the LAD and the circumflex. The ramus intermedius is free of disease. The LAD terminates at the LV apex and has elongated area of mild stenosis at its mid segment. This measures 25% to 30% at its worst point. The circumflex is a large caliber vessel. There is a proximal 15% to 20% stenosis and an area of ectasia in the proximal circumflex. Distally, this circumflex gives rise to a large bifurcating marginal artery and beyond that point, the circumflex is a small vessel within the AV groove.,The aortogram demonstrates eccentric aneurysm formation. This may represent a small retrograde dissection as well. There was some dye hang up in the wall.,IMPRESSION,1. Successful stenting of subtotal stenosis of the proximal coronary artery.,2. Non-obstructive coronary artery disease in the mid left anterior descending as described above and ectasia of the proximal circumflex coronary artery.,3. Left to right collateral filling noted prior to coronary intervention.,4. Small area of eccentric aneurysm formation in the abdominal aorta. | 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 HOSPITALIZATION: ,Suspicious calcifications upper outer quadrant, left breast.,HISTORY OF PRESENT ILLNESS: , The patient is a 78-year-old woman who had undergone routine screening mammography on 06/04/08. That study disclosed the presence of punctate calcifications that were felt to be in a cluster distribution in the left breast mound at the 2 o'clock position. Additional imaging studies confirmed the suspicious nature of these calcifications. The patient underwent a stereotactic core needle biopsy of the left breast 2 o'clock position on 06/17/08. The final histologic diagnosis of the tissue removed during that procedure revealed focal fibrosis. No calcifications could be identified in examination of the biopsy material including radiograph taken of the preserved tissue.,Two days post stereotactic core needle biopsy, however, the patient returned to the breast center with severe swelling and pain and mass in the left breast. She underwent sonographic evaluation and was found to have a development of false aneurysm formation at the site of stereotactic core needle biopsy. I was called to see the patient in the emergency consultation in the breast center. At the same time, Dr. Y was consulted in Interventional Radiology. Dr. Z and Dr. Y were able to identify the neck of the false aneurysm in the left breast mound and this was injected with ultrasound guidance with thrombin material. This resulted in immediate occlusion of the false aneurysm. The patient was seen in my office for followup appointment on 06/24/08. At that time, the patient continued to have signs of a large hematoma and extensive ecchymosis, which resulted from the stereotactic core needle biopsy. There was, however, no evidence of reforming of the false aneurysm. There was no evidence of any pulsatile mass in the left breast mound or on the left chest wall.,I discussed the issues with the patient and her husband. The underlying problem is that the suspicious calcifications, which had been identified on mammography had not been adequately sampled with the stereotactic core needle biopsy; therefore, the histologic diagnosis is not explanatory of the imaging findings. For this reason, the patient was advised to have an excisional biopsy of this area with guidewire localization. Since the breast mound was significantly disturbed from the stereotactic core needle biopsy, the decision was to postpone any surgical intervention for at least three to four months. The patient now returns to undergo the excision of the left breast tissue with preoperative guidewire localization to identify the location of suspicious calcifications.,The patient has a history of prior stereotactic core needle biopsy of the left breast, which was performed on 01/27/04. This revealed benign histologic findings. The family history is positive involving a daughter who was diagnosed with breast cancer at the age of 40. Other than her age, the patient has no other risk factors for development of breast cancer. She is not receiving any hormone replacement therapy. She has had five children with the first pregnancy occurring at the age of 24. Other than her daughter, there are no other family members with breast cancer. There are no family members with a history of ovarian cancer.,PAST MEDICAL HISTORY: , Other hospitalizations have occurred for issues with asthma and pneumonia.,PAST SURGICAL HISTORY: , Colon resection in 1990 and sinus surgeries in 1987, 1990 and 2005.,CURRENT MEDICATIONS:,1. Plavix.,2. Arava.,3. Nexium.,4. Fosamax.,5. Advair.,6. Singulair.,7. Spiriva.,8. Lexapro.,DRUG ALLERGIES:, ASPIRIN, PENICILLIN, IODINE AND CODEINE.,FAMILY HISTORY:, Positive for heart disease, hypertension and cerebrovascular accidents. Family history is positive for colon cancer affecting her father and a brother. The patient has a daughter who was diagnosed with breast cancer at age 40.,SOCIAL HISTORY: , The patient does not smoke. She does have an occasional alcoholic beverage.,REVIEW OF SYSTEMS: ,The patient has multiple medical problems, for which she is under the care of Dr. X. She has a history of chronic obstructive lung disease and a history of gastroesophageal reflux disease. There is a history of anemia and there is a history of sciatica, which has been caused by arthritis. The patient has had skin cancers, which have been treated with local excision.,PHYSICAL EXAMINATION:,GENERAL: The patient is an elderly aged female who is alert and in no distress.,HEENT: Head, normocephalic. Eyes, PERRL. Sclerae are clear. Mouth, no oral lesions.,NECK: Supple without adenopathy.,HEART: Regular sinus rhythm.,CHEST: Fair air entry bilaterally. No wheezes are noted on examination.,BREASTS: Normal topography bilaterally. There are no palpable abnormalities in either breast mound. Nipple areolar complexes are normal. Specifically, the left breast upper outer quadrant near the 2 o'clock position has no palpable masses. The previous tissue changes from the stereotactic core needle biopsy have resolved. Axillary examination normal bilaterally without suspicious lymphadenopathy or masses.,ABDOMEN: Obese. No masses. Normal bowel sounds are present.,BACK: No CVA tenderness.,EXTREMITIES: No clubbing, cyanosis or edema.,ASSESSMENT:,1. Left breast mound clustered calcifications, suspicious by imaging located in the upper outer quadrant at the 2 o'clock position.,2. Prior stereotactic core needle biopsy of the left breast did not resolve the nature of the calcifications, this now requires excision of the tissue with preoperative guidewire localization.,3. History of chronic obstructive lung disease and asthma, controlled with medications.,4. History of gastroesophageal reflux disease, controlled with medications.,5. History of transient ischemic attack managed with medications.,6. History of osteopenia and osteoporosis, controlled with medications.,7. History of anxiety controlled with medications.,PLAN: , Left breast excisional biopsy with preoperative guidewire localization and intraoperative specimen radiography. This will be performed on an outpatient 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' | 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' | REASON FOR NEUROLOGICAL CONSULTATION: , Cervical spondylosis and kyphotic deformity. The patient was seen in conjunction with medical resident Dr. X. I personally obtained the history, performed examination, and generated the impression and plan.,HISTORY OF PRESENT ILLNESS: ,The patient is a 45-year-old African-American female whose symptoms first started some one and a half years ago with pain in the left shoulder and some neck pain. This has subsequently resolved. She started vigorous workouts in November 2005. In March of this year, she suddenly could not feel her right foot on the bathroom floor and subsequently went to her primary care physician. By her report, she had a nerve conduction study and a diagnosis of radiculopathy was made. She had an MRI of lumbosacral spine, which was within normal limits. She then developed a tingling sensation in the right middle toe. Symptoms progressed to sensory symptoms of her knees, elbows, and left middle toe. She then started getting sensory sensations in the left hand and arm. She states that she feels a little bit wobbly at the knees and that she is slightly dragging her left leg. Symptoms have been mildly progressive. She is unaware of any trigger other than the vigorous workouts as mentioned above. She has no associated bowel or bladder symptoms. No particular position relieves her symptoms.,Workup has included two MRIs of the C-spine, which were personally reviewed and are discussed below. She saw you for consultation and the possibility of surgical decompression was raised. At this time, she is somewhat reluctant to go through any surgical procedure.,PAST MEDICAL HISTORY:,1. Ocular migraines.,2. Myomectomy.,3. Infertility.,4. Hyperglycemia.,5. Asthma.,6. Hypercholesterolemia.,MEDICATIONS: , Lipitor, Pulmicort, Allegra, Xopenex, Patanol, Duac topical gel, Loprox cream, and Rhinocort.,ALLERGIES: , Penicillin and aspirin.,Family history, social history, and review of systems are discussed above as well as documented in the new patient information sheet. Of note, she does not drink or smoke. She is married with two adopted children. She is a paralegal specialist. She used to exercise vigorously, but of late has been advised to stop exercising and is currently only walking.,REVIEW OF SYSTEMS: , She does complain of mild blurred vision, but these have occurred before and seem associated with headaches.,PHYSICAL EXAMINATION: , On examination, blood pressure 138/82, pulse 90, respiratory rate 14, and weight 176.5 pounds. Pain scale is 0. A full general and neurological examination was personally performed and is documented on the chart. Of note, she has a normal general examination. Neurological examination reveals normal cognition and cranial nerve examination including normal jaw jerk. She has mild postural tremor in both arms. She has mild decreased sensation in the right palm and mild decreased light touch in the right palm and decreased vibration sense in both distal lower extremities. Motor examination reveals no weakness to individual muscle testing, but on gait she does have a very subtle left hemiparesis. She has hyperreflexia in her lower extremities, worse on the left. Babinski's are downgoing.,PERTINENT DATA: ,MRI of the brain from 05/02/06 and MRI of the C-spine from 05/02/06 and 07/25/06 were personally reviewed. MRI of the brain is broadly within normal limits. MRI of the C-spine reveals large central disc herniation at C6-C7 with evidence of mild cord compression and abnormal signal in the cord suggesting cord edema. There is also a fairly large disc at C3-C4 with cord deformity and partial effacement of the subarachnoid space. I do not appreciate any cord edema at this level.,IMPRESSION AND PLAN: ,The patient is a 45-year-old female with cervical spondylosis with a large C6-C7 herniated disc with mild cord compression and signal change at that level. She has a small disc at C3-C4 with less severe and only subtle cord compression. History and examination are consistent with signs of a myelopathy.,Results were discussed with the patient and her mother. I am concerned about progressive symptoms. Although she only has subtle symptoms now, we made her aware that with progression of this process, she may have paralysis. If she is involved in any type of trauma to the neck such as motor vehicle accident, she could have an acute paralysis. I strongly recommended to her and her mother that she followup with you as soon as possible for surgical evaluation. I agree with the previous physicians who have told her not to exercise as I am sure that her vigorous workouts and weight training since November 2005 have contributed to this problem. I have recommended that she wear a hard collar while driving. The results of my consultation were discussed with you telephonically. | 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' | PROCEDURES:, Cystourethroscopy and transurethral resection of prostate.,COMPLICATIONS:, None.,ADMITTING DIAGNOSIS:, Difficulty voiding.,HISTORY:, This 67-year old Hispanic male patient was admitted because of enlarged prostate and symptoms of bladder neck obstruction. Physical examination revealed normal heart and lungs. Abdomen was negative for abnormal findings. ,LABORATORY DATA:, BUN 19 and creatinine 1.1. Blood group was A, Rh positive, Hemoglobin 13, Hematocrit 32.1, Prothrombin time 12.6 seconds, PTT 37.1. Discharge hemoglobin 11.4, and hematocrit 33.3. Chest x-ray calcified old granulomatous disease, otherwise normal. EKG was normal. ,COURSE IN THE HOSPITAL:, The patient had a cysto and TUR of the prostate. Postoperative course was uncomplicated. The pathology report is pending at the time of dictation. He is being discharged in satisfactory condition with a good urinary stream, minimal hematuria, and on Bactrim DS one a day for ten days with a standard postprostatic surgery instruction sheet. ,DISCHARGE DIAGNOSIS: , Enlarged prostate with benign bladder neck obstruction. ,To be followed in my office in one week and by Dr. ABC next available as an outpatient. | 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' | IDENTIFICATION OF PATIENT: , This is a 31-year-old female who was referred by herself. She was formerly seen at Counseling Center. She is a reliable historian.,CHIEF COMPLAINT:, "I'm bipolar and I have severe anxiety disorder. I have posttraumatic stress syndrome." ,HISTORY OF PRESENT ILLNESS: , At age 19, Ms. Abc had a recurrence of memories. Her father had molested her, and the memories returned. In 1992, at the age of 18, she entered her first abusive marriage. She was beaten and her husband shared her sexually with his friends. This lasted until age 24. The second marriage was age 26, her second husband was a drug abuser and "he slapped me around." She had two children during that marriage. In 2001, she was married in Indiana to a military man. This was her third marriage and she stated, "This marriage is good." She had EMDR in Indiana when she was being treated for Posttraumatic Stress Disorder. ,Historically, her first husband threw her down the stairs at age 21, and she had a miscarriage. Her sexual abuse began at age 5, and at that time she lost interest in other activities that normal school children have. Currently, she is unable to have sex with the lights on. She states, "Sometimes I hurt all over." Her husband was deployed three days ago, on April 21, to a foreign theater of operations. She has panic attacks every day.,Review of symptoms shows her to have physiological distress at the memory of her trauma, she has psychological distress, and this comes about when she smells Old Spice aftershave. She does not avoid thoughts of her trauma, but she avoids the perpetrators and placements. She is not unable to recall details of her trauma. She does feel detached and isolated. She has restrictive range of affect and she had a foreshortened future. She also had a loss of interest in things, starting at age 5. She has anger, which is uncontrollable at times, she has poor sleep, she has nightmares, flashbacks, she is hypervigilant, she has exaggerated startle reflex, and with respect to concentration, she says, "I don't do as good as I can." Further review of symptoms shows her to have periods of constant cleaning and increased sex drive. She also has had euphoria, poor judgment, distractibility, and inability to concentrate. She has been irritable. She has had a decreased need for sleep, which lasts for six or seven days. She had racing thoughts, rapid speech, but has not had grandiosity. These symptoms of mania occurred in the last week of November 2005 and lasted for seven days from, which she was not hospitalized. Furthermore, she endorses the following symptoms: She states, "When I'm depressed, I have neck pain, jaw pain, abdominal pain. I have migraines and urinary tract pain." She also complains of chest pain, pain during sex, and excess pain during her menstrual period. She has an increased gag reflex, which has caused her to have emesis. She states it is easy to choke. She has had physical symptoms, "for as long as I can remember," and she states, "I've felt like crap most of my life," "it affects my marriage." She has also admitted to having nausea and vomiting, with excess gas. She has constipation and she cannot eat certain foods, mainly broccoli and cauliflower, and she does not have diarrhea. She states that sex is only important to her in mania. Otherwise, she has no desire. She has had irregular periods for two or three weeks at a time. She has had no episodes of excess bleeding. She has had no paralysis, no balance issues, no diplopia, no seizures, no blindness, no deafness, no amnesia, no loss of consciousness, but she does have a lump in her throat on occasion. Currently, she is sleeping from 10 p.m. to 3 a.m., and that is under the influence of Lunesta. Her energy is "not good. Her appetite is "I'm craving crap," stating that she wants to eat carbohydrates. Concentration is poor today. She feels worthless, hopeless, and guilty. Her self-esteem is "I don't have any." She has no anhedonia, and she has no libido. She also has had feelings of chronic emptiness. She feels abandoned. She has had unstable relationships. She self-mutilated, but she stopped at age 22. She has trouble controlling her anger. She did not have stress-related paranoia or dissociative phenomena, but she did have those during the sexual transgressions when she was a child. She has no identity disturbance. ,CURRENT MEDICATIONS: , Seroquel 700 mg p.o. q.d.; Wellbutrin XL 300 mg p.o. q.d.; Desyrel 100 mg p.o. q.h.s.; Ativan p.r.n. dosage unknown. In the past, she has been on Prozac, Paxil, lithium, Depakote, Depakene, and Zoloft. ,PSYCHIATRIC HISTORY: , She saw Dr. B. She saw Chris. She is diagnosed with Posttraumatic Stress Disorder, depression, and Bipolar Disorder. She had counseling in Indiana in 2001. She had inpatient treatment in Indiana in 2001 also, at age 19. She had three suicide attempts. At age 14, she took too many aspirin; the second one was at age 19, she took pain medication and sleep medication; and when she discussed her third suicide attempt, she began to cry and would not speak of it any more. She has had no psychological testing. ,MEDICAL HISTORY: , Significant for migraines, hyperactive and gag reflex. She states she has had cardiovascular workups due to panic disorder, but nothing was found. She also has astigmatism. She states she has stomach pain and may have irritable bowel syndrome, and she had had recurrent kidney infections with a stent in the right kidney during one of her pregnancy. She has no history of head injury or MRI test of the brain. No history of EEG, seizures, thyroid problems, or asthma. There are no drug allergies. She has never had an EKG. She does have musculoskeletal problems and has arthritis-like joint pains on occasion. She has had ear infections and sinus infections intermittently. Hearing test was normal. She is currently not pregnant. She saw her gynecologist four months ago at Elmendorf Air Force Base. ,Surgical history is significant for having a tubal ligation at age 27, an appendectomy at age 19. She had surgery on her right ovary due to pain, a cyst was found; the date on that is unknown. ,She has no hypertension, no diabetes, no glaucoma.,FAMILY HISTORY: , Significant for her paternal grandmother not being mentally competent. Her mother was depressed and was treated. Her mother is currently age 55. She has a paternal grandmother who may have had Schizophrenia. There is also a family history of the paternal grandfather using substance. He was "an extreme alcoholic." She had maternal aunts who used alcohol, and a maternal uncle use alcohol to excess. The maternal uncle committed suicide; he drowned himself. ,There is no family history of bipolar disorder, anxiety, nor attention deficit, mental netardation, Tourette's syndrome, or learning disabilities. ,Medical history in the family is significant for her son, age 4, who is having seizures ruled out. Her mother and two maternal aunts have thyroid disease. She has a brother, age 32, with diabetes, a maternal uncle with heart disease, and several paternal great aunts had breast cancer. There is no family history of hypertension.,ABUSE HISTORY: , Significant for being physically abused by her father, her first husband, and her second husband. She was sexually abused by her father from age 5 to age 18. She states, "my first husband gave me away for four years to his friends to be used sexually." She was emotionally abused by her mother, father, and both of her first two husbands. She was neglected by her mother and her father. She never witnessed domestic violence. She has not witnessed traumatic events. ,SUBSTANCE ABUSE: , Significant for having used nerve pills, but she stated she has not used them excessively, and never had to get her prescription refilled early. She has never used alcohol, tobacco, marijuana, or any other drugs.,PARENT/SIBLING RELATIONSHIP INFORMATION: , She had had a poor relationship with her parents. She has no contact with them. She has no contact with her brother. She was married three times, as stated in the history. She has two children with Asperger's and autism. ,HOBBIES/SPIRITUAL: , She likes to read and write. She likes to cross-stitch, quilt, and do music, and has found a good church in Anchorage. ,EDUCATIONAL:, She states she was teased in school because "I was so depressed." She got good grades otherwise. She finished high school.,WORK HISTORY:, She has worked in the past managing a Dollar General store. She has been a waitress and an executive secretary. ,LEGAL HISTORY:, She has never been arrested.,MENTAL STATUS:, Significant for a well groomed, well kempt young white female who appears her stated age. She has a pierced nose and has a nose ring. She is cooperative, alert, and attentive. She makes good eye contact. Her speech is normal, prosody is normal, and rate and rhythm are normal. Motor is normal. She has no gait abnormalities. No psychomotor retardation or agitation. Her mood is "I'm sad and depressed." Her affect is restricted. She is tearful at times when discussing the sexual traumas, and she became anxious and panicky at certain points during the interviews. Perception is normal. She denies auditory and visual hallucinations. She denies depersonalization and derealization, except that those occurred when the sexual transgressions occurred. Otherwise, she has not had dissociative phenomena. Thought processes are normal. She has no loosening of association, no flight of ideas, no tangentiality, and no circumstantiality. She is goal directed and oriented. Insight and judgment are good. She is alert and oriented to person, place, and time, stating it was 04/18/06, Tuesday, it was Anchorage in the spring. She is able to register three words and recall them at five minutes. She is able to do simple calculations, stating 2x3 is 6, and 1 dollar 15 cents has 23 nickels. She is given a proverb to interpret. She was asked what judging a book by its cover meant. She said, "You can't always tell what a person is by looking at them on the outside." She is appropriate in her abstraction, and is able to identify the last four presidents.,CLINICAL IMPRESSION: ,Abc is a 31-year-old female with a family history of mood disorder, suicide, alcoholism, and possible psychosis. She has had an extensive history of sexual abuse and emotional abuse. She has not used drugs and alcohol, and she has been treated in the past. She was treated with EMDR and stated that she did not benefit from that. She has an extensive medical history and brought her medical records, and they were thoroughly reviewed. She currently has symptoms of dysthymia and she had had a recent bout of bipolar hypomania, which was in November of 2005. She also has symptoms of somatization, but these are not chronic in the fact that they only exist during her dysphoric periods and do not exist when she has mania. Medical records review a history of dysmenorrhea with surgery to the right cystic ovary. The EMDR did not benefit her in the past. She also has not had good psychotherapeutic consultation. ,DIAGNOSES:,AXIS I. 309.81 Posttraumatic Stress Disorder. | 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: ,Cervical spondylosis and herniated nucleus pulposus of C4-C5.,POSTOPERATIVE DIAGNOSIS:, Cervical spondylosis and herniated nucleus pulposus of C4-C5.,TITLE OF OPERATION:, Anterior cervical discectomy C4-C5 arthrodesis with 8 mm lordotic ACF spacer, corticocancellous, and stabilization with Synthes Vector plate and screws.,ESTIMATED BLOOD LOSS:, Less than 100 mL.,OPERATIVE PROCEDURE IN DETAIL: , After identification, the patient was taken to the operating room and placed in supine position. Following the induction of satisfactory general endotracheal anesthesia, the patient was prepared for surgery. A shoulder roll was placed between the scapula and the head was rested on a doughnut in a slightly extended position. A preoperative x-ray was obtained to identify the operative level and neck position. An incision was marked at the C4-C5 level on the right side. The incision was opened with #10 blade knife. Dissection was carried down through subcutaneous tissues using Bovie electrocautery. The platysma muscle was divided with the cautery and mobilized rostrally and caudally. The anterior border of sternocleidomastoid muscle was then dissected rostrally and caudally with sharp and blunt dissection. The avascular plane was then entered and dissection was carried bluntly down to the anterior cervical fascia. This was opened with scissors and dissected rostrally and caudally with the peanut dissectors. The operative level was confirmed with an intraoperative x-ray. The longus colli muscles were mobilized bilaterally using bipolar electrocautery and periosteal elevator. The anterior longitudinal ligament was then taken down with the insulated Bovie electrocautery tip exposing the vertebral bodies of C4 and C5. Self-retaining retractor was placed in submuscular position, and distraction pins were placed in the vertebral bodies of C4 and C5, and distraction was instituted. We then incise the annulus of C4-C5 and a discectomy was now carried out using pituitary rongeurs and straight and angled curettes. Operating microscope was draped and brought into play. Dissection was carried down through the disc space to the posterior aspect of the disc space removing the disc with the angled curette as we went. We now use the diamond bit to thin the posterior bone spurs and osteophytes at the uncovertebral joints bilaterally. Bone was then removed with 2 mm Kerrison punch and then we were able to traverse the posterior longitudinal ligament and this ligament was now removed in a piecemeal fashion with a 2 mm Kerrison punch. There was a transligamentous disc herniation, which was removed during this process. We then carried out bilateral foraminotomies with removal of the uncovertebral osteophytes until the foramina were widely patent. Cord was seen to be pulsating freely behind the dura. There appeared to be no complications and the decompression appeared adequate. We now used a cutting bit to prepare the inner space for arthrodesis fashioning a posterior ledge on the posterior aspect of the C5 vertebral body. An 8 mm lordotic trial was used and appeared perfect. We then used a corticocancellous 8 mm lordotic graft. This was tapped into position. Distraction was released, appeared to be in excellent position. We then positioned an 18 mm Vector plate over the inner space. Intraoperative x-ray was obtained with the stay screw in place; plates appeared to be in excellent position. We then use a 14 mm self-tapping variable angle screws in each of the four locations drilling 14 mm pilot holes at each location prior to screw insertion. All of the screws locked to the plate and this was confirmed on visual inspection. Intraoperative x-ray was again obtained. Construct appeared satisfactory. Attention was then directed to closure. The wound was copiously irrigated. All of the self-retaining retractors were removed. Bleeding points were controlled with bone wax and bipolar electrocautery. The platysma layer was now closed with interrupted 3-0 Vicryl sutures. The skin was closed with running 3-0 Vicryl subcuticular stitch. Steri-Strips were applied. A sterile bandage was applied. All sponge, needle, and cottonoid counts were reported as correct. The patient tolerated the procedure well. He was subsequently extubated in the operating room and transferred to PACU 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' | PREOPERATIVE DIAGNOSIS:, Osteomyelitis, right hallux.,POSTOPERATIVE DIAGNOSIS: , Osteomyelitis, right hallux.,PROCEDURE PERFORMED:, Amputation distal phalanx and partial proximal phalanx, right hallux.,ANESTHESIA:, TIVA/local.,HISTORY:, This 44-year-old male patient was admitted to ABCD General Hospital on 09/02/2003 with a diagnosis of osteomyelitis of the right hallux and cellulitis of the right lower extremity. The patient has a history of diabetes and has had a chronic ulceration to the right hallux and has been on outpatient antibiotics, which he failed. The patient after a multiple conservative treatments such as wound care antibiotics, the patient was given the option of amputation as a treatment for the chronic resistant osteomyelitis. The patient desires to attempt a surgical correction. The risks versus benefits of the procedure were discussed with the patient in detail by Dr. X. The consent was available on the chart for review.,PROCEDURE IN DETAIL: , After patient was taken to the operating room via cart and placed on the operating table in the supine position, a safety strap was placed across his waist. Adequate IV sedation was administered by the Department of Anesthesia and a total of 3.5 cc of 1:1 mixture 1% lidocaine and 0.5% Marcaine plain were injected into the right hallux as a digital block. The foot was prepped and draped in the usual aseptic fashion lowering the operative field.,Attention was directed to the hallux where there was a full-thickness ulceration to the distal tip of the hallux measuring 0.5 cm x 0.5 cm. There was a ________ tract, which probed through the distal phalanx and along the sides of the proximal phalanx laterally. The toe was 2.5 times to the normal size. There were superficial ulcerations in the medial arch of both feet secondary to history of a burn, which were not infected. The patient had dorsalis pedis and posterior tibial pulses that were found to be +2/4 bilaterally preoperatively. X-ray revealed complete distraction of the distal phalanx and questionable distraction of the lateral aspect of the proximal phalanx. A #10 blade was used to make an incision down the bone in a transverse fashion just proximal to the head of the proximal phalanx. The incision was carried mediolaterally and plantarly encompassing the toe leaving a large amount of plantar skin intact. Next, the distal phalanx was disarticulated at the interphalangeal joint and removed. The distal toe was amputated and sent to laboratory for bone culture and sensitivity as well as tissue pathology. Next, the head of the proximal phalanx was inspected and found to be soft on the distal lateral portion as suspected. Therefore, a sagittal saw was used to resect approximately 0.75 cm of the distal aspect of head of the proximal phalanx. This bone was also sent off for culture and was labeled proximal margin. Next, the flexor hallucis longus tendon was identified and retracted as far as possible distally and transected. The flexor tendon distally was gray discolored and was not viable. A hemostat was used to inspect the flexor sheath to ensure no infection tracking up the sheath proximally. None was found. No purulent drainage or abscess was found. The proximal margin of the surgical site tissue was viable and healthy. There was no malodor. Anaerobic and aerobic cultures were taken and passed this as a specimen to microbiology. Next, copious amounts of gentamicin and impregnated saline were instilled into the wound.,A #3-0 Vicryl was used to reapproximate the deep subcutaneous layer to release skin tension. The plantar flap was viable and was debulked with Metzenbaum scissors. The flap was folded dorsally and reapproximated carefully with #3-0 nylon with a combination of simple interrupted and vertical mattress sutures. Iris scissors were used to modify and remodel the plantar flap. An excellent cosmetic result was achieved. No tourniquet was used in this case. The patient tolerated the above anesthesia and surgery without apparent complications. A standard postoperative dressing was applied consisting of saline-soaked Owen silk, 4x4s, Kerlix, and Coban. The patient was transported via cart to Postanesthesia Care Unit with vital signs able and vascular status intact to right foot. He will be readmitted to Dr. Katzman where we will continue to monitor his blood pressure and regulate his medications. Plan is to continue the antibiotics until further IV recommendations.,He will be nonweightbearing to the right foot and use crutches. He will elevate his right foot and rest the foot, keep it clean and dry. He is to follow up with Dr. X on Monday or Tuesday of next week. | 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' | REFERRAL INDICATION,1. Tachybrady syndrome.,2. Chronic atrial fibrillation.,PROCEDURES PLANNED AND PERFORMED,1. Implantation of a single-chamber pacemaker.,2. Fluoroscopic guidance for implantation of single-chamber pacemaker.,FLUOROSCOPY TIME: ,1.2 minutes.,MEDICATIONS AT THE TIME OF STUDY,1. Ancef 1 g.,2. Benadryl 50 mg.,3. Versed 3 mg.,4. Fentanyl 150 mcg.,CLINICAL HISTORY: , The patient is a pleasant 73-year-old female with chronic atrial fibrillation. She has been found to have tachybrady syndrome, has been referred for pacemaker implantation.,RISKS AND BENEFITS: , Risks, benefits, and alternatives of implantation of a single-chamber pacemaker were discussed with the patient. The patient agreed both verbally and via written consent. Risks that were discussed included but were not limited to bleeding, infection, vascular injury, cardiac perforation, stroke, myocardial infarction, need for urgent cardiovascular surgery, and death were discussed with the patient. The patient agreed both verbally and via written consent.,DESCRIPTION OF PROCEDURE: , The patient was transported to the cardiac catheterization laboratory in a fasting state. The region of the left deltopectoral groove was prepped and draped in the usual sterile manner. Lidocaine 1% (20 mL) was administered to the area. Percutaneous access of the left axillary vein was then performed. A wire was then advanced in the left axillary vein using fluoroscopy. Following this, a 4-inch long transverse incision was made through the skin and subcutaneous tissue exposing the pectoral fascia and muscle beneath. Lidocaine 1% (10 mL) was then administered to the medial aspect of the incision and a pocket was fashioned in the medial direction. Using the previously placed guidewire, a 7-French sidearm sheath was advanced over the wire into the vein. The dilator and wire were removed. An active pacing lead was then advanced down in the right atrium. The peel-away sheath was removed. Lead was passed across the tricuspid valve and positioned in an apical septal location. This was an active fixed lead and the screw was deployed. Adequate pacing and sensing function were established. The suture sleeve was then advanced to the entry point of the tissue and connected securely to the tissue. The pocket was washed with antibiotic-impregnated saline. A pulse generator was obtained and connected securely to the lead. The lead was then carefully wrapped behind the pulse generator, and the entire system was placed in the pocket. Pocket was then closed with 2-0, 3-0, and 4-0 Vicryl using a running mattress stitch. No acute complications were noted.,DEVICE DATA,1. Pulse generator, manufacturer St. Jude model 12345, serial #123456.,2. Right ventricular lead, manufacturer St. Jude model 12345, serial #ABCD123456.,MEASURED INTRAOPERATIVE DATA:, Right ventricular lead impedance 630 ohms. R wave measures 17.5 mV. Pacing threshold of 0.8 V at 0.5 msec.,DEVICE SETTINGS: , VVI 70 to 120.,CONCLUSIONS,1. Successful implantation of the single-chamber pacemaker with adequate pacing and sensing function.,2. No acute complications.,PLAN,1. The patient will be admitted for overnight observation and dismissed at the discretion of primary service.,2. Chest x-ray to rule out pneumothorax and verify lead position.,3. Completion of course of antibiotics.,4. Device interrogation in the morning.,5. Home dismissal instructions provided in a written format.,6. Wound check in 7 to 10 days.,7. Enrollment in Device Clinic. | 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' | FINAL DIAGNOSES:,1. Herniated nucleuses pulposus, C5-6 greater than C6-7, left greater than C4-5 right with left radiculopathy.,2. Moderate stenosis C5-6.,OPERATION: , On 06/25/07, anterior cervical discectomy and fusions C4-5, C5-6, C6-7 using Bengal cages and Slimlock plate C4 to C7; intraoperative x-ray.,This is a 60-year-old white male who was in the office on 05/01/07 because of neck pain with left radiculopathy and "tension headaches." In the last year or so, he has had more and more difficulty and more recently has developed tingling and numbness into the fingers of the left hand greater than right. He has some neck pain at times and has seen Dr. X for an epidural steroid injection, which was very helpful. More recently he saw Dr. Y and went through some physical therapy without much relief.,Cervical MRI scan was obtained and revealed a large right-sided disc herniation at C4-5 with significant midline herniations at C5-6 and a large left HNP at C6-7. In view of the multiple levels of pathology, I was not confident that anything short of surgical intervention would give him significant relief. The procedure and its risk were fully discussed and he decided to proceed with the operation.,HOSPITAL COURSE: , Following admission, the procedure was carried out without difficulty. Blood loss was about 125 cc. Postop x-ray showed good alignment and positioning of the cages, plate, and screws. After surgery, he was able to slowly increase his activity level with assistance from physical therapy. He had some muscle spasm and soreness between the shoulder blades and into the back part of his neck. He also had some nausea with the PCA. He had a low-grade fever to 100.2 and was started on incentive spirometry. Over the next 12 hours, his fever resolved and he was able to start getting up and around much more easily.,By 06/27/07, he was ready to go home. He has been counseled regarding wound care and has received a neck sheet for instruction. He will be seen in two weeks for wound check and for a followup evaluation/x-rays in about six weeks. He has prescriptions for Lortab 7.5 mg and Robaxin 750 mg. He is to call if there are any problems. | 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' | Her evaluation today reveals restriction in the range of motion of the cervical and lumbar region with tenderness and spasms of the paraspinal musculature. Motor strength was 5/5 on the MRC scale. Reflexes were 2+ and symmetrical. Palpable trigger points were noted bilaterally in the trapezius and lumbar paraspinal musculature bilaterally.,Palpable trigger points were noted on today's evaluation. She is suffering from ongoing myofascitis. Her treatment plan will consist of a series of trigger point injections, which were performed today. She tolerated the procedure well. I have asked her to ice the region intermittently for 15 minutes off and on x 3. She will be followed in four weeks' time for repeat trigger point injections if indicated., | 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: , Basal cell carcinoma, nasal tip, previous positive biopsy.,POSTOPERATIVE DIAGNOSIS: , Basal cell carcinoma, nasal tip, previous positive biopsy.,OPERATION PERFORMED: , Excision of nasal tip basal carcinoma. Total area of excision, approximately 1 cm to 12 mm frozen section x2, final margins clear.,INDICATION: , A 66-year-old female for excision of nasal basal cell carcinoma. This area is to be excised accordingly and closed. We had multiple discussions regarding types of closure.,SUMMARY: , The patient was brought to the OR in satisfactory condition and placed supine on the OR table. Underwent general anesthesia along with Marcaine in the nasal tip areas for planned excision. The area was injected, after sterile prep and drape, with Marcaine 0.25% with 1:200,000 adrenaline.,The specimen was sent to pathology. Margins were still positive at the inferior 6 o'clock ***** margin and this was resubmitted accordingly. Final margins were clear.,Closure consisted of undermining circumferentially. Advancement closure with dog ear removal distally and proximally was accomplished without difficulty. Closure with interrupted 5-0 Monocryl running 7-0 nylon followed by Xeroform gauze, light pressure dressing, and Steri-Strips.,The patient is discharged on minocycline and Darvocet-N 100.,NOTE:, The 2.6 mm loupe magnification was utilized throughout the procedure. No complications noted with excellent and all clear margins at the termination. An advancement closure technique was utilized. | 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 CONSULT: , Medical management, status post left total knee arthroplasty.,PAST MEDICAL HISTORY:,1. Polyarthritis.,2. Acromegaly.,3. Hypothyroidism.,4. Borderline hypertension.,5. Obesity.,PAST SURGICAL HISTORY: , Hernia repair, resection of tumor, right thumb arthrodesis, carpal tunnel decompression, bilateral hip replacement, right total knee replacement about 2 months ago, open reduction of left elbow fracture.,REVIEW OF SYSTEMS:,CONSTITUTIONAL SYMPTOMS: No fever or recent general malaise.,ENT: Not remarkable.,RESPIRATORY: No cough or shortness of breath.,CARDIOVASCULAR: The patient denies any heart problems. No orthopnea. No palpitations. No syncopal episodes.,GASTROINTESTINAL: No nausea. No vomiting. No history of GI bleed.,GENITOURINARY: No dysuria, no hematuria.,ENDOCRINE: The patient is status post pituitary tumor resection and is on supplemental hormone.,MEDICATIONS: Depo-Testosterone 200 mg IM q.3 weekly, prednisone 1 tablet p.o. daily, octreotide IM on a monthly basis, morphine extended release 50 mg p.o. b.i.d., Synthroid 100 mcg p.o. daily, desmopressin 1 tablet p.o. every bedtime, aspirin/oxycodone on a p.r.n. basis, aspirin on p.r.n. basis.,ALLERGIES: , IBUPROFEN AND TYLENOL.,SOCIAL HISTORY: , The patient does not smoke nor drink alcohol.,FAMILY HISTORY: , Noncontributory.,PHYSICAL EXAMINATION,GENERAL: Obese, 57-year-old gentleman, not in acute distress.,VITAL SIGNS: Blood pressure of 105/55, pulse is 90. He is afebrile. O2 saturation is 95% on room air.,HEAD AND NECK: Face symmetrical. Cranial nerves are intact. No distended neck veins. No palpable neck masses.,CHEST: Clear to auscultation. No wheezing. No crepitations.,CARDIOVASCULAR: First and second heart sounds were heard. No murmur was appreciated.,ABDOMEN: Benign.,EXTREMITIES: The left knee is in closed dressing. The lower extremities are still numb from spinal anesthesia.,ASSESSMENT AND PLAN:,1. Polyarthritis, status post left total knee replacement. The patient tolerated the procedure well.,2. Acromegaly, status post pituitary resection. Continue supplemental hormones.,3. Borderline hypertension, blood pressure is under control with monitoring.,4. Deep venous thrombosis prophylaxis as per surgeon.,5. Anemia due to repeated blood loss with monitor hemoglobin and hematocrit. | 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' | 2-D M-MODE: , ,1. Left atrial enlargement with left atrial diameter of 4.7 cm.,2. Normal size right and left ventricle.,3. Normal LV systolic function with left ventricular ejection fraction of 51%.,4. Normal LV diastolic function.,5. No pericardial effusion.,6. Normal morphology of aortic valve, mitral valve, tricuspid valve, and pulmonary valve.,7. PA systolic pressure is 36 mmHg.,DOPPLER: , ,1. Mild mitral and tricuspid regurgitation.,2. Trace aortic and pulmonary regurgitation. | Cardiovascular / Pulmonary |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROBLEMS LIST:,1. Nonischemic cardiomyopathy.,2. Branch vessel coronary artery disease.,3. Congestive heart failure, NYHA Class III.,4. History of nonsustained ventricular tachycardia.,5. Hypertension.,6. Hepatitis C.,INTERVAL HISTORY: , The patient was recently hospitalized for CHF exacerbation and was discharged with increased medications. However, he did not fill his prescriptions and came back with persistent shortness of breath on exertion and on rest. He has history of orthopnea and PND. He has gained a few pounds of weight but denied to have any palpitation, presyncope, or syncope.,REVIEW OF SYSTEMS: , Positive for right upper quadrant pain. He has occasional nausea, but no vomiting. His appetite has decreased. No joint pain, TIA, seizure or syncope. Other review of systems is unremarkable.,I reviewed his past medical history, past surgical history, and family history.,SOCIAL HISTORY: , He has quit smoking, but unfortunately was positive for cocaine during last hospital stay in 01/08.,ALLERGIES: , He has no known drug allergies.,MEDICATIONS:, I reviewed his medication list in the chart. He states he is compliant, but he was not taking the revised dose of medications as per discharge orders and prescription.,PHYSICAL EXAMINATION:,VITAL SIGNS: Pulse 91 per minute and regular, blood pressure 151/102 in the right arm and 152/104 in the left arm, weight 172 pounds, which is about 6 pounds more than last visit in 11/07. HEENT: Atraumatic and normocephalic. No pallor, icterus or cyanosis. NECK: Supple. Jugular venous distention 5 cm above the clavicle present. No thyromegaly. LUNGS: Clear to auscultation. No rales or rhonchi. Pulse ox was 98% on room air. CVS: S1 and S2 present. S3 and S4 present. ABDOMEN: Soft and nontender. Liver is palpable 5 cm below the right subcostal margin. EXTREMITIES: No clubbing or cyanosis. A 1+ edema present.,ASSESSMENT AND PLAN:, The patient has hypertension, nonischemic cardiomyopathy, and branch vessel coronary artery disease. Clinically, he is in NYHA Class III. He has some volume overload and was not unfortunately taking Lasix as prescribed. I have advised him to take Lasix 40 mg p.o. b.i.d. I also increased the dose of hydralazine from 75 mg t.i.d. to 100 mg t.i.d. I advised him to continue to take Toprol and lisinopril. I have also added Aldactone 25 mg p.o. daily for survival advantage. I reinforced the idea of not using cocaine. He states that it was a mistake, may be somebody mixed in his drink, but he has not intentionally taken any cocaine. I encouraged him to find a primary care provider. He will come for a BMP check in one week. I asked him to check his blood pressure and weight. I discussed medication changes and gave him an updated list. I have asked him to see a gastroenterologist for hepatitis C. At this point, his Medicaid is pending. He has no insurance and finds hard to find a primary care provider. I will see him in one month. He will have his fasting lipid profile, AST, and ALT checked in one week. | 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 rigidus, left foot.,2. Elevated first metatarsal, left foot.,POSTOPERATIVE DIAGNOSES:,1. Hallux rigidus, left foot.,2. Elevated first metatarsal, left foot.,PROCEDURE PERFORMED:,1. Austin/Youngswick bunionectomy with Biopro implant.,2. Screw fixation, left foot.,HISTORY: , This 51-year-old male presents to ABCD General Hospital with the above chief complaint. The patient states that he has had degenerative joint disease in his left first MPJ for many years that has been progressively getting worse and more painful over time. The patient desires surgical treatment.,PROCEDURE IN DETAIL: , An IV was instituted by the Department of Anesthesia in the preoperative holding area. The patient was transported from the operating room and placed on the operating room table in the supine position with the safety belt across his lap. Copious amount of Webril was placed around the left ankle followed by a blood pressure cuff. After adequate sedation by the Department of Anesthesia, a total of 7 cc of 0.5% Marcaine plain was injected in a Mayo-type block. 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 then inflated to 250 mmHg. The foot was lowered to the operating table, the stockinet was reflected, and the foot was cleansed with wet and dry sponge.,Attention was then directed to the left first metatarsophalangeal joint. Approximately a 6 cm dorsomedial incision was created over the first metatarsophalangeal joint, just medial to the extensor hallucis longus tendon. The incision was then deepened with a #15 blade. All vessels encountered were ligated for hemostasis. The skin and subcutaneous tissue was undermined medially, off of the joint capsule. A dorsal linear capsular incision was then made. Care was taken to identify and preserve the extensor hallucis longus tendon. The capsule and periosteum were then reflected off of the head of the first metatarsal as well as the base of the proximal phalanx. There was noted to be a significant degenerative joint disease. There was little to no remaining healthy articular cartilage left on the head of the first metatarsal. There was significant osteophytic formation medially, dorsally, and laterally in the first metatarsal head as well as at the base of the proximal phalanx. A sagittal saw was then used to resect the base of the proximal phalanx. Care was taken to ensure that the resection was parallel to the nail. After the bone was removed in toto, the area was inspected and the flexor tendon was noted to be intact. The sagittal saw was then used to resect the osteophytic formation medially, dorsally, and laterally on the first metatarsal. The first metatarsal was then re-modelled and smoothed in a more rounded position with a reciprocating rasp. The sizers were then inserted for the Biopro implant. A large was noted to be of the best size. There was noted to be some hypertrophic bone laterally in the base of the proximal phalanx. Following inspection, the sagittal saw was used to clean both the medial and lateral sides of the base. A small bar drill was then used to pre-drill for the Biopro sizer. The bone was noted to be significantly hardened. The sizer was placed and a large Biopro was deemed to be the correct size implant. The sizer was removed and bar drill was then again used to ream the medullary canal. The hand reamer with a Biopro set was then used to complete the process. The Biopro implant was then inserted and tamped with a hammer and rubber mallet to ensure tight fit. There was noted to be distally increased range of motion after insertion of the implant.,Attention was then directed to the first metatarsal. A long dorsal arm Austin osteotomy was then created. A second osteotomy was then created just plantar and parallel to the first osteotomy site. The wedge was then removed in toto. The area was feathered to ensure high compression of the osteotomy site. The head was noted to be in a more plantar flexed position. The capital fragment was then temporarily fixated with two 0.45 K-wires. A 2.7 x 16 mm screw was then inserted in the standard AO fashion. A second more proximal 2.7 x 60 mm screw was also inserted in a standard AO fashion. With both screws, there was noted to be tight compression at the osteotomy sites.,The K-wires were removed and the areas were then smoothed with reciprocating rash. A screw driver was then used to check and ensure screw tightness. The area was then flushed with copious amounts of sterile saline. Subchondral drilling was performed with a 1.5 drill bit. The area was then flushed with copious amounts of sterile saline. Closure consisted of capsular closure with #3-0 Vicryl followed by subcutaneous closure with #4-0 Vicryl, followed by running subcuticular stitch of #5-0 Vicryl. Dressings consisted of Steri-Strips, Owen silk, 4x4s, Kling, Kerlix, and Coban. A total of 10 cc of 1:1 mixture of 1% lidocaine plain and 0.5% Marcaine plain was injected intraoperatively for further anesthesia. The pneumatic ankle tourniquet was released and immediate hyperemic flush was noted to all five digits of the left foot. The patient tolerated the above procedure and anesthesia well. The patient was transported to PACU with vital signs stable and vascular status intact to the right foot. The patient was given postoperative pain prescription for Vicodin ES and instructed to take 1 q. 4-6h. p.o. p.r.n. pain. The patient was instructed to ice and elevate his left lower extremity as much as possible to help decrease postoperative edema. The patient is to follow up with Dr. X in his office 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' | PREOPERATIVE DIAGNOSES,1. Neck pain with bilateral upper extremity radiculopathy.,2. Residual stenosis, C3-C4, C4-C5, C5-C6, and C6-C7 with probable instability.,POSTOPERATIVE DIAGNOSES,1. Neck pain with bilateral upper extremity radiculopathy.,2. Residual stenosis, C3-C4, C4-C5, C5-C6, and C6-C7 secondary to facet arthropathy with scar tissue.,3. No evidence of instability.,OPERATIVE PROCEDURE PERFORMED,1. Bilateral C3-C4, C4-C5, C5-C6, and C6-C7 medial facetectomy and foraminotomy with technical difficulty.,2. Total laminectomy C3, C4, C5, and C6.,3. Excision of scar tissue.,4. Repair of dural tear with Prolene 6-0 and Tisseel.,FLUIDS:, 1500 cc of crystalloid.,URINE OUTPUT: , 200 cc.,DRAINS: , None.,SPECIMENS: , None.,COMPLICATIONS: , None.,ANESTHESIA:, General endotracheal anesthesia.,ESTIMATED BLOOD LOSS:, Less than 250 cc.,INDICATIONS FOR THE OPERATION: ,This is the case of a very pleasant 41 year-old Caucasian male well known to me from previous anterior cervical discectomy and posterior decompression. Last surgery consisted of four-level decompression on 08/28/06. The patient continued to complain of posterior neck pain radiating to both trapezius. Review of his MRI revealed the presence of what still appeared to be residual lateral recess stenosis. It also raised the possibility of instability and based on this I recommended decompression and posterolateral spinal instrumention; however, intraoperatively, it appeared like there was no abnormal movement of any of the joint segments; however, there was still residual stenosis since the laminectomy that was done previously was partial. Based on this, I did total decompression by removing the lamina of C3 through C6 and doing bilateral medial facetectomy and foraminotomy at C3-C4, C4-C5, C5-C6, and C6-C7 with no spinal instrumentation. Operation and expected outcome risks and benefits were discussed with him prior to the surgery. Risks include but not exclusive of bleeding and infection. Infection can be superficial, but may also extend down to the epidural space, which may require return to the operating room and evacuation of the infection. There is also the risk of bleeding that could be superficial but may also be in the epidural space resulting in compression of spinal cord. This may result in weakness of all four extremities, numbness of all four extremities, and impairment of bowel and bladder function, which will require an urgent return to the operating room and evacuation of the hematoma. There is also the risk of a dural tear with its attendant problems of CSF leak, headache, nausea, vomiting, photophobia, pseudomeningocele, and dural meningitis. This too may require return to the operating room for evacuation of said pseudomeningocele and repair. The patient understood the risk of the surgery. I told him there is just a 30% chance that there will be no improvement with the surgery; he understands this and agreed to have the procedure performed.,DESCRIPTION OF PROCEDURE: , The patient was brought to the operating room, awake, alert, not in any form of distress. After smooth induction and intubation, a Foley catheter was inserted. Monitoring leads were also placed by Premier Neurodiagnostics for both SSEP and EMG monitoring. The SSEPs were normal, and the EMGs were silent during the entire case. After completion of the placement of the monitoring leads, the patient was then positioned prone on a Wilson frame with the head supported on a foam facial support. Shave was then carried out over the occipital and suboccipital region. All pressure points were padded. I proceeded to mark the hypertrophic scar for excision. This was initially cleaned with alcohol and prepped with DuraPrep.,After sterile drapes were laid out, incision was made using a scalpel blade #10. Wound edge bleeders were carefully controlled with bipolar coagulation and a hot knife was utilized to excise the hypertrophic scar. Dissection was then carried down to the cervical fascia, and by careful dissection to the scar tissue, the spinous process of C2 was then identified. There was absence of the spinous process of C3, C4, C5, and C6, but partial laminectomy was noted; removal of only 15% of the lamina. With this completed, we proceeded to do a total laminectomy at C3, C4, C5, and C6, which was technically difficult due to the previous surgery. There was also a dural tear on the right C3-C4 space that was exposed and repaired with Prolene 6-0 and later with Tisseel. By careful dissection and the use of a -5 and 3 mm bur, total laminectomy was done as stated with bilateral medial facetectomy and foraminotomy done at C3-C4, C4-C5, C5-C6, and C6-C7. There was significant epidural bleeding, which was carefully coagulated. At two points, I had to pack this with small pieces of Gelfoam. After repair of the dural tear, Valsalva maneuver showed no evidence of any CSF leakage. Area was irrigated with saline and bacitracin and then lined with Tisseel. The wound was then closed in layers with Vicryl 0 simple interrupted sutures to the fascia; Vicryl 2-0 inverted interrupted sutures to the dermis and a running nylon 2-0 continuous vertical mattress stitch. The patient was extubated and transferred to recovery. | 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: , Brain tumors, multiple.,POSTOPERATIVE DIAGNOSES:, Brain tumors multiple - adenocarcinoma and metastasis from breast.,PROCEDURE:, Occipital craniotomy, removal of large tumor using the inner hemispheric approach, stealth system operating microscope and CUSA.,PROCEDURE:, The patient was placed in the prone position after general endotracheal anesthesia was administered. The scalp was prepped and draped in the usual fashion. The CUSA was brought in to supplement the use of operating microscope as well as the stealth, which was used to localize the tumor. Following this, we then made a transverse linear incision, the scalp galea was reflected and the quadrilateral bone flap was removed after placing burr holes in the midline and over the parietal areas directly over the tumor. The bone flap was elevated. The ultrasound was then used. The ultrasound showed the tumors directly I believe are in the interhemispheric fissure. We noticed that the dura was quite tense despite that the patient had slight hyperventilation. We gave 4 ounce of mannitol, the brain became more pulsatile. We then used the stealth to perform a ventriculostomy. Once this was done, the brain began to pulsate nicely. We then entered the interhemispheric space after we incised the dura in an inverted U fashion based on the superior side of the sinus. After having done this we then used operating microscope and slight self-retaining retraction was used. We obtained access to the tumor. We biopsied this and submitted it. This was returned as a malignant brain tumor - metastatic tumor, adenocarcinoma compatible with breast cancer.,Following this we then debulked this tumor using CUSA and then removed it in total. After gross total removal of this tumor, the irrigation was used to wash the tumor bed and a meticulous hemostasis was then obtained using bipolar cautery. The next step was after removal of this tumor, closure of the wound, a large piece of Duragen was placed over the dural defect and the bone flap was reapproximated and held secured with Lorenz plates. The tumors self extend into the ventricle and after we had removed the tumor, we could see our ventricular catheter in the occipital horn of the ventricle. This being the case, we left this ventricular catheter in, brought it out through a separate incision and connected to sterile drainage. The next step was to close the wound after reapproximating the bone flap. The galea was closed with 2-0 Vicryl and the skin was closed with interrupted 3-0 nylon sutures inverted with mattress sutures. The sterile dressings were applied to the scalp. The patient returned to the recovery room in satisfactory condition. Hemodynamically remained stable throughout the operation.,Once again, we performed occipital craniotomy, total removal of her large metastatic tumor involving the parietal lobe using a biparietal craniotomy. The tumor was removed using the combination of CUSA, ultrasound, stealth guided-ventriculostomy and the patient will have a second operation today, we will perform a selective craniectomy to remove another large tumor in the posterior fossa. | 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' | DIAGNOSES:,1. Bronchiolitis, respiratory syncytial virus positive; improved and stable.,2. Innocent heart murmur, stable.,HOSPITAL COURSE: , The patient was admitted for an acute onset of congestion. She was checked for RSV, which was positive and admitted to the hospital for acute bronchiolitis. She has always been stable on room air; however, because of her age and her early diagnosis, she was admitted for observation as RSV bronchiolitis typically worsens the third and fourth day of illness. She was treated per pathway orders. However, on the second day of admission, the patient was not quite eating well and parents live far away and she did have a little bit of trouble on first night of admission. There was a heart murmur that was heard that sounded innocent, but yet there was no chest x-ray that was obtained. We did obtain a chest x-ray, which did show a slight perihilar infiltrate in the right upper lobe. However, the rest of the lungs were normal and the heart was also normal. There were no complications during her hospitalization and she continued to be stable and eating better. On day 2 of the admission, it was decided she was okay to go home. Mother was advised regarding signs and symptoms of increased respiratory distress, which includes tachypnea, increased retractions, grunting, nasal flaring etc. and she was very comfortable looking for this. During her hospitalization, albuterol MDI was given to the patient and more for mom to learn outpatient care. The patient did receive a couple of doses, but she did not have any significant respiratory distress and she was discharged in improved condition.,DISCHARGE PHYSICAL EXAMINATION:,VITAL SIGNS: She is afebrile. Vital signs were stable within normal limits on room air.,GENERAL: She is sleeping and in no acute distress.,HEENT: Her anterior fontanelle was soft and flat. She does have some upper airway congestion.,CARDIOVASCULAR: Regular rate and rhythm with a 2-3/6 systolic murmur that radiates to bilateral axilla and the back.,EXTREMITIES: Her femoral pulses were 2+ and her extremities were warm and well perfused with good capillary refill.,LUNGS: Her lungs did show some slight coarseness, but good air movement with equal breath sounds. She does not have any wheezes at this time, but she does have a few scattered crackles at bilateral bases. She did not have any respiratory distress while she was asleep.,ABDOMEN: Normal bowel sounds. Soft and nondistended.,GENITOURINARY: She is Tanner I female.,DISCHARGE WEIGHT:, Her weight at discharge 3.346 kg, which is up 6 grams from admission.,DISCHARGE INSTRUCTIONS: , ,ACTIVITY: No one should smoke near The patient. She should also avoid all other exposures to smoke such as from fireplaces and barbecues. She is to avoid contact with other infants since she is sick and they are to limit travel. There should be frequent hand washings.,DIET: Regular diet. Continue breast-feeding as much as possible and encourage oral intake.,MEDICATIONS: She will be sent home on albuterol MDI to be used as needed for cough, wheezes or dyspnea.,ADDITIONAL INSTRUCTIONS:, Mom is quite comfortable with bulb suctioning the nose with saline and they know that they are to return immediately if she starts having difficulty breathing, if she stops breathing or she decides that she does not want to eat., | 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, O.D.,RE: ABC,DOB: MM/DD/YYYY,Dear Dr. XYZ:,Thank you for your referral of patient ABC. The patient was referred for evaluation of cataracts bilaterally.,On examination, the patient was seeing 20/40 in her right eye and 20/50 in the left eye. Extraocular muscles were intact, visual fields were full to confrontation OU, and applanations are 12 mmHg bilaterally. There is no relative afferent pupillary defect. On slit lamp examination, lids and lashes were within normal limits. The conj is quiet. The cornea shows 1+ guttata bilaterally. The AC is deep and quiet and irises are within normal limits bilaterally. There is a dense 3 to 4+ nuclear sclerotic cataract in each eye. On dilated fundus examination, cup-to-disc ratio is 0.1 OU. The vitreous, macula, vessels, and periphery all appear within normal limits.,Impression: It appears that Ms. ABC' visual decline is caused by bilateral cataracts. She would benefit from having removed. The patient also showed some mild guttata OU indicating possible early Fuchs dystrophy. The patient should do well with cataract surgery and I have recommended this and she agreed to proceed with the first eye here shortly. I will keep you up to date of her progress and any new findings as we perform her surgery in each eye.,Again, thank you for your kind referral of this kind lady and I will be in touch with you.,Sincerely,, | Letters |
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. Hematochezia.,2. Refractory dyspepsia.,POSTOPERATIVE DIAGNOSES:,1. Colonic polyps at 35 cm and 15 cm.,2. Diverticulosis coli.,2. Acute and chronic gastritis.,PROCEDURE PERFORMED:,1. Colonoscopy to cecum with snare polypectomy.,2. Esophagogastroduodenoscopy with biopsies.,INDICATIONS FOR PROCEDURES: ,This is a 43-year-old white male who presents as an outpatient to the General Surgery Service with hematochezia with no explainable source at the anal verge. He also had refractory dyspepsia despite b.i.d., Nexium therapy. The patient does use alcohol and tobacco. The patient gave informed consent for the procedure.,GROSS FINDINGS: , At the time of colonoscopy, the entire length of colon was visualized. The patient was found to have a sigmoid diverticulosis. He also was found to have some colonic polyps at 35 cm and 15 cm. The polyps were large enough to be treated with snare cautery technique. The polyps were achieved and submitted to pathology. EGD did confirm acute and chronic gastritis. The biopsies were performed for H&E and CLO testing. The patient had no evidence of distal esophagitis or ulcers. No mass lesions were seen.,PROCEDURE: ,The patient was taken to the Endoscopy Suite with the heart and lungs examination unremarkable. The vital signs were monitored and found to be stable throughout the procedure. The patient was placed in the left lateral position where intravenous Demerol and Versed were given in a titrated fashion.,The video Olympus colonoscope was advanced per anus and without difficulty to the level of cecum. Photographic documentation of the diverticulosis and polyps were obtained. The patient's polyps were removed in a similar fashion, each removed with snare cautery. The polyps were encircled at their stalk. Increasing the tension and cautery was applied as coagulation and cutting blunt mode, 15/15 was utilized. Good blanching was seen. The polyp was retrieved with the suction port of the scope. The patient was re-scoped to the polyp levels to confirm that there was no evidence of perforation or bleeding at the polypectomy site. Diverticulosis coli was also noted. With colonoscopy completed, the patient was then turned for EGD. The oropharynx was previously anesthetized with Cetacaine spray and a biteblock was placed. Video Olympus GIF gastroscope model was inserted per os and advanced without difficulty through the hypopharynx. The esophagus revealed a GE junction at 39 cm. The GE junction was grossly within normal limits. The stomach was entered and distended with air. Acute and chronic gastritis features as stated were appreciated. The pylorus was traversed with normal duodenum. The stomach was again reentered. Retroflex maneuver of the scope confirmed that there was no evidence of hiatal hernia. There were no ulcers or mass lesions seen. The patient had biopsy performed of the antrum for H&E and CLO testing. There was no evidence of untoward bleeding at biopsy sites. Insufflated air was removed with withdrawal of the scope. The patient will be placed on a reflux diet, given instruction and information on Nexium usage. Additional recommendations will follow pending biopsy results. He is to also abstain from alcohol and tobacco. He will require follow-up colonoscopy again in three years for polyp disease. | 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. Chronic eustachian tube dysfunction.,2. Retained right pressure equalization tube.,3. Retracted left tympanic membrane.,4. Dizziness.,POSTOPERATIVE DIAGNOSES:,1. Chronic eustachian tube dysfunction.,2. Retained right pressure equalization tube.,3. Retracted left tympanic membrane.,4. Dizziness.,PROCEDURE:,1. Removal of the old right pressure equalizing tube with placement of a tube. Tube used was Santa Barbara.,2. Myringotomy with placement of a left pressure equalizing tube. The tube used was Santa Barbara.,ANESTHESIA:, General.,INDICATION: , This is a 98-year-old female whom I have known for several years. She has a marginal hearing. With the additional conductive loss secondary to the retraction of the tympanic membrane, her hearing aid and function deteriorated significantly. So, we have kept sets of tubes in her ears at all times. The major problem is that she has got small ear canals and a very sensitive external auditory canal; therefore it cannot tolerate even the wax cleaning in the clinic awake.,The patient was seen in the OR and tubes were placed. There were no significant findings.,PROCEDURE IN DETAIL: , After obtaining informed consent from the patient, she was brought to the neurosensory OR, placed under general anesthesia. Mask airway was used. IV had already been started.,On the right side, we removed the old tube and then cleaned the cerumen and found that it was larger than the side of the tube in perfection or perforation in tympanic membrane in the anterior inferior quadrant. In the same area, a small Santa Barbara tube was placed. This T-tube was cut to 80% of its original length for comfort and then positioned to point straight out and treated. Three drops of ciprofloxacin eyedrops was placed in the ear canal.,On the left side, the tympanic membrane adhered and it was retracted and has some myringosclerosis. Anterior, inferior incision was made. Tympanic membrane bounced back to neutral position. A Santa Barbara tube was cut to the 80% of the original length and placed in the hole. Ciprofloxacin drops were placed in the ear. Procedure completed.,ESTIMATED BLOOD LOSS: , None.,COMPLICATION: , None.,SPECIMEN:, None.,DISPOSITION:, To PACU 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' | CHIEF COMPLAINT:, A 2-month-old female with 1-week history of congestion and fever x2 days.,HISTORY OF PRESENT ILLNESS:, The patient is a previously healthy 2-month-old female, who has had a cough and congestion for the past week. The mother has also reported irregular breathing, which she describes as being rapid breathing associated with retractions. The mother states that the cough is at times paroxysmal and associated with posttussive emesis. The patient has had short respiratory pauses following the coughing events. The patient's temperature has ranged between 102 and 104. She has had a decreased oral intake and decreased wet diapers. The brother is also sick with URI symptoms, and the patient has had no diarrhea. The mother reports that she has begun to regurgitate after her feedings. She did not do this previously.,MEDICATIONS: , None.,SMOKING EXPOSURE: , None.,IMMUNIZATIONS: , None.,DIET: ,Similac 4 ounces every 2 to 3 hours.,ALLERGIES:, No known drug allergies.,PAST MEDICAL HISTORY: ,The patient delivered at term. Birth weight was 6 pounds 1 ounce. Postnatal complications: Neonatal Jaundice. The patient remained in the hospital for 3 days. The in utero ultrasounds were reported to be normal.,PRIOR HOSPITALIZATIONS: , None.,FAMILY/SOCIAL HISTORY: , Family history is positive for asthma and diabetes. There is also positive family history of renal disease on the father's side of the family.,DEVELOPMENT: , Normal. The patient tests normal on the newborn hearing screen.,REVIEW OF SYSTEMS: GENERAL: , The patient has had fever, there have been no chills. SKIN: No rashes. HEENT: Mild congestion x1 week. Cough, at times paroxysmal, no cyanosis. The patient turns red in the face during coughing episodes, posttussive emesis. CARDIOVASCULAR: No cyanosis. GI: Posttussive emesis, decreased oral intake. GU: Decreased urinary output. ORTHO: No current issues. NEUROLOGIC: No change in mental status. ENDOCRINE: There is no history of weight loss. DEVELOPMENT: No loss of developmental milestones.,PHYSICAL EXAMINATION: ,VITAL SIGNS: Weight is 4.8 kg, temperature 100.4, heart rate is 140, respiratory rate 30, and saturations 100%.,GENERAL: This is a well-appearing infant in no acute distress.,HEENT: Shows anterior fontanelle to be open and flat. Pupils are equal and reactive to light with red reflex. Nares are patent. Oral mucosa is moist. Posterior pharynx is clear. Hard palate is intact. Normal gingiva.,HEART: Regular rate and rhythm without murmur.,LUNGS: A few faint rales. No retractions. No stridor. No wheezing on examination. Mild tachypnea.,EXTREMITIES: Warm, good perfusion. No hip clicks.,NEUROLOGIC: The patient is alert. Normal tone throughout. Deep tendon reflexes are 2+/4. No clonus.,SKIN: Normal.,LABORATORY DATA:, CBC shows a white count of 12.4, hemoglobin 10.1, platelet count 611,000; 38 segs 3 bands, 42 lymphocytes, and 10 monocytes. Electrolytes were within normal limits. C-reactive protein 0.3. Chest x-ray shows no acute disease with the exception of a small density located in the retrocardiac area on the posterior view. UA shows 10 to 25 bacteria.,ASSESSMENT/PLAN: ,This is a 2-month-old, who presents with fever, paroxysmal cough and episodes of respiratory distress. The patient is currently stable in the emergency room. We will admit the patient to the pediatric floor. We will send out pertussis PCR. We will also follow results of urine culture and that the urine dip shows 10 to 25 bacteria. The patient will be followed up for signs of sepsis, apnea, urinary tract infection, and pneumonia. We will wait for a radiology reading on the chest x-ray to determine if the density seen on the lateral film is a normal variant or represents pathology. | Pediatrics - Neonatal |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PROCEDURE IN DETAIL: , Following premedication with Vistaril 50 mg and Atropine 0.4 mg IM, the patient received Versed 5.0 mg intravenously after Cetacaine spray to the posterior palate. The Olympus video gastroscope was then introduced into the upper esophagus and passed by direct vision to the descending duodenum. The upper, mid and lower portions of the esophagus; the lesser and greater curves of the stomach; anterior and posterior walls; body and antrum; pylorus; duodenal bulb; and duodenum were all normal. No evidence of friability, ulceration or tumor mass was encountered. The instrument was withdrawn to the antrum, and biopsies taken for CLO testing, and then the instrument removed. | 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' | 2-D STUDY,1. Mild aortic stenosis, widely calcified, minimally restricted.,2. Mild left ventricular hypertrophy but normal systolic function.,3. Moderate biatrial enlargement.,4. Normal right ventricle.,5. Normal appearance of the tricuspid and mitral valves.,6. Normal left ventricle and left ventricular systolic function.,DOPPLER,1. There is 1 to 2+ aortic regurgitation easily seen, but no aortic stenosis.,2. Mild tricuspid regurgitation with only mild increase in right heart pressures, 30-35 mmHg maximum.,SUMMARY,1. Normal left ventricle.,2. Moderate biatrial enlargement.,3. Mild tricuspid regurgitation, but only mild increase in right heart pressures. | 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' | CT ANGIOGRAPHY CHEST WITH CONTRAST,REASON FOR EXAM: , Chest pain, shortness of breath and cough, evaluate for pulmonary arterial embolism.,TECHNIQUE: ,Axial CT images of the chest were obtained for pulmonary embolism protocol utilizing 100 mL of Isovue-300.,FINDINGS: ,There is no evidence for pulmonary arterial embolism.,The lungs are clear of any abnormal airspace consolidation, pleural effusion, or pneumothorax. No abnormal mediastinal or hilar lymphadenopathy is seen.,Limited images of the upper abdomen are unremarkable. No destructive osseous lesion is detected.,IMPRESSION: , Negative for pulmonary arterial embolism. | Radiology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Recurring bladder infections with frequency and urge incontinence, not helped with Detrol LA.,POSTOPERATIVE DIAGNOSIS: , Normal cystoscopy with atrophic vaginitis.,PROCEDURE PERFORMED: , Flexible cystoscopy.,FINDINGS:, Atrophic vaginitis.,PROCEDURE: ,The patient was brought in to the procedure suite, prepped and draped in the dorsal lithotomy position. The patient then had flexible scope placed through the urethral meatus and into the bladder. Bladder was systematically scanned noting no suspicious areas of erythema, tumor or foreign body. Significant atrophic vaginitis is noted.,IMPRESSION: , Atrophic vaginitis with overactive bladder with urge incontinence.,PLAN: , The patient will try VESIcare 5 mg with Estrace and follow up in approximately 4 weeks. | Urology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | HISTORY OF PRESENT ILLNESS: , The patient is a 53-year-old right-handed gentleman who presents to the clinic for further evaluation of diplopia. He states that he was in his usual state of health when he awoke one morning in January 2009. He had double vision. He states when he closed each eye, the double vision dissipated. The double vision entirely dissipated within one hour. He was able to drive. However, the next day he woke up and he had double vision again. Over the next week, the double vision worsened in intensity and frequency and by the second week, it was severe. He states that he called Sinai Hospital and spoke to a physician who recommended that he come in for evaluation. He was seen by a primary care physician who sent him for an ophthalmologic evaluation. He was seen and referred to the emergency department for an urgent MRI to evaluate for possible aneurysm. The patient states that he had a normal MRI and was discharged to home.,For the next month, the double vision improved, although he currently still experiences constant diplopia. Whereas in the past, when he would see two objects, they were very far apart in a horizontal plane; now they are much closer together. He still does not drive. He also is not working due to the double vision. There is no temporal fluctuation to the double vision. More recently, over the past month, he has developed right supraorbital pain. It actually feels like there is pain under his right lid. He denies any dysphagia, dysarthria, weakness, numbness, tingling, or any other neurological symptoms.,There is a neurology consultation in the computer system. Dr. X saw the patient on February 2, 2009, when he was in the emergency department. He underwent an MRI that showed a questionable 3 mm aneurysm of the medial left supraclinoid internal carotid artery, but there were no abnormalities on the right side. MRV was negative and MRI of the brain with and without contrast was also negative. He also had an MRI of the orbit with and without contrast that was normal. His impression was that the patient should follow up for a possible evaluation of myasthenia gravis or other disorder.,At the time of the examination, it was documented that he had right lid ptosis. He had left gaze diplopia. The pupils were equal, round, and reactive to light. His neurological examination was otherwise entirely normal. According to Dr. X's note, the ophthalmologist who saw him thought that there was ptosis of the right eye as well as an abnormal pupil. There was also right medial rectus as well as possibly other extraocular abnormalities. I do not have the official ophthalmologic consultation available to me today.,PAST MEDICAL HISTORY: , The patient denies any previous past medical history. He currently does not have a primary care physician as he is uninsured.,MEDICATIONS:, He does not take any medications.,ALLERGIES: , He has no known drug allergies.,SOCIAL HISTORY: , The patient lives with his wife. He was an IT software developer, but he has been out of work for several months. He smokes less than a pack of cigarettes daily. He denies alcohol or illicit drug use.,FAMILY HISTORY: , His mother died of a stroke in her 90s. His father had colon cancer. He is unaware of any family members with neurological disorders.,REVIEW OF SYSTEMS: , A complete review of systems was obtained and was negative except for as mentioned above. This is documented in the handwritten notes from today's visit.,PHYSICAL EXAMINATION:,Vital Signs: BP 124/76 | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | CHIEF COMPLAINT:, Palpitations.,CHEST PAIN / UNSPECIFIED ANGINA PECTORIS HISTORY:, The patient relates the recent worsening of chronic chest discomfort. The quality of the pain is sharp and the problem started 2 years ago. Pain radiates to the back and condition is best described as severe. Patient denies syncope. Beyond baseline at present time. Past work up has included 24 hour Holter monitoring and echocardiography. Holter showed PVCs.,PALPITATIONS HISTORY:, Palpitations - frequent, 2 x per week. No caffeine, no ETOH. + stress. No change with Inderal.,VALVULAR DISEASE HISTORY:, Patient has documented mitral valve prolapse on echocardiography in 1992.,PAST MEDICAL HISTORY:, No significant past medical problems. Mitral Valve Prolapse.,FAMILY MEDICAL HISTORY:, CAD.,OB-GYN HISTORY:, The patients last child birth was 1997. Para 3. Gravida 3.,SOCIAL HISTORY:, Denies using caffeinated beverages, alcohol or the use of any tobacco products.,ALLERGIES:, No known drug allergies/Intolerances.,CURRENT MEDICATIONS:, Inderal 20 prn.,REVIEW OF SYSTEMS:, Generally healthy. The patient is a good historian.,ROS Head and Eyes: Denies vision changes, light sensitivity, blurred vision, or double vision.,ROS Ear, Nose and Throat: The patient denies any ear, nose or throat symptoms.,ROS Respiratory: Patient denies any respiratory complaints, such as cough, shortness of breath, chest pain, wheezing, hemoptysis, etc.,ROS Gastrointestinal: Patient denies any gastrointestinal symptoms, such as anorexia, weight loss, dysphagia, nausea, vomiting, abdominal pain, abdominal distention, altered bowel movements, diarrhea, constipation, rectal bleeding, hematochezia.,ROS Genitourinary: Patient denies any genito-urinary complaints, such as hematuria, dysuria, frequency, urgency, hesitancy, nocturia, incontinence.,ROS Gynecological: Denies any gynecological complaints, such as vaginal bleeding, discharge, pain, etc.,ROS Musculoskeletal: The patient denies any past or present problems related to the musculoskeletal system.,ROS Extremities: The patient denies any extremities complaints.,ROS Cardiovascular: As per HPI.,EXAMINATION:,Exam Abdomen/Flank: The abdomen is soft without tenderness or palpable masses. No guarding, rigidity or rebound tenderness. The liver and spleen are not palpable. Bowel sounds are active and normal.,Exam Extremities: Lower extremities are normal in color, touch and temperature. No ischemic changes are noted.,Range of motion is normal. There is no cyanosis, clubbing or edema.,General: Healthy appearing, well developed,. The patient is in no acute distress.,Exam Skin Negative to inspection or palpation. There are no obvious lesions or new rashes noted. Non-diaphoretic.,Exam Ears Canals are clear. Throat is not injected. Tonsils are not swollen or injected.,Exam Neck: There is no thyromegaly, carotid bruits, lymphadenopathy, or JVD. Neck is supple.,Exam Respiratory: Normal breath sounds are heard bilaterally. There is no wheezing. There is no use of accessory muscles.,Exam Cardiovascular: Regular heart rate and rhythm, Normal S1 and S2 without murmur, gallops or rubs.,IMPRESSION / DIAGNOSIS:, Mitral Valve Prolapse. Palpitations.,TESTS ORDERED:, Cardiac tests: Echocardiogram.,MEDICATION PRESCRIBED:, ,Cardizem 30-60 qid prn. | 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:, Chronic otitis media with effusion, conductive hearing loss, and recurrent acute otitis media.,POSTOPERATIVE DIAGNOSES:, Chronic otitis media with effusion, conductive hearing loss, and recurrent acute otitis media.,OPERATION: , Bilateral myringotomies, insertion of PE tubes, and pharyngeal anesthesia.,ANESTHESIA: ,General via facemask.,ESTIMATED BLOOD LOSS: , None.,COMPLICATIONS: , None.,INDICATIONS: ,The patient is a one-year-old with history of chronic and recurrent episodes of otitis media with persistent middle ear effusions resistant to medical therapy.,PROCEDURE: , The patient was brought to the operating room, was placed in supine position. General anesthesia was begun via face mask technique. Once an adequate level of anesthesia was obtained, the operating microscope was brought, positioned and visualized the right ear canal. A small amount of wax was removed with a loop. A 4-mm operating speculum was then introduced. An anteroinferior quadrant radial myringotomy was then performed. A large amount of mucoid middle ear effusion was aspirated from the middle ear cleft. Reuter bobbin PE tube was then inserted, followed by Floxin otic drops and a cotton ball in the external meatus. Head was then turned to the opposite side, where similar procedure was performed. Once again, the middle ear cleft had a mucoid effusion. A tube was inserted to an anteroinferior quadrant radial myringotomy.,Anesthesia was then reversed and the patient was transported to the recovery room having tolerated the procedure well with stable signs. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | ADMISSION DIAGNOSES:,1. Menorrhagia.,2. Uterus enlargement.,3. Pelvic pain.,DISCHARGE DIAGNOSIS: , Status post vaginal hysterectomy.,COMPLICATIONS: , None.,BRIEF HISTORY OF PRESENT ILLNESS: , This is a 36-year-old, gravida 3, para 3 female who presented initially to the office with abnormal menstrual bleeding and increase in flow during her period. She also had symptoms of back pain, dysmenorrhea, and dysuria. The symptoms had been worsening over time. The patient was noted also to have increasing pelvic pain over the past 8 months and she was noted to have uterine enlargement upon examination.,PROCEDURE:, The patient underwent a total vaginal hysterectomy.,HOSPITAL COURSE: ,The patient was admitted on 09/04/2007 to undergo total vaginal hysterectomy. The procedure preceded as planned without complication. Uterus was sent for pathologic analysis. The patient was monitored in the hospital, 2 days postoperatively. She recovered quite well and vitals remained stable.,Laboratory studies, H&H were followed and appeared stable on 09/05/2007 with hemoglobin of 11.2 and hematocrit of 31.8.,The patient was ready for discharge on Monday morning of 09/06/2007.,LABORATORY FINDINGS: , Please see chart for full studies during admission.,DISPOSITION: ,The patient was discharged to home in stable condition. She was instructed to follow up in the office postoperatively. | 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' | PROCEDURES:,1. Right frontal craniotomy with resection of right medial frontal brain tumor.,2. Stereotactic image-guided neuronavigation for resection of tumor.,3. Microdissection and micro-magnification for resection of brain tumor.,ANESTHESIA: , General via endotracheal tube.,INDICATIONS FOR THE PROCEDURE: ,The patient is a 71-year-old female with a history of left-sided weakness and headaches. She has a previous history of non-small cell carcinoma of the lung, treated 2 years ago. An MRI was obtained which showed a large enhancing mass in the medial right frontal lobe consistent with a metastatic lesion or possible primary brain tumor. After informed consent was obtained, the patient was brought to the operating room for surgery.,PREOPERATIVE DIAGNOSES: , Medial right frontal brain tumor with surrounding edema and mass effect and right to left brain shift.,POSTOPERATIVE DIAGNOSES: , Medial right frontal brain tumor with surrounding edema and mass effect and right to left brain shift, probable metastatic lung carcinoma.,DESCRIPTION OF THE PROCEDURE: , The patient was wheeled into the operating room and satisfactory general anesthesia was obtained via endotracheal tube. She was positioned on the operating room table in the Sugita frame with the head secured.,Using the preoperative image-guided MRI, we carefully registered the fiducials and then obtained the stereotactic image-guided localization to guide us towards the tumor. We marked external landmarks. Then we shaved the head over the right medial frontal area. This area was then sterilely prepped and draped.,Evoked potential monitoring and sensory potentials were carried out throughout the case and no changes were noted.,A horseshoe shaped flap was based on the right and then brought across to the midline. This was opened and hemostasis obtained using Raney clips. The skin flap was retracted medially. Two burr holes were made and were carefully connected. One was placed right over the sinus and we carefully then removed a rectangular shaped bone flap. Hemostasis was obtained. Using the neuronavigation, we identified where the tumor was. The dura was then opened based on a horseshoe flap based on the medial sinus. We retracted this medially and carefully identified the brain. The brain surface was discolored and obviously irritated consistent with the tumor.,We used the stereotactic neuronavigation to identify the tumor margins.,Then we used a bipolar to coagulate a thin layer of brain over the tumor. Subsequently, we entered the tumor. The tumor itself was extremely hard. Specimens were taken and send for frozen section analysis, which showed probable metastatic carcinoma.,We then carefully dissected around the tumor margins.,Using the microscope, we then brought microscopic magnification and dissection into the case. We used paddies and carefully developed microdissection planes all around the margins of the tumor superiorly, medially, inferiorly, and laterally.,Then using the Cavitron, we cored out the central part of the tumor. Then we collapsed the tumor on itself and removed it entirely. In this fashion, microdissection and magnification resection of the tumor was carried out. We resected the entire tumor. Neuronavigation was used to confirm that no further tumor residual was remained.,Hemostasis was obtained using bipolar coagulation and Gelfoam. We also lined the cavity with Surgicel. The cavity was nicely dry and excellent hemostasis was obtained.,The dura was closed using multiple interrupted 4-0 Nurolon sutures in a watertight fashion. Surgicel was placed over the dural closure. The bone flap was repositioned and held in place using CranioFIX cranial fixators. The galea was re-approximated and the skin was closed with staples. The wound was dressed. The patient was returned to the intensive care unit. She was awake and moving extremities well. No apparent complications were noted. Needle and sponge counts were listed as correct at the end of the procedure. Estimated intraoperative blood loss was approximately 150 mL and none was replaced. | 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:, Colonoscopy.,PREOPERATIVE DIAGNOSES: , Change in bowel habits and rectal prolapse.,POSTOPERATIVE DIAGNOSIS: , Normal colonoscopy.,PROCEDURE: ,The Olympus pediatric variable colonoscope was introduced through the rectum and advanced carefully through the colon to the cecum identified by the ileocecal valve and the appendiceal orifice. The preparation was poor, but mucosa was visible after lavage and suction. Small lesions might have been missed in certain places, but no large lesions are likely to have been missed. The mucosa was normal, was visualized. In particular, there was no mucosal abnormality in the rectum and distal sigmoid, which is reported to be prolapsing. Biopsies were taken from the rectal wall to look for microscopic changes. The anal sphincter was considerably relaxed, with no tone and a gaping opening. The patient tolerated the procedure well and was sent to recovery room.,FINAL DIAGNOSIS: , Normal colonic mucosa to the cecum. No contraindications to consideration of a repair of the prolapse. | 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: , Hemangioma, nasal tip.,POSTOPERATIVE DIAGNOSIS:, Hemangioma, nasal tip.,PROCEDURE PERFORMED: ,1. Debulking of hemangioma of the nasal tip through an open rhinoplasty approach.,2. Rhinoplasty.,ESTIMATED BLOOD LOSS: ,Minimal.,FINDINGS: , Large hemangioma involving the midline of the columella separated the lower lateral cartilages at a level of the columella and the nasal domes.,CONDITION: ,Condition of the patient at end of the procedure stable, transferred to recovery room.,INDICATIONS FOR THE PROCEDURE: , The patient is a 2-year-old female with a history of a nasal tip hemangioma. The hemangioma has involved at her upper tongue. There has not been any change in the last 6 months. We have discussed with the parents the situation and decided to proceed with the debulking of the nasal tip hemangioma. They understand the nature of the incision, the nature of the surgery, and the possibility of future revision surgeries. They understand the risk of bleeding, infection, dehiscence, scarring, need for future revision surgery, and minor asymmetry. They wished to proceed with surgery.,Because of the procedure, informed consent is obtained. The patient is taken to operating room and placed in the supine position. General anesthetic is administrated to an oroendotracheal tube. The face is prepped and draped in the usual manner. The incision is designed to the lower aspect of the hemangioma, which corresponds to the columella and upper lip junction and then the remaining of the incision is designed as an open rhinoplasty with bilateral rim incisions. The area is infiltrated with lidocaine with epinephrine. We waited 7 minutes for the hemostatic effect and proceeded with the incision. The incision was then done with a 15 C blade starting at the columella and then going laterally to the level of the rim and the double hook is placed at the level of the dome and the intracartilage incision is done through the mucosa, then extended laterally and upward to follow the lower lateral cartilage. This is done in both sides. Further incision is done. A small tenotomy scissors is used and with the help of retraction of the lower lateral cartilage, the hemangioma is separated gently from the lower lateral cartilage on both sides and I proceeded to leave that the central part of the incision lifting up the entire columella to the level of the nasal tip. The hemangioma is removed and is found to be involving the medial aspects of both medial crura. This gently separated from the medial crura and from the soft tissue care is taken not to remove the entire hemangioma from the skin as the nose not to devascularize the distal columella portion. Hemostasis is achieved with electrocautery. Then, we proceed to place some interdomal stitches with the help of a 6-0 clear nylon and intercrural stitches are placed and then an interdomal stitch, a single one was placed. The skin is redraped and the nose found to have satisfactory shape. The columellar piece was tailored on the lateral aspect corresponding to rim incisions to match the newly created width of the columella. Portions of skin and hemangioma are taken laterally on both sides of the columella distally. The skin was closed with 6-0 mild chromic stitches, including the portion at the level of the columella and rim incisions medially. The remaining of the internal incisions are closed with 5-0 chromic interrupted stitches. The nose is irrigated and suctioned. The patient tolerated the procedure without complications. I was present and participated in all aspects of the procedure. Sponge and instrument count were complete at the end of the procedure. | 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' | PROCEDURES:,1. Robotic-assisted pyeloplasty.,2. Anterograde right ureteral stent placement.,3. Transposition of anterior crossing vessels on the right.,4. Nephrolithotomy.,DIAGNOSIS:, Right ureteropelvic junction obstruction.,DRAINS:,1. Jackson-Pratt drain times one from the right flank.,2. Foley catheter times one.,ESTIMATED BLOOD LOSS: , Less than 30 cc.,COMPLICATIONS: , None.,SPECIMENS:,1. Renal pelvis.,2. Kidney stones.,INDICATIONS: ,The patient is a 30-year-old Caucasian gentleman with history of hematuria subsequently found to have right renal stones and patulous right collecting system with notable two right crossing renal arteries. Up on consideration of various modalities and therapy, the patient decided to undergo surgical therapy.,PROCEDURE IN DETAIL: ,The patient was verified by armband and the procedure being robotic-assisted right pyeloplasty with nephrolithotomy was verified, and the procedure was carried out. After institution of general endotracheal anesthesia and intravenous preoperative antibiotics, the patient was positioned into the right flank position with his right flank elevated. Great care was taken to pad all pressure points and a right arm hanger was used. The patient was flexed slightly, and a kidney rest was used. Sequential compression devices were also placed. Next, the patient was prepped and draped in normal sterile fashion with povidone-iodine. Pneumoperitoneum was obtained by placing a Veress needle in the area of the umbilicus after it passed the water test. A low pressure, high flow pneumoperitoneum was adequately obtained using CO2 gas. Next, a 12-mm camera port was placed near the umbilicus. The camera was inserted, and no bowel injury was seen. Next, under direct vision flanking 8 mm camera ports, a 12 mm assist port, a 5 mm liver retraction port, and 5 mm assist port were placed. The robot was docked and the instruments passed through respective checks. Initial attention was directed to mobilizing the right colon from the abdominal wall totally medially. Next, the right lateral duodenum was cauterized for further access to the right retroperitoneum. At this point, the right kidney was in clear view, and the fascia was entered. Initial attention was directed at careful dissection of the renal pelvis and proximal ureter which was done with a combination of electrocautery and blunt dissection. It became readily apparent that there were two crossing vessels one in the medial inferior region of the kidney and another one in the most inferior portion of the lower pole. These arteries were dissected carefully and vessel loops were applied. Next, a small hole was then made in the renal pelvis using electrocautery and the contents of the renal pelvis were suctioned out. The pyelotomy was extended so that the renal collecting system could be directly inspected. Sequentially, each major calyx was inspected under direct vision and irrigated. A total of four round kidney stones were extracted to be sent for analysis to being satisfied for the patient. At this point, we directed our attention at the proximal right ureter which was dismembered from the remaining renal pelvis. The proximal ureter was spatulated using cold scissors. Next, redundant renal pelvis was excised using cold scissors and sent for permanent section. We then identified the most inferior/dependent portion of the renal pelvis and placed a heel stitch at this for ureteral-renal pelvis anastomosis in a semi running fashion. 3-0 Monocryl sutures were used to re-anastomose the newly spatulated right ureter to the inferior portion of the renal pelvis. Next, remainder of the pyelotomy was closed to itself also using 2-0 Monocryl sutures. Before final stitches were placed, a 6x28 ureteral stent was placed anterograde. This was accomplished by placing the stents over a guidewire, placing the guidewire under direct vision anterograde through the ureter. This was done until the proximal end was in the renal pelvis, the guidewire was removed, and good proximal curl was verified by direct vision. Then, the pyelotomy was completely closed again with 2-0 Monocryl sutures. Next, attention was directed at transposition of the crossing renal artery by fixing it with Vicryl suture that would impinge less upon the renal pelvis. Good pulsation was verified by direct vision proximal and distal to these pexy sutures. Next, Gerota's fascia was reapproximated and closed with Vicryl sutures as was the right peritoneum. Hemostasis appeared excellent at this point. There was no obvious urine extravasation. At this time, the procedure was terminated. The robot was undocked. Under direct visualization all 8 and 12 mm ports were closed at the level of the fascia with 0 Vicryl sutures in an interrupted fashion. Then, all skin port sites were closed with 4-0 Monocryl in a subcuticular fashion and Dermabond and band-aids were applied over this. Also, notably a Jackson-Pratt drain was placed in the area of the right kidney and additional right flank stab incision. The patient tolerated the procedure well and no immediate perioperative complication was noted.,DISPOSITION: , The patient was discharged to Post Anesthesia Care Unit and subsequently to genitourinary floor to begin his recovery. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | FINAL DIAGNOSES,1. Morbid obesity, status post laparoscopic Roux-en-Y gastric bypass. ,2. Hypertension. ,3. Obstructive sleep apnea, on CPAP.,OPERATION AND PROCEDURE: , Laparoscopic Roux-en-Y gastric bypass.,BRIEF HOSPITAL COURSE SUMMARY: ,This is a 30-year-old male, who presented recently to the Bariatric Center for evaluation and treatment of longstanding morbid obesity and associated comorbidities. Underwent standard bariatric evaluation, consults, diagnostics, and preop Medifast induced weight loss in anticipation of elective bariatric surgery. ,Taken to the OR via same day surgery process for elective gastric bypass, tolerated well, recovered in the PACU, and sent to the floor for routine postoperative care. There, DVT prophylaxis was continued with subcu heparin, early and frequent mobilization, and SCDs. PCA was utilized for pain control, efficaciously, he utilized the CPAP, was monitored, and had no new cardiopulmonary complaints. Postop day #1, labs within normal limits, able to clinically start bariatric clear liquids at 2 ounces per hour, this was tolerated well. He was ambulatory, had no cardiopulmonary complaints, no unusual fever or concerning symptoms. By the second postoperative day, was able to advance to four ounces per hour, tolerated this well, and is able to discharge in stable and improved condition today. He had his drains removed today as well.,DISCHARGE INSTRUCTIONS: , Include re-appointment in the office in the next week, call in the interim if any significant concerning complaints. Scripts left in the chart for omeprazole and Lortab. Med rec sheet completed (on no meds). He will maintain bariatric clear liquids at home, goal 64 ounces per day, maintain activity at home, but no heavy lifting or straining. Can shower starting tomorrow, drain site care and wound care reviewed. He will re-appoint in the office in the next week, certainly call in the interim if any significant concerning complaints. | Bariatrics |
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: , "I want my colostomy reversed.",HISTORY OF PRESENT ILLNESS: , Mr. A is a pleasant 43-year-old African-American male who presents to our clinic for a colostomy reversal as well as repair of an incisional hernia. The patient states that in November 2007, he presented to High Point Regional Hospital with sharp left lower quadrant pain and was emergently taken to Surgery where he woke up with a "bag." According to some notes that were faxed to our office from the surgeon in High Point who performed his initial surgery, Dr. X, the patient had diverticulitis with perforated sigmoid colon, and underwent a sigmoid colectomy with end colostomy and Hartmann's pouch. The patient was unaware of his diagnosis; therefore, we discussed that with him today in clinic. The patient also complains of the development of an incisional hernia since his surgery in November. He was seen back by Dr. X in April 2008 and hopes that Dr. X may reverse his colostomy and repair his hernia since he did his initial surgery, but because the patient has lost his job and has no insurance, he was referred to our clinic by Dr. X. Currently, the patient does state that his hernia bothers him more so than his colostomy, and if it were not for the hernia then he may just refrain from having his colostomy reversed; however, the hernia has grown in size and causing him significant discomfort. He feels that he always has to hold his hand over the hernia to prevent it from prolapsing and causing him even more discomfort.,PAST MEDICAL AND SURGICAL HISTORY:,1. Gastroesophageal reflux disease.,2. Question of hypertension.,3. Status post sigmoid colectomy with end colostomy and Hartmann's pouch in November 2007 at High Point Regional.,4. Status post cholecystectomy.,7. Status post unknown foot surgery.,MEDICATIONS:, None.,ALLERGIES: , No known drug allergies.,SOCIAL HISTORY: , The patient lives in Greensboro. He smokes one pack of cigarettes a day and has done so for 15 years. He denies any IV drug use and has an occasional alcohol.,FAMILY HISTORY: ,Positive for diabetes, hypertension, and coronary artery disease.,REVIEW OF SYSTEMS: , Please see history of present illness; otherwise, the review of systems is negative.,PHYSICAL EXAMINATION:,VITAL SIGNS: Temperature 95.9, pulse 67, blood pressure 135/79, and weight 208 pounds.,GENERAL: This is a pleasant African-American male appearing his stated age in no acute distress.,HEENT: Normocephalic, atraumatic. Pupils are equal, round, and reactive to light and accommodation. Moist mucous membranes. Extraocular movements intact.,NECK: Supple, no JVD, and no lymphadenopathy.,CARDIOVASCULAR: Regular rate and rhythm.,LUNGS: Clear to auscultation bilaterally.,ABDOMEN: Soft, nontender, and nondistended with a left lower quadrant stoma. The stoma is pink, protuberant, and productive. The patient also has a midline incisional hernia approximately 6 cm in diameter. It is reducible. Otherwise, there are no further hernias or masses noted.,EXTREMITIES: No clubbing, cyanosis or edema.,ASSESSMENT AND PLAN: ,This is a 43-year-old gentleman who underwent what sounds like a sigmoid colectomy with end colostomy and Hartmann's pouch in November of 2007 secondary to perforated colon from diverticulitis. The patient presents for reversal of his colostomy as well as repair of his incisional hernia. I have asked the patient to return to High Point Regional and get his medical records including the operative note and pathology results from his initial surgery so that I would have a better idea of what was done during his initial surgery. He stated that he would try and do this and bring the records to our clinic on his next appointment. I have also set him up for a barium enema to study the rectal stump. He will return to us in two weeks at which time we will review his radiological studies and his medical records from the outside hospital and determine the best course of action from that point. This was discussed with the patient as well as his sister and significant other in the clinic today. They were in agreement with this plan. We also called the social worker to come and help the patient get more ostomy appliances, as he stated that he had no more and he was having to reuse the existing ostomy bag. To my understanding, his social worker, as well as the ostomy nurses were able to get him some assistance with this., | 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. Oxygen dependency.,2. Chronic obstructive pulmonary disease.,POSTOPERATIVE DIAGNOSES:,1. Oxygen dependency.,2. Chronic obstructive pulmonary disease.,PROCEDURES PERFORMED:,1. Tracheostomy with skin flaps.,2. SCOOP procedure FastTract.,ANESTHESIA: , Total IV anesthesia.,ESTIMATED BLOOD LOSS: , Minimal.,COMPLICATIONS: ,None.,INDICATIONS FOR PROCEDURE: , The patient is a 55-year-old Caucasian male with a history of chronic obstructive pulmonary disease and O2 dependency of approximately 5 liters nasal cannula at home. The patient with extensive smoking history who presents after risks, complications, and consequences of the SCOOP FastTract procedure were explained.,PROCEDURE:, The patient was brought to operating suite by Anesthesia and placed on the operating table in the supine position. After this, the patient was then placed under total IV anesthesia and the operating bed was then placed in reverse Trendelenburg. The patient's sternal notch along with cricoid and thyroid cartilages were noted and palpated and a sternal marker was utilized to mark the cricoid cartilage in the sternal notch. The midline was also marked and 1% lidocaine with epinephrine 1:100,000 at approximately 4 cc total was then utilized to localize the neck. After this, the patient was then prepped and draped with Hibiclens. A skin incision was then made in the midline with a #15 Bard-Parker in a vertical fashion. After this, the skin was retracted laterally and a small anterior jugular branch was clamped and cross clamped and tied with #2-0 undyed Vicryl ties. Further bleeding was controlled with monopolar cauterization and attention was then drawn down on to the strap muscles. The patient's sternohyoid muscle was identified and grasped on either side and the midline raphe was identified. Cauterization was then utilized to take down the midline raphe and further dissection was utilized with the skin hook and stat clamps. The anterior aspect of the thyroid isthmus was identified and palpation on the cricoid cartilage was performed. The cricoid cauterization over the cricoid cartilage was obtained with the monopolar cauterization and blunt dissection then was carried along the posterior aspect of the thyroid isthmus. Stats were then placed on either side of the thyroid isthmus and the mid portion was bisected with the monopolar cauterization. After this, the patient's anterior trachea was then identified and cleaned with pusher. After this, the cricoid cartilage along the first and second tracheal rings was identified. The cricoid hook was placed and the trachea was brought more anteriorly and superiorly. After this, the patient's head incision was placed below the second tracheal ring with a #15 Bard-Parker. After this, the patient had a tracheal punch with the SCOOP FastTract kit to create a small 4 mm punch within the tracheal cartilage. After this, the patient then had a tracheal stent placed within the tracheal punched lumen and the patient was then had the tracheal stent secured to the neck with a Vicryl strap. After this, the cricoid hook was removed and the patient then had FiO2 on the monitor noted with pulse oximetry of 100%. The patient was then turned back to the anesthesia and transferred to the recovery room in stable condition. The patient tolerated the procedure well and will stay in the hospital for approximately 23 hours. The patient will have the stent guidewire removed with a scoop catheter 11 cm placed. | 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: , | Office Notes |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR VISIT:, This 48-year-old woman returns in followup after a full-night sleep study performed to evaluate her for daytime fatigue and insomnia.,HISTORY OF PRESENT ILLNESS: , The patient presented initially to the Pulmonary Clinic with dyspnea on minimal exertion. At that time, she was evaluated and found to have evidence for sleep disruption and daytime fatigue. She also complained of nocturnal choking episodes that have since abated over the past several months. In the meantime, she had been scheduled for an overnight sleep study performed to evaluate her for sleep apnea, returns today to review her study results.,The patient's sleep patterns consist of going to bed between 9.00 and 10.00 p.m. and awakening in the morning between 5.00 and 6.00 a.m. She reports difficulty in initiating sleep and then recurrent awakenings every 1 to 2 hours throughout the night. She reports tossing and turning throughout the night and awakening with the sheets in disarray. She reports that her sleep was much better quality in the sleep laboratory as compared to home. When she awakens, she might have a dull headache and feels tired in the morning. Her daughter reports that she has heard the patient talking during sleep and snoring. There are no apneic episodes. The patient reports that she used to cough a lot in the middle of the night, but has no longer been doing so in recent weeks.,During the daytime, the patient reports spending a lot of sedentary time reading and watching TV. She routinely dozes off during these sedentary activities. She also might nap between 2.00 and 3.00 p.m., and nods off in the evening hours.,The patient smokes perhaps one to two packs of cigarettes per day, particularly after dinner.,She reports that her weight has fluctuated and peaked at 260 pounds approximately 1 year ago. Since that time, her weight is down by approximately 30 pounds.,The patient is managed in Outpatient Psychiatry and at her Maintenance Clinic. She takes methadone, trazodone, and Seroquel.,PAST MEDICAL HISTORY:,1. Depression.,2. Hepatitis C.,3. Hypertension.,4. Inhaled and intravenous drug abuse history.,The patient has a history of smoking two packs per day of cigarettes for approximately 25 pounds. She also has a history of recurrent atypical chest pain for which she has been evaluated.,FAMILY HISTORY: , As previously documented.,SOCIAL HISTORY: ,The patient has a history of inhalation on intravenous drug abuse. She is currently on methadone maintenance. She is being followed in Psychiatry for depression and substance abuse issues. She lives with a room-mate.,REVIEW OF SYSTEMS:, Not contributory.,MEDICATIONS: , Current medications include the following:,1. Methadone 110 mg by mouth every day.,2. Paxil 60 mg by mouth every day.,3. Trazodone 30 mg by mouth nightly.,4. Seroquel 20 mg by mouth nightly.,5. Avalide (irbesartan) and hydrochlorothiazide.,6. Albuterol and Flovent inhalers two puffs by mouth twice a day.,7. Atrovent as needed.,FINDINGS: , Vital Signs: Blood pressure 126/84, pulse 67, respiratory rate 18, weight 232 pounds, height 5 feet 8 inches, temperature 97.4 degrees, SaO2 is 99 percent on room air at rest. HEENT: Sclerae anicteric. Conjunctivae pink. Extraocular movements are intact. Pupils are equal, round, and reactive to light. The nasal passages show deviation in the nasal septum to the right. There is a slight bloody exudate at the right naris. Some nasal mucosal edema was noted with serous exudate bilaterally. The jaw is not foreshortened. The tongue is not large. Mallampati airway score was 3. The oropharynx was not shallow. There is no pharyngeal mucosa hypertrophy. No tonsillar tissue noted. The tongue is not large. Neck is supple. Thyroid without nodules or masses. Carotid upstrokes normal. No bruits. No jugular venous distention. Chest is clear to auscultation and percussion. No wheezing, rales, rhonchi or adventitious sounds. No prolongation of the expiratory phase. Cardiac: PMI not palpable. Regular rate and rhythm. S1 and S2 normal. No murmurs or gallops. Abdomen: Nontender. Bowel sounds normal. No liver or spleen palpable. Extremities: No clubbing or cyanosis. There is 1+ pretibial edema. Pulses are 2+ in upper and lower extremities. Neurologic: Grossly nonfocal.,LABORATORIES:, Pulmonary function studies reportedly show a mild restrictive ventilatory defect without obstruction. Diffusing capacity is well preserved.,An overnight sleep study was performed on this patient at the end of 02/07. At that time, she reported that her sleep was better in the laboratories compared to home. She slept for a total sleep time of 398 minutes out of 432 minutes in bed (sleep proficiency 92 percent). She fell asleep in the middle of latency of less than 1 minute. She woke up after sleep onset of 34 minutes. She had stage I sleep that was some elevated at 28 percent of total sleep time, and stage I sleep is predominantly evident in the lateral portion of the night. The remainders were stage II at 69 percent, stage III and IV at 3 percent of total sleep time.,The patient had no REM sleep.,The patient had no periodic limb movements during sleep.,The patient had no significant sleep-disordered breathing during non-REM sleep with less than one episode per hour. Oxyhemoglobin saturation remained in the low to mid 90s throughout the night.,Intermittent inspiratory flow limitation compatible with snoring was observed during non-REM sleep.,ASSESSMENT AND PLAN: , This patient presents with history of sleep disruption and daytime sleepiness with fatigue. Her symptoms are multifactorial.,Regarding the etiology of difficulty in initiating and maintaining sleep, the patient has a component of psychophysiologic insomnia, based on reports of better sleep in the laboratory as compared to home. In addition, nontrivial smoking in the home setting may be contributing significantly to sleep disruption.,Regarding her daytime sleepiness, the patient is taking a number of long-acting central nervous system acting medications to sedate her and can produce a lasting sedation throughout the daytime. These include trazodone, Seroquel, and methadone. Of these medications, the methadone is clearly indicative, given the history of substance abuse. It would be desirable to reduce or discontinue trazodone and then perhaps consider doing the same with Seroquel. I brought this possibility up with the patient, and I asked her to discuss this further with her psychiatrist.,Finally, to help mitigate sleep disruption at night, I have provided her with tips for sleep hygiene. These include bedtime rituals, stimulus control therapy, and sleep restriction as well as avoidance of nicotine in the evening hours. | 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' | PAST MEDICAL HISTORY: , She has a history of hypertension and shortness of breath.,PAST SURGICAL HISTORY: , Pertinent for cholecystectomy.,PSYCHOLOGICAL HISTORY: , Negative.,SOCIAL HISTORY: , She is single. She drinks alcohol once a week. She does not smoke.,FAMILY HISTORY: , Pertinent for obesity and hypertension.,MEDICATIONS: , Include Topamax 100 mg twice daily, Zoloft 100 mg twice daily, Abilify 5 mg daily, Motrin 800 mg daily, and a multivitamin.,ALLERGIES: , She has no known drug allergies.,REVIEW OF SYSTEMS: , Negative.,PHYSICAL EXAM: ,This is a pleasant female in no acute distress. Alert and oriented x 3. HEENT: Normocephalic, atraumatic. Extraocular muscles intact, nonicteric sclerae. Chest is clear to auscultation bilaterally. Cardiovascular is normal sinus rhythm. Abdomen is obese, soft, nontender and nondistended. Extremities show no edema, clubbing or cyanosis.,ASSESSMENT/PLAN: ,This is a 34-year-old female with a BMI of 43 who is interested in surgical weight via the gastric bypass as opposed to Lap-Band. ABC will be asking for a letter of medical necessity from Dr. XYZ. She will also see my nutritionist and social worker and have an upper endoscopy. Once this is completed, we will submit her to her insurance company for approval. | Bariatrics |
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: ,Delayed motor development.,HX:, This 21 month old male presented for delayed motor development, "jaw quivering" and "lazy eye." He was an 8 pound 10 ounce product of a full term, uncomplicated pregnancy-labor-spontaneous vaginal delivery to a G3P3 married white female mother. There had been no known toxic intrauterine exposures. He had no serious illnesses or hospitalizations since birth. He sat independently at 7 months, stood at 11 months, crawled at 16 months, but did not cruise until 18 months.,He currently cannot walk and easily falls. His gait is reportedly marked by left "intoeing." His upper extremity strength and coordination reportedly appear quite normal and he is able to feed himself, throw and transfer objects easily. He knows greater than 20 words and speaks two-word phrases.,No seizures or unusual behavior were reported except for "quivering" movement of his jaw. This has occurred since birth. In addition the parents have noted transient left exotropia.,PMH: ,As above.,FHX:, Many family members with "lazy eye." No other neurologic diseases declared.,9 and 5 year old sisters who are healthy.,SHX:, lives with parents and sisters.,EXAM:, BP83/67 HR122 36.4C Head circumference 48.0cm Weight 12.68kg (70%) Height 86.0cm (70%),MS: fairly cooperative.,CN: Minimal transient esotropia OS. Tremulous quivering of jaw--increased with crying. No obvious papilledema, though difficult to evaluate due to patient movement.,Motor: sat independently with normal posture and no truncal ataxia. symmetric and normal strength and muscle bulk throughout.,Sensory: withdrew to vibration.,Coordination: unremarkable in BUE.,Station: no truncal ataxia.,Gait: On attempting to walk, his right foot rotated laterally at almost 70degrees. Both lower extremities could rotate outward to 90degrees. There was marked passive eversion at the ankles as well.,Reflexes: 2+/2+ throughout.,Musculoskeletal: pes planovalgus bilaterally.,COURSE: ,CK normal. The parents decided to forego an MRI in 8/90. The patient returned 12/11/92 at age 4 years. He was ambulatory and able to run awkwardly. His general health had been good, but he showed signs developmental delay. Formal evaluation had tested his IQ at 87 at age 3.5 years. He was weakest on tasks requiring visual/motor integration and fine motor and visual discrimination skills. He was 6 months delayed in cognitive development at that time. On exam, age 4 years, he displayed mild right ankle laxity on eversion and inversion, but normal gait. The rest of the neurological exam was normal. Head circumference was 49.5cm (50%) and height and weight were in the 90th percentile. Fragile X analysis and karyotyping were unremarkable. | 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. 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. | 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: ,Thoracic Spine.,REASON FOR EXAM: , Injury.,INTERPRETATION: , The thoracic spine was examined in the AP, lateral and swimmer's projections. There is mild chronic-appearing anterior wedging of what is believed to represent T11 and 12 vertebral bodies. A mild amount of anterior osteophytic lipping is seen involving the thoracic spine. There is a suggestion of generalized osteoporosis. The intervertebral disc spaces appear generally well preserved.,The pedicles appear intact.,IMPRESSION:,1. Mild chronic-appearing anterior wedging of what is believed to represent the T11 and 12 vertebral bodies.,2. Mild degenerative changes of the thoracic spine.,3. Osteoporosis. | 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' | HISTORY OF PRESENT ILLNESS:, The patient is a 68-year-old man who returns for recheck. He has a history of ischemic cardiac disease, he did see Dr. XYZ in February 2004 and had a thallium treadmill test. He did walk for 8 minutes. The scan showed some mild inferior wall scar and ejection fraction was well preserved. He has not had difficulty with chest pain, palpitations, orthopnea, nocturnal dyspnea, or edema.,PAST MEDICAL HISTORY/SURGERIES/HOSPITALIZATIONS: , He had tonsillectomy at the age of 8. He was hospitalized in 1996 with myocardial infarction and subsequently underwent cardiac catheterization and coronary artery bypass grafting procedure. He did have LIMA to the LAD and had three saphenous vein grafts performed otherwise.,MEDICATIONS:, Kerlone 10 mg 1/2 pill daily, gemfibrozil 600 mg twice daily, Crestor 80 mg 1/2 pill daily, aspirin 325 mg daily, vitamin E 400 units daily, and Citrucel one daily.,ALLERGIES: , None known.,FAMILY HISTORY: ,Father died at the age of 84. He had a prior history of cancer of the lung and ischemic cardiac disease. Mother died in her 80s from congestive heart failure. He has two brothers and six sisters living who remain in good health.,PERSONAL HISTORY: ,Quit smoking in 1996. He occasionally drinks alcoholic beverages.,REVIEW OF SYSTEMS:,Endocrine: He has hypercholesterolemia treated with diet and medication. He reports that he did lose 10 pounds this year.,Neurologic: Denies any TIA symptoms.,Genitourinary: He has occasional nocturia. Denies any difficulty emptying his bladder.,Gastrointestinal: He has a history of asymptomatic cholelithiasis.,PHYSICAL EXAMINATION:,Vital Signs: Weight: 225 pounds. Blood pressure: 130/82. Pulse: 83. Temperature: 96.4 degrees.,General Appearance: He is a middle-aged man who is not in any acute distress.,HEENT: Mouth: The posterior pharynx is clear.,Neck: Without adenopathy or thyromegaly.,Chest: Lungs are resonant to percussion. Auscultation reveals normal breath sounds.,Heart: Normal S1, S2, without gallops or rubs.,Abdomen: Without tenderness or masses.,Extremities: Without edema.,IMPRESSION/PLAN:,1. Ischemic cardiac disease. This remains stable. He will continue on the same medication. He reports he has had some laboratory studies today.,2. Hypercholesterolemia. He will continue on the same medication.,3. Facial tic. We also discussed having difficulty with the facial tic at the left orbital region. This occurs mainly when he is under stress. He has apparently had numerous studies in the past and has seen several doctors in Wichita about this. At one time was being considered for some type of operation. His description, however, suggests that they were considering an operation for tic douloureux. He does not have any pain with this tic and this is mainly a muscle spasm that causes his eye to close. Repeat neurology evaluation was advised. He will be scheduled to see Dr. XYZ in Newton on 09/15/2004.,4. Immunization. Addition of pneumococcal vaccination was discussed with him but had been decided by him at the end of the appointment. We will have this discussed with him further when his laboratory results are back. | 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 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' | PREOPERATIVE DIAGNOSES:,1. Nasal septal deviation.,2. Bilateral internal nasal valve collapse.,3. Bilateral external nasal valve collapse.,POSTOPERATIVE DIAGNOSES:,1. Nasal septal deviation.,2. Bilateral internal nasal valve collapse.,3. Bilateral external nasal valve collapse.,PROCEDURES:,1. Revision septoplasty.,2. Repair of internal nasal valve collapse using auricular cartilage.,3. Repair of bilateral external nasal valve collapse using auricular cartilage.,4. Harvest of right auricular cartilage.,ANESTHESIA: , General endotracheal anesthesia.,ESTIMATED BLOOD LOSS: , Approximately 20 mL.,IV FLUIDS: , Include a liter of crystalloid fluid.,URINE OUTPUT: , None.,FINDINGS: , Include that of significantly deviated septum with postoperative changes and a significant septal spur along the floor. There is also evidence of bilateral internal as well as external nasal valve collapse.,INDICATIONS: ,The patient is a pleasant 49-year-old gentleman who had undergone a previous septorhinoplasty after significant trauma in his 20s. He now presents with significant upper airway resistance and nasal obstruction and is unable to tolerate a CPAP machine. Therefore, for repair of the above-mentioned deformities including the internal and external nasal valve collapse as well as straightening of the deviated septum, the risks and benefits of the procedure were discussed with him included but not limited to bleeding, infection, septal perforation, need for further surgeries, external deformity, and he desired to proceed with surgery.,DESCRIPTION OF THE PROCEDURE IN DETAIL: ,The patient was taken to the operating room and laid supine upon the OR table. After the induction of general endotracheal anesthesia, the nose was decongested using Afrin-soaked pledgets followed by the injection of % lidocaine with 1:100,000 epinephrine in the submucoperichondrial planes bilaterally. Examination revealed significant deviation of the nasal septum and the bony cartilaginous junction as well as the large septal spur along the floor. The caudal septum appeared to be now in adequate position. There was evidence that there had been a previous caudal septal graft on the right nares and it was decided to leave this in place. Following the evaluation of the nose, a hemitransfixion incision was made on the left revealing a large septal spur consisting primarily down on the floor of the left nostril creating nearly a picture of the vestibular stenosis on the side. Very carefully, the mucoperichondrial flaps were elevated over this, and it was excised using an osteotome taking care to preserve the 1.5 cm dorsal and caudal strap of the nasal septum and keep it attached to the nasal spine. Very carefully, the bony cartilaginous junction was identified and a small piece of the bone, where the spur was, was carefully removed. Following this, it was noted that the cartilaginous region was satisfactory in quantity as well as quality to perform adequate grafting procedures. Therefore, attention was turned to harvesting the right-sided auricular cartilage, which was done after the region had adequately been prepped and draped in a sterile fashion. Postauricular incision using a #15 blade, the area of the submucoperichondrial plane was elevated in order to preserve the nice lining and identifiable portion of the cartilage taking care to preserve the ridge of the helix at all times. This was very carefully harvested. This area had been injected previously with 1% lidocaine and 1:100,000 epinephrine. Following this, the cartilage was removed. It was placed in saline, noted to be fashioned in the bilateral spreader graft and alar rim graft as well as a small piece of crush which was used to be placed along the top of the dorsal irregularity. The spreader grafts were sutured in place using submucoperichondrial pockets. After an external septorhinoplasty approach had been performed and reflection of the skin and soft tissue envelope had been performed, adequately revealing straight septum with significant narrowing with what appeared to be detached perhaps from his ipsilateral cartilages rather from his previous surgery. These were secured in place in the pockets using a 5-0 PDS suture in a mattress fashion in two places. Following this, attention was turned to placing the alar rim grafts where pockets were created along the caudal aspect of the lower lateral cartilage and just along the alar margin. Subsequently, the alar rim grafts were placed and extended all the way to the piriform aperture. This was sutured in place using a 5-0 self-absorbing gut suture. The lower lateral cartilage has had some inherent asymmetry. This may have been related to his previous surgery with some asymmetry of the dome; however, this was left in place as he did not desire any changes in the tip region, and there was adequate support. An endodermal suture was placed just to reenforce the region using a 5-0 PDS suture. Following all this, the area was closed using a mattress 4-0 plain gut on a Keith needle followed by the application of ***** 5-0 fast-absorbing gut to close the hemitransfixion incision. Very carefully, the skin and subcutaneous tissue envelopes were reflected. The curvilinear incision was closed using a Vicryl followed by interrupted 6-0 Prolene sutures. The marginal incisions were then closed using 5-0 fast-absorbing gut. Doyle splints were placed and secured down using a nylon suture. They had ointment also placed on them. Following this, nasopharynx was suctioned. There were no further abnormalities noted and everything appeared to be in nice position. Therefore, an external splint was placed after the application of Steri-Strips. The patient tolerated the procedure well. He was awakened in the operating room. He was extubated and taken to the recovery room in stable condition. | ENT - Otolaryngology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREPROCEDURE DIAGNOSIS:, Change in bowel function.,POSTPROCEDURE DIAGNOSIS:, Proctosigmoiditis.,PROCEDURE PERFORMED:, Colonoscopy with biopsy.,ANESTHESIA: , IV sedation.,POSTPROCEDURE CONDITION: , Stable. ,INDICATIONS:, The patient is a 33-year-old with a recent change in bowel function and hematochezia. He is here for colonoscopy. He understands the risks and wishes to proceed. ,PROCEDURE: , The patient was brought to the endoscopy suite where he was placed in left lateral Sims position, underwent IV sedation. Digital rectal examination was performed, which showed no masses, and a boggy prostate. The colonoscope was placed in the rectum and advanced, under direct vision, to the cecum. In the rectum and sigmoid, there were ulcerations, edema, mucosal abnormalities, and loss of vascular pattern consistent with proctosigmoiditis. Multiple random biopsies were taken of the left and right colon to see if this was in fact pan colitis.,RECOMMENDATIONS: , Follow up with me in 2 weeks and we will begin Canasa suppositories. | 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' | FINDINGS:,By dates the patient is 8 weeks, 2 days.,There is a gestational sac within the endometrial cavity measuring 2.1cm consistent with 6 weeks 4 days. There is a fetal pole measuring 7mm consistent with 6 weeks 4 days. There was no fetal heart motion on Doppler or on color Doppler.,There is no fluid within the endometrial cavity.,There is a 2.8 x 1.2cm right adnexal cyst.,IMPRESSION:,Gestational sac with a fetal pole but no fetal heart motion consistent with fetal demise at 6 weeks 4 days. By dates the patient is 8 weeks, 2 days.,A preliminary report was called by the ultrasound technologist to the referring physician. | Radiology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS:, Right inguinal hernia.,POSTOPERATIVE DIAGNOSIS:, Right inguinal hernia.,PROCEDURE:, Right inguinal hernia repair.,INDICATIONS FOR PROCEDURE: , This patient is a 9-year-old boy with a history of intermittent swelling of the right inguinal area consistent with a right inguinal hernia. The patient is being taken to the operating room for inguinal hernia repair.,DESCRIPTION OF PROCEDURE: , The patient was taken to the operating room, placed supine, put under general endotracheal anesthesia. The patient's inguinal and scrotal area were prepped and draped in the usual sterile fashion. An incision was made in the right inguinal skin crease. The incision was taken down to the level of the aponeurosis of the external oblique, which was incised up to the level of the external ring. The hernia sac was verified and dissected at the level of the internal ring and a high ligation performed. The distal remnant was taken to its end and excised. The testicle and cord structures were placed back in their native positions. The aponeurosis of the external oblique was reapproximated with 3-0 Vicryl as well as the Scarpa's, the skin closed with 5-0 Monocryl and dressed with Steri-Strips. The patient was extubated in the operating room and taken back to the recovery room. The patient tolerated the procedure well. | Surgery |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | 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. | Nephrology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | REASON FOR EXAM: , Atrial flutter/cardioversion.,PROCEDURE IN DETAIL: , The procedure was explained to the patient with risks and benefits. The patient agreed and signed the consent form. The patient received sedation prior to the cardioversion with a transesophageal echo as dictated earlier with a total of 50 mcg of fentanyl and 6 mg of Versed. The pads were applied in the anterior-posterior approach. The synchronized cardioversion with biphasic energy delivered at 150 J. First attempt was unsuccessful. Second attempt at 200 J with anterior-posterior approach. With biphasic synchronized energy delivered was also unsuccessful with degeneration of the atrial flutter into atrial fibrillation.,The patient was decided to be on wave control and amiodarone and reattempted cardioversion after anticoagulation for four to six weeks and because of the reduced LV function, the success of the rate without antiarrhythmic may be low.,IMPRESSION: , Unsuccessful direct current cardioversion with permanent atrial fibrillation. | 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: , Incompetent glottis.,POSTOPERATIVE DIAGNOSIS:, Incompetent glottis.,OPERATION PERFORMED:,1. Fat harvesting from the upper thigh.,2. Micro-laryngoscopy.,3. Fat injection thyroplasty.,FINDINGS AND PROCEDURE: , With the patient in the supine position under adequate general endotracheal anesthesia, the operative area was prepped and draped in a routine fashion. A 1-cm incision was made in the upper thigh, and approximately 5 cc of fat was liposuctioned from the subcutaneous space. After this had been accomplished, the wound was closed with an interrupted subcuticular suture of 4-0 chromic and a light compression dressing was applied.,Next, the fat was placed in a urine strainer and copiously washed using 100 cc of PhysioSol containing 100 units of regular insulin. After this had been accomplished, it was placed in a 3-cc BD syringe and, thence, into the Stasney fat injector device. Next, a Dedo laryngoscope was used to visualize the larynx, and approximately *** cc of fat was injected into the right TA muscle and *** cc of fat into the left TA muscle.,The patient tolerated the procedure well and was returned to the recovery room in satisfactory condition. Estimated blood loss was negligible. | 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' | HISTORY: , The patient is a 67-year-old female, was referred to Medical Center's Outpatient Rehabilitation Department for skilled speech therapy to improve her functional communication skills and swallowing function and safety. At the onset of therapy, on 03/26/08, the patient was NPO with a G-tube and the initial speech and language evaluation revealed global aphasia with an aphasia quotient of 3.6/100 based on the Western Aphasia Battery. Since the initial evaluation, the patient has attended 60 outpatient speech therapy sessions, which have focussed on her receptive communication, expressive language, multimodality communication skills, and swallowing function and safety.,SHORT-TERM GOALS:,1. The patient met 3 out of 4 original short-term therapy goals, which were to complete a modified barium swallow study, which she did do and which revealed no aspiration. At this time, the patient is eating and drinking and taking all medications by mouth; however, her G-tube is still present. The patient was instructed to talk to the primary care physician about removal of her feeding tube.,2. The patient will increase accuracy of yes-no responses to greater than 80% accuracy. She did accomplish this goal. The patient is also able to identify named objects with greater than 80% accuracy.,ADDITIONAL GOALS: , Following the completion of these goals, additional goals were established. Based on reevaluation, the patient met 2 out of these 3 initial goals and she is currently able to read and understand simple sentences with greater than 90% accuracy independently and she is able to write 10 words related to basic wants and needs with greater than 80% accuracy independently. The patient continues to have difficulty stating verbally, yes or no, to questions as well as accurately using head gestures and to respond to yes-no questions. The patient continues to have marked difficulty with her expressive language abilities. She is able to write simple words to help express her basic wants and needs. She has made great strides; however, with her receptive communication, she is able to read words as well as short phrases and able to point to named objects and answer simple-to-moderate complex yes-no questions. A reevaluation completed on 12/01/08, revealed an aphasia quotient of 26.4. Once again, she made significant improvement and comprehension, but continues to have unintelligible speech. An alternative communication device was discussed with the patient and her husband, but at this time, the patient does not want to utilize a communication device. If, in the future, the patient continues to struggle with her expressive communication, an alternative augmented communication device would be a benefit to her. Please reconsult at that time if and when the patient is ready to use a speech generating device. The patient is discharged from my services at this time due to a plateau in her progress. Numerous home activities were recommended to allow her to continue to make progress at home. | Speech - Language |
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: , Atrial fibrillation and shortness of breath.,HISTORY OF PRESENTING ILLNESS: , The patient is an 81-year-old gentleman. The patient had shortness of breath over the last few days, progressively worse. Yesterday he had one episode and got concerned and came to the Emergency Room, also orthopnea and paroxysmal dyspnea. Coronary artery disease workup many years ago. He also has shortness of breath, weakness, and tiredness.,CORONARY RISK FACTORS: , History of hypertension, no history of diabetes mellitus, ex-smoker, cholesterol status elevated, no history of established coronary artery disease, and family history positive.,FAMILY HISTORY: , Positive for coronary artery disease.,SURGICAL HISTORY: , Knee surgery, hip surgery, shoulder surgery, cholecystectomy, and appendectomy.,MEDICATIONS: , Thyroid supplementation, atenolol 25 mg daily, Lasix, potassium supplementation, lovastatin 40 mg daily, and Coumadin adjusted dose.,ALLERGIES: , ASPIRIN.,PERSONAL HISTORY:, Married, ex-smoker, and does not consume alcohol. No history of recreational drug use.,PAST MEDICAL HISTORY: , Hypertension, hyperlipidemia, atrial fibrillation chronic, on anticoagulation.,SURGICAL HISTORY: , As above.,PRESENTATION HISTORY: , Shortness of breath, weakness, fatigue, and tiredness. The patient also relates history of questionable TIA in 1994.,REVIEW OF SYSTEMS:,CONSTITUTIONAL: Weakness, fatigue, tiredness.,HEENT: No history of cataracts, blurry vision or glaucoma.,CARDIOVASCULAR: Arrhythmia, congestive heart failure, no coronary artery disease.,RESPIRATORY: Shortness of breath. No pneumonia or valley fever.,GASTROINTESTINAL: Nausea, no vomiting, hematemesis, or melena.,UROLOGICAL: Some frequency, urgency, no hematuria.,MUSCULOSKELETAL: Arthritis, muscle weakness.,SKIN: Chronic skin changes.,CNS: History of TIA. No CVA, no seizure disorder.,ENDOCRINE: Nonsignificant.,HEMATOLOGICAL: Nonsignificant.,PSYCHOLOGICAL: No anxiety or depression.,PHYSICAL EXAMINATION:,VITAL SIGNS: Pulse of 67, blood pressure 159/49, afebrile, and respiratory rate 18 per minute.,HEENT: Atraumatic and normocephalic.,NECK: Neck veins flat. No significant carotid bruits.,LUNGS: Air entry bilaterally fair, decreased in basal areas. No rales or wheezes.,HEART: PMI displaced. S1 and S2 regular.,ABDOMEN: Soft and nontender. Bowel sounds present.,EXTREMITIES: Chronic skin changes. Pulses are palpable. No clubbing or cyanosis.,CNS: Grossly intact.,LABORATORY DATA: , H&H stable 30 and 39, INR of 1.86, BUN and creatinine within normal limits, potassium normal limits. First set of cardiac enzymes profile negative. BNP 4810.,Chest x-ray confirms unremarkable findings. EKG reveals atrial fibrillation, nonspecific ST-T changes.,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' | IDENTIFYING DATA: , This is a 26-year-old Caucasian male of unknown employment, who has been living with his father.,CHIEF COMPLAINT AND/OR REACTION TO HOSPITALIZATION: , The patient is unresponsive.,HISTORY OF PRESENT ILLNESS: , The patient was found by outpatient case manager to be unresponsive and incontinent of urine and feces at his father's home. It is unknown how long the patient has been decompensated after a stay at Hospital.,PAST PSYCHIATRIC HISTORY: , Inpatient ITA stay at Hospital one year ago, outpatient at Valley Cities, but currently not engaged in treatment.,MEDICAL HISTORY: , Due to the patient being unresponsive and very little information available in the chart, the only medical history that we can identify is to observe that the patient is quite thin for height. He is likely dehydrated, as it appears that he has not had food or fluids for quite some time.,CURRENT MEDICATIONS:, Prior to admission, we do not have that information. He has been started on Ativan 2 mg p.o. or IM if he refuses the p.o. and this would be t.i.d. to treat the catatonia.,SOCIAL AND DEVELOPMENTAL HISTORY: ,The patient has been living in his father's home and this is all the information that we have available from the chart.,SUBSTANCE AND ALCOHOL HISTORY: ,It is unknown with the exception of nicotine use.,LEGAL HISTORY: , Unknown.,GENETIC PSYCHIATRIC HISTORY: , Unknown.,MENTAL STATUS EXAM:,Attitude: The patient is unresponsive.,Appearance: He is lying in bed in the fetal position with a blanket over his head.,Psychomotor: Catatonic.,EPS/TD: Unable to assess though his limbs are quite contracted.,Affect: Unresponsive.,Mood: Unresponsive.,Speech: Unresponsive.,Thought Process And Thought Content: Unresponsive.,Psychosis: Unable to elicit information to make this assessment.,Suicidal/Homicidal: Also unable to elicit this information.,Cognitive Assessment: Unable to elicit.,Judgment And Insight: Unable to elicit.,Assets: The patient is young.,Limitations: Severe decompensation.,FORMULATION: ,This is a 26-year-old Caucasian male with a diagnosis of psychosis, NOS, admitted with catatonia.,DIAGNOSES:,AXIS I: Psychosis, NOS.,AXIS II: Deferred.,AXIS III: Dehydration.,AXIS IV: Severe.,AXIS V: 10.,ESTIMATED LENGTH OF STAY: , 10 to 14 days.,RECOMMENDATIONS AND PLAN:,1. Stabilize medically from the dehydration per internal medicine.,2. Medications, milieu therapy to assist with re-compensation. | 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' | CHIEF COMPLAINT:, Headache and pain in the neck and lower back.,HISTORY OF PRESENT ILLNESS:, The patient is a 34 year old white man with AIDS (CD4 -67, VL -341K) and Castleman’s Disease who presents to the VA Hospital complaining of headaches, neck pain, and lower back pain over the last 2-3 weeks. He was hospitalized 3 months prior to his current presentation with abdominal pain and diffuse lymphadenopathy. Excisional lymph node biopsy during that admission showed multicentric Castleman’s Disease. He was started on cyclophosphamide and prednisone and his lymphadenopathy dramatically improved. His hospitalization was complicated by the development of acute renal failure from tumor lysis syndrome and he required hemodialysis for only a few sessions. The patient was discharged on HAART and later returned for 2 cycles of modified CHOP chemotherapy.,Approximately five weeks prior to his current presentation, the patient was involved in a motor vehicle accident at 40 mph. He said he was not wearing his seatbelt and had hit his head on the roof of the car. He did not lose consciousness. The patient went to the VA ER but left against medical advice prior to being fully evaluated. Records showed that the patient had complained of some neck soreness but he was able to move his neck without any difficulty.,Two weeks later, the patient started having headaches, neck and lower back pain during a road trip with his family to Mexico . He returned to Houston and approximately one week prior to admission, the patient presented to the VA ER for further evaluation. Spinal films were unremarkable and the patient was sent home on pain medications with a diagnosis of muscle strain. The patient followed up with his primary care physician and was admitted for further workup.,On the day of admission, the patient complains of severe pain that is worse in the lower back than in the neck. The pain is 7-8 out of 10 and does not radiate. He also complains of diffuse headaches and intermittent blurriness of his vision. He complains of having a very stiff neck that hurts when he bends it. He denies any fevers, chills, or night sweats. He denies any numbness or tingling of his extremities and he denies any bowel or bladder incontinence. None of the medications that he takes provides adequate relief of his pain.,Regarding his AIDS and Castleman’s Disease, his lymphadenopathy have completely resolved by physical exam. He no longer has any of the symptoms from his previous hospitalization. He is scheduled to have his next cycle of chemotherapy during the week of his current admission. He has been noncompliant with his HAART and has been off the medications for >3 weeks.,Past Medical History:, HIV diagnosed 11 years ago. No history of opportunistic infections. Recently diagnosed with Castleman’s Disease (9/03) from excisional lymph node biopsy s/p cyclophosphamide/prednisone ( 9/25/03 ) and modified CHOP ( 10/15/03 , 11/10/03 ). Last CD4 count is 67 and viral load is 341K (9/03). Currently is off HAART x 3 weeks because of noncompliance.,PAST SURGICAL HISTORY:, Excisional lymph node biopsy (9/03).,FAMILY HISTORY:, There was no history of hypertension, coronary artery disease, stroke, cancer or diabetes.,SOCIAL HISTORY:, Patient is single and he lives alone. He is heterosexual and has a history of sexual encounter with prostitutes in Japan. He works as a plumber over the last 5 years. He smokes and drinks occasionally and denies any history of IV drug use. No blood transfusion. No history of incarceration. Recently traveled to Mexico .,MEDICATION:, Tylenol #3 q6h prn, ibuprofen 800 mg q8h prn, methocarbamol 750 mg qid.,ALLERGIES:, , Sulfa (rash).,REVIEW OF SYSTEMS:, The patient complains of feeling weak and fatigued. He has no appetite over the past week and has lost 8 pounds during this period. No chest pain, palpitations, shortness of breath or coughing. He denies any nausea, vomiting, or abdominal pain. No focal neuro deficits. Otherwise, as stated in HPI.,PHYSICAL EXAM:,VS: T 98 BP 121/89 P 80 R 20 O2 Sat 100% on room air.,Ht: 5'9" Wt: 159 lbs.,GEN: Well developed man in no apparent distress. Alert and Oriented X 3.,HEENT: Pupils equally round and reactive to light. Extra-ocular movements intact. Anicteric. Papilledema present bilaterally. Moist mucous membranes. No oropharyngeal lesions.,NECK: Stiff, difficulty with neck flexion; no lymphadenopathy,LUNGS: Clear to auscultation bilaterally.,CV: Regular rate and rhythm. No murmurs, gallops, rubs.,ABD: Soft with active bowel sounds. Nontender/Nondistended. No rebound or guarding. No hepatosplenomegaly.,EXT: No clubbing, cyanosis, or edema. 2+ pulses bilaterally.,BACK: No point tenderness to spine,NEURO: Cranial nerves intact. 2+ DTRs bilaterally and symmetrically. Motor strength and sensation within the normal limits.,LYMPH: No cervical, axillary, or inguinal lymph nodes palpated,SKIN: warm, no rashes, no lesions,STUDIES:,C-spine/lumbosacral spine (11/30): Within normal limits.,CXR (12/8): Normal heart size, no infiltrate. Hila and mediastinum are not enlarged.,CT Head with and without contrast (12/8): Ventriculomegaly and potentially minor hydrocephalus. Otherwise normal CT scan of the brain. No evidence of abnormal enhancement of the brain or mass lesions within the brain or dura.,HOSPITAL COURSE:, The patient was admitted to the medicine floor and a lumbar puncture was performed. The opening pressure was greater than 55. The CSF results are shown in the table. A diagnostic study was sent. | 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: ,Thoracic Spine.,REASON FOR EXAM: , Injury.,INTERPRETATION: , The thoracic spine was examined in the AP, lateral and swimmer's projections. There is mild chronic-appearing anterior wedging of what is believed to represent T11 and 12 vertebral bodies. A mild amount of anterior osteophytic lipping is seen involving the thoracic spine. There is a suggestion of generalized osteoporosis. The intervertebral disc spaces appear generally well preserved.,The pedicles appear intact.,IMPRESSION:,1. Mild chronic-appearing anterior wedging of what is believed to represent the T11 and 12 vertebral bodies.,2. Mild degenerative changes of the thoracic spine.,3. Osteoporosis. | 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' | DIAGNOSIS: , Aortic valve stenosis with coronary artery disease associated with congestive heart failure. The patient has diabetes and is morbidly obese.,PROCEDURES: , Aortic valve replacement using a mechanical valve and two-vessel coronary artery bypass grafting procedure using saphenous vein graft to the first obtuse marginal artery and left radial artery graft to the left anterior descending artery.,ANESTHESIA: , General endotracheal,INCISION: , Median sternotomy,INDICATIONS: , The patient presented with severe congestive heart failure associated with the patient's severe diabetes. The patient was found to have moderately stenotic aortic valve. In addition, The patient had significant coronary artery disease consisting of a chronically occluded right coronary artery but a very important large obtuse marginal artery coming off as the main circumflex system. The patient also has a left anterior descending artery which has moderate disease and this supplies quite a bit of collateral to the patient's right system. It was decided to perform a valve replacement as well as coronary artery bypass grafting procedure.,FINDINGS: , The left ventricle is certainly hypertrophied· The aortic valve leaflet is calcified and a severe restrictive leaflet motion. It is a tricuspid type of valve. The coronary artery consists of a large left anterior descending artery which is associated with 60% stenosis but a large obtuse marginal artery which has a tight proximal stenosis.,The radial artery was used for the left anterior descending artery. Flow was excellent. Looking at the targets in the posterior descending artery territory, there did not appear to be any large branches. On the angiogram these vessels appeared to be quite small. Because this is a chronically occluded vessel and the patient has limited conduit due to the patient's massive obesity, attempt to bypass to this area was not undertaken. The patient was brought to the operating room,PROCEDURE: , The patient was brought to the operating room and placed in supine position. A median sternotomy incision was carried out and conduits were taken from the left arm as well as the right thigh. The patient weighs nearly three hundred pounds. There was concern as to taking down the left internal mammary artery. Because the radial artery appeared to be a good conduit The patient would have arterial graft to the left anterior descending artery territory. The patient was cannulated after the aorta and atrium were exposed and full heparinization.,The patient went on cardiopulmonary bypass and the aortic cross-clamp was applied Cardioplegia was delivered through the coronary sinuses in a retrograde manner. The patient was cooled to 32 degrees. Iced slush was applied to the heart. The aortic valve was then exposed through the aortic root by transverse incision. The valve leaflets were removed and the #23 St. Jude mechanical valve was secured into position by circumferential pledgeted sutures. At this point, aortotomy was closed.,The first obtuse marginal artery was a very large target and the vein graft to this target indeed produced an excellent amount of flow. Proximal anastomosis was then carried out to the foot of the aorta. The left anterior descending artery does not have severe disease but is also a very good target and the radial artery was anastomosed to this target in an end-to-side manner. The two proximal anastomoses were then carried out to the root of the aorta.,The patient came off cardiopulmonary bypass after aortic cross-clamp was released. The patient was adequately warmed. Protamine was given without adverse effect. Sternal closure was then done using wires. The subcutaneous layers were closed using Vicryl suture. The skin was approximated using staples. | 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. Chronic adenotonsillitis.,2. Ankyloglossia,POSTOPERATIVE DIAGNOSES:,1. Chronic adenotonsillitis.,2. Ankyloglossia,PROCEDURE PERFORMED:,1. Adenoidectomy and tonsillectomy.,2. Lingual frenulectomy.,ANESTHESIA: , General endotracheal.,FINDINGS/SPECIMEN:, Tonsil and adenoid tissue.,COMPLICATIONS: , None.,CONDITION: ,The patient is stable and tolerated the procedure well, and sent to PACU.,HISTORY OF PRESENT ILLNESS: , This is a 3-year-old child with a history of adenotonsillitis.,PROCEDURE: , The patient was prepped and draped in the usual sterile fashion. A curved hemostat was used to grasp the lingual frenulum. The stat was removed and Metzenbaum scissors were used to free the lingual frenulum. Cautery was used to allow hemostasis. The patient was then turned. McIvor mouth gag was inserted. Tonsils and adenoids were exposed. The patient's right tonsil was first grasped with a curved hemostat. Needle tip cautery was used to free the superior pole of tonsil. The tonsil was then grasped in medial superior aspect with a straight hemostat. The tonsil fascia planes were identified with Bovie dissection along the plane. The tonsil was freed from anterior pillar and posterior pillar. Amputation occurred along the same plane as the patient's tongue. Suction cautery was then used to allow for hemostasis. The patient's adenoids were then viewed with an adenoid mirror. An adenoid curet was used to remove the patient's adenoid tissue. Specimen sent. Suction cautery was used to allow for hemostasis. Superior pole of left tonsil was then grasped with a curved hemostat. Superior pole was freed using needle tip Bovie dissection. Beginning with 15 desiccate, after superior pole was free, Bovie was switched to 15 fulgurate, and the tonsil was stripped from anterior and posterior pillars. The tonsil was then amputated at the same plane as tongue base. Hemostasis was achieved with using suction cautery. Mouth gag was removed. Dual position and occlusion were tested. The patient was extubated and tolerated the procedure well and sent back to PACU. | ENT - Otolaryngology |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | PREOPERATIVE DIAGNOSIS: , Bilateral vesicoureteral reflux with right reflux nephropathy after Deflux injection.,POSTOPERATIVE DIAGNOSIS: , Bilateral vesicoureteral reflux with right reflux nephropathy after Deflux injection.,PROCEDURE:, Cystoscopy under anesthesia, bilateral HIT/STING with Deflux under general anesthetic.,ANESTHESIA: , General inhalational anesthetic.,FLUIDS RECEIVED: , 250 mL crystalloids.,ESTIMATED BLOOD LOSS:, Less than 5 mL.,SPECIMENS:, Urine sent for culture.,ABNORMAL FINDINGS: ,Gaping ureteral orifices, right greater than left, with Deflux not in or near the ureteral orifices. Right ureteral orifice was HIT with 1.5 mL of Deflux and left with 1.2 mL of Deflux.,HISTORY OF PRESENT ILLNESS: ,The patient is a 4-1/2-year-old boy with history of reflux nephropathy and voiding and bowel dysfunction. He has had a STING procedure performed but continues to have reflux bilaterally. Plan is for another injection.,DESCRIPTION OF OPERATION: ,The patient was taken to the operating room where surgical consent, operative site, and patient identification were verified. Once he was anesthetized, IV antibiotics were given. He was then placed in a lithotomy position with adequate padding of his arms and legs. His urethra was calibrated to 12-French with a bougie a boule. A 9.5-French cystoscope was used and the offset system was then used. His urethra was normal without valves or strictures. His bladder was fairly normal with minimal trabeculations but no cystitis noted. Upon evaluation, the patient's right ureteral orifice was found to be remarkably gaping and the Deflux that was present was not in or near ureteral orifice but it was inferior to it below the trigone. This was similarly found on the left side where the Deflux was not close to the orifice as well. It was slightly more difficult because of the amount impacted upon our angle for injection. We were able to ultimately get the Deflux to go ahead with HIT technique on the right into the ureter itself to inject a total of 1.5 mL to include the HIT technique as well as the ureteral orifice itself on the right and left sides and some on the uppermost aspect. Once we injected this, we ran the irrigant over the orifice and it no longer fluttered and there was no bleeding. Similar procedure was done on the left. This was actually more difficult as the Deflux injection from before displaced the ureter slightly more laterally but again HIT technique was performed. There was some mild bleeding and Deflux was used to stop this as well and again no evidence of fluttering of the ureteral orifice after injection. At the end of the procedure, the irrigant was drained and 2% lidocaine jelly was instilled in the urethra. The patient tolerated the procedure well and was in stable condition upon transfer to Recovery. A low-dose of IV Toradol was given at the end of the procedure as well. | 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' | FEMALE PHYSICAL EXAMINATION,Eye: Eyelids normal color, no edema. Conjunctivae with no erythema, foreign body, or lacerations. Sclerae normal white color, no jaundice. Cornea clear without lesions. Pupils equally responsive to light. Iris normal color, no lesions. Anterior chamber clear. Lacrimal ducts normal. Fundi clear.,Ear: External ear has no erythema, edema, or lesions. Ear canal unobstructed without edema, discharge, or lesions. Tympanic membranes clear with normal light reflex. No middle ear effusions.,Nose: External nose symmetrical. No skin lesions. Nares open and free of lesions. Turbinates normal color, size and shape. Mucus clear. No internal lesions.,Throat: No erythema or exudates. Buccal mucosa clear. Lips normal color without lesions. Tongue normal shape and color without lesion. Hard and soft palate normal color without lesions. Teeth show no remarkable features. No adenopathy. Tonsils normal shape and size. Uvula normal shape and color.,Neck: Skin has no lesions. Neck symmetrical. No adenopathy, thyromegaly, or masses. Normal range of motion, nontender. Trachea midline.,Chest: Symmetrical. Clear to auscultation bilaterally. No wheezing, rales or rhonchi. Chest nontender. Normal lung excursion. No accessory muscle use.,Cardiovascular: Heart has regular rate and rhythm with no S3 or S4. Heart rate is normal.,Abdominal: Soft, nontender, nondistended, bowel sounds present. No hepatomegaly, splenomegaly, masses, or bruits.,Genital: Labia majora normal shape without erythema or lesions. Labia minora normal shape without erythema or lesions. Clitoris normal shape and contour. Vaginal mucosa normal color without lesions. No significant discharge. Cervix normal shape and parity without lesions. Ovaries normal shape and contour. No pelvic masses. Uterus normal shape and contour. No external hemorrhoids.,Musculoskeletal: Normal strength all muscle groups. Normal range of motion all joints. No joint effusions. Joints normal shape and contour. No muscle masses.,Foot: No erythema. No edema. Normal range of motion all joints in the foot. Nontender. No pain with inversion, eversion, plantar or dorsiflexion.,Ankle: Anterior and posterior drawer test negative. No pain with inversion, eversion, dorsiflexion, or plantar flexion. Collateral ligaments intact. No joint effusion, erythema, edema, crepitus, ecchymosis, or tenderness.,Knee: Normal range of motion. No joint effusion, erythema, nontender. Anterior and posterior drawer tests negative. Lachman's test negative. Collateral ligaments intact. Bursas nontender without edema.,Wrist: Normal range of motion. No edema or effusion, nontender. Negative Tinel and Phalen tests. Normal strength all muscle groups.,Elbow: Normal range of motion. No joint effusion or erythema. Normal strength all muscle groups. Nontender. Olecranon bursa flat and nontender, no edema. Normal supination and pronation of forearm. No crepitus.,Hip: Negative swinging test. Trochanteric bursa nontender. Normal range of motion. Normal strength all muscle groups. No pain with eversion and inversion. No crepitus. Normal gait.,Psychiatric: Alert and oriented times four. No delusions or hallucinations, no loose associations, no flight of ideas, no tangentiality. Affect is appropriate. No psychomotor slowing or agitation. Eye contact is appropriate. | 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' | GENERAL APPEARANCE: , This is a well-developed and well-nourished, ??,VITAL SIGNS: , Blood pressure ??, heart rate ?? and regular, respiratory rate ??, temperature is ?? degrees Fahrenheit. Height is ?? feet ?? inches. Weight is ?? pounds. This yields a body mass index of ??.,HEAD, EYES, EARS, NOSE AND THROAT:, The pupils were equal, round and reactive to light. Extraocular movements are intact. Sclera are nonicteric. Ears, nose, mouth and throat - Externally the ears and nose are normal. The mucous membranes are moist and midline.,NECK: ,The neck is supple without masses. No thyromegaly, no carotid bruits, no adenopathy.,LUNGS: ,There is a normal respiratory effort. Bilateral breath sounds are clear. No wheezes or rales or rhonchi.,CARDIAC: , Normal cardiac impulse location. S1 and S2 are normal. No rubs, murmurs or gallops. A regular rate and rhythm. There are no abdominal aortic bruits. The carotid, brachial, radial, femoral, popliteal and dorsalis pedis pulses are 2+ and equal bilaterally.,EXTREMITIES: , The extremities are without clubbing, cyanosis, or edema.,CHEST: , The chest examination is unremarkable.,BREASTS: ,The breasts show no masses or tenderness. No axillary adenopathy.,ABDOMEN:, The abdomen is flat, soft, nontender, no organomegaly, no masses, normal bowel sounds are present.,RECTAL: , Examination was deferred.,LYMPHATIC: , No neck, axillary or groin adenopathy was noted.,SKIN EXAMINATION:, Unremarkable.,MUSCULOSKELETAL EXAMINATION: , Grossly normal.,NEUROLOGIC: , The cranial nerves two through twelve are grossly intact. Patellar and biceps reflexes are normal.,PSYCHIATRIC: , The patient is awake, alert and oriented times three. Judgment and insight are good. Affect is appropriate. | Consult - History and Phy. |
Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list:
'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology' | DISCHARGE SUMMARY,SUMMARY OF TREATMENT PLANNING:, This discharge is at the family's request.,IDENTIFIED PROBLEMS/OUTCOMES:,1. | 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' | REASON FOR REFERRAL: , The patient was referred to me by Dr. X of the Hospitalist Service at Children's Hospital due to a recent admission for pseudoseizures. This was a 90-minute initial intake completed on 10/19/2007 with the patient's mother. I have reviewed with her the boundaries of confidentiality and the treatment consent form, and she stated that she had understood these concepts.,PRESENTING PROBLEM: , It is reported that the patient was recently hospitalized and has been hospitalized in 2 occasions for pseudoseizure activity. These were confirmed by video EEG and consist of trembling, shaking, and things of that nature. She does have a history of focal seizures and perhaps simple seizures, which were diagnosed when she was 5 years old, but the seizure activity that was documented during the hospital stay is of a significant different quality. I had met with them in the hospital and introduced myself and gathered some basic background information, but this is a supplement to that information, which is contained within this chart. It was reported to me that she has been under considerable stress. First of all, it should be noted that the patient is developmentally delayed. Although she is 17 years old, she operates at about a fourth grade level. Mother reported that The patient becomes stressed because she thinks that everyone is against her, that she cannot do anything unless someone is there, that she needs a lot of direction, that she gets confused easily, that she thinks that people become angry at her, that she misinterprets what people are saying and thinks that they are upset. It is reported, the patient feels that her mother yells at her, and that is mad at her often. It was reported that in addition she recently has had change in her visitation with her father, that she within the last 6 months, has started seeing her father every other weekend after he had been discharged from prison. She reported that what is stress for her is that sometimes he does not always show up for visits or is late and that upsets her a lot and that she is upset when she has to leave him, also additional stressor is at school. She reports that she has no friends that she feels unwanted and picked on. She gets confused easily at school, worries about things, and believes that the teachers become angry with her. In regards to her mood, mother reported that she is usually happy, unless things do not go her way, and then, she becomes upset and says that nobody cares about her. She sits in the couch, she become angry, does not speak. Mother sends her to her room, and she calms down, takes a couple of deep breaths, and that passes. It is reported that the patient has "always been this way" and that is not a change in her behavior. Mother did think that she did seem a little more depressed, that she seems more lonely. Over the last few months, she has seemed a little bit more down because she does not have any friends and that she is bored. Mother reported that she frequently complains of being bored, but has always been this way. No sleep disturbance was noted. No changes in weight. No suicidal ideation. No deficits in energy were noted. Mother did report that she does tend to worry, but her worries tend to be because she gets confused, does not understand what she needs to do, and is quite rigid, but mother did not feel that the worry was actually affecting her functioning on a daily basis.,DEVELOPMENTAL HISTORY:, The patient was the 5 pound 12 ounce product of an unplanned pregnancy and normal spontaneous vaginal delivery. She was delivered at 36 weeks' gestation. Mother reported that she received prenatal care. Difficulties during the pregnancy were denied. The use of drugs, alcohol, tobacco during the pregnancy were denied. No eating or sleeping difficulties during the perinatal period were reported. Temperament was described as easy. The patient is described as a cuddly baby. In terms of serious injuries, they were denied. Serious illnesses: She has been diagnosed since age 5 with seizures. Mother was not able to tell me the exact kind of seizures, but it would appear from I could gather that they are focal seizures and possibly simple-to-complex partial seizures. The patient does not have a history of allergy or toileting problems. She is currently taking Trileptal 450 mg b.i.d., and she is currently taking Depakote, although she is going to be weaned off the Depakote by her neurologist. She is taking Prevacid and ibuprofen. The neurologist that she sees is Dr. Y here at Children's Hospital.,FAMILY BACKGROUND:, In terms of family background, the patient lives with her mother age 38 and her mother's partner, who is age 40, and with her 16-year-old sister who does not have any developmental delays. Mother had been married to the patient's father, but they were together as a couple beginning 1990, married in 1997, separated in 2002, and divorced in 2003; he lives in the ABC area and visits them every other Saturday, but there are no overnight visits. The paternal grandparents are both living here in California, but are separated. They are 3 paternal uncles and 2 paternal aunts. In terms of the maternal family, maternal grandmother and grandfather are deceased. Maternal grandfather deceased in 1991 due to cancer. Maternal grandmother deceased in 2001 due to cancer. There are 5 maternal aunts and 2 maternal uncles, all who live in California. She reported that the patient is particularly close to her maternal aunt, whose name is Carmen. Mother's partner had been married previously; he has 2 children from that relationship, a 23-year-old, and a 20-year-old female, who really are not part of the patient's daily life. In terms of other family background, it was reported that the mother's partner gets frustrated with The patient, does not completely understand the degree of her delay and how that may affect her ability to do things as well as her interpretation of things. The sister was described as having some resentment towards her older sister, that she feels like she was just to watch out for her, care for her, and that sister has always wanted to follow her around and do the things that she does. The biological father allegedly was in jail for a year due to drug possession. Mother reported that he had a problem with methamphetamine. In addition, she reported there is an accusation that he had molested their niece; however, she stated that there was a trial, and he was found to be not guilty of that. She stated there was no evidence that he had ever molested the patient or her sister. There had been quite a bit of chaos in the family when the mother and father were together. There was a lot of arguing. There were a lot of moves, there was domestic violence both from father to mother and mother to father consisting mostly of pushing and shoving by mother's report. The patient did observe this. After the separation, it was reported that there were continued difficulties that the father took the patient and her sister from school without mother's knowledge and had filed to get custody of them and actually ended up having custody of them for a month, and told the patient and her sister that the mother had abandoned them. Mother reported that they went to court, and there was a court order giving the mother custody back after the father went to jail. Mother stated that was approximately 5 years ago. In terms of current, mother reports that she currently works 2 jobs from 8 to 5 on Monday and Friday and from 6 to 10 on Monday, Wednesday's, and Friday's, but she does have the weekends off. The patient was reported also to have a job through her school on several weeknights.,Mother reported that she graduated from high school, had a year of college. She was an average student, had learning difficulties in reading. No psychological or drug or alcohol history was reported by mother. In terms of the biological father, mother stated that he graduated from high school, had a couple of years of college, was a good student, no learning problems or psychological problems for him were reported. Mother reported that he had a history of methamphetamine use.,Other psychiatric history in the family was denied.,SOCIAL HISTORY: , She reported that the patient feels like she does not have any friends, that she is lonely and bored, really does not do much for fun. Her fun consists primarily of doing crafts with mother, sewing, painting, drawing, beadwork, and things like that. It was reported that she really feels that she is bored and does not have much to do.,ACADEMIC BACKGROUND: ,The patient is in the 11th grade at High School. She has 2 regular education classes, mother could not tell me what they were, but the rest of her classes are special education. Mother could not tell me what her IQ was, although she noticed she works at about a 4th or 5th grade level. Mother reported that the terminology most often used with the patient was developmental delay. Her counselor's name is Mr. XYZ, but she reported that overall she is a good student, but she does have sometimes some difficulties at school, becoming upset or angry regarding the little things that she does not seem to understand. It is reported that the patient feels that she has no friends at school that she is lonely, and that is she does not really care for school. She reported that the patient is involved in a work program through the school where she works at Pet Extreme on Mondays and Wednesdays from 3 to 8 p.m. where she stocks shelves. It is reported that she does not like to go to school because she feels like nobody likes her. She is not involved in any kind of clubs or groups at school. Mother reported that she is also not receiving CVRC services.,PREVIOUS COUNSELING: , Mother reported that she has been in counseling before, but mother could not give me any information about that, who did the counseling, or what it was about. She does receive evidently some peer counseling at school because she gets upset and needs help in calming down.,DIAGNOSTIC SUMMARY AND IMPRESSION:, It appears that the patient best qualifies for a diagnosis of conversion disorder, and information from Neurology suggests that the "seizure episodes" are not true seizures, but appear to be pseudoseizures. The patient is experiencing quite bit of stress with a lot of changes in her life, also difficulty in functioning likely due to her developmental delay makes it difficult for her to understand.,PLAN:, My plan is to meet with the patient in approximately 1 to 2 weeks to complete a clinical interview with her, and then to begin teaching coping skills as well as explore ways for reducing her stress.,DSM IV DIAGNOSES: ,AXIS I: Conversion disorder (300.11).,AXIS II: Diagnoses deferred.,AXIS III: Seizure disorder.,AXIS IV: Problems with primary support group, peer problems, and educational problems.,AXIS V: Global assessment of functioning equals 60. | Consult - History and Phy. |
Subsets and Splits
No saved queries yet
Save your SQL queries to embed, download, and access them later. Queries will appear here once saved.