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Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

CHIEF COMPLAINT: , Cough and abdominal pain for two days.,HISTORY OF PRESENT ILLNESS: , This is a 76-year-old female who has a history of previous pneumonia, also hypertension and macular degeneration, who presents with generalized body aches, cough, nausea, and right-sided abdominal pain for two days. The patient stated that the abdominal pain was only associated with coughing. The patient reported that the cough is dry in nature and the patient had subjective fevers and chills at home.,PAST MEDICAL HISTORY: ,Significant for pneumonia in the past, pleurisy, macular degeneration, hypertension, and phlebitis.,PAST SURGICAL HISTORY: ,The patient had bilateral cataract extractions in 2007, appendectomy as a child, and three D&Cs in the past secondary to miscarriages.,MEDICATIONS: , On presentation included hydrochlorothiazide 12.5 mg p.o. daily, aspirin 81 mg p.o. daily, and propranolol 40 mg p.o. daily. The patient also takes multivitamin and Lutein over-the-counter for macular degeneration.,ALLERGIES: , THE PATIENT HAS NO KNOWN DRUG ALLERGIES.,FAMILY HISTORY:, Mother died at the age of 59 due to stomach cancer and father died at the age of 91 years old.,SOCIAL HISTORY:, The patient quit smoking 17 years ago; prior to that had smoked one pack per day for 44 years. Denies any alcohol use. Denies any IV drug use.,PHYSICAL EXAMINATION: ,GENERAL: This is a 76-year-old female, well nourished. VITAL SIGNS: On presentation included a temperature of 100.1, pulse of 144 with a blood pressure of 126/77, the patient is saturating at 95% on room air, and has respiratory rate of 20. HEENT: Anicteric sclerae. Conjunctivae pink. Throat was clear. Mucosal membranes were dry. CHEST: Coarse breath sounds bilaterally at the bases. CARDIAC: S1 and S2. No murmurs, rubs or gallops. No evidence of carotid bruits. ABDOMEN: Positive bowel sounds, presence of soreness on examination in the abdomen on palpation. There is no rebound or guarding. EXTREMITIES: No clubbing, cyanosis or edema.,HOSPITAL COURSE: , The patient had a chest x-ray, which showed increased markings present bilaterally likely consistent with chronic lung changes. There is no evidence of effusion or consolidation. Degenerative changes were seen in the shoulder. The patient also had an abdominal x-ray, which showed nonspecific bowel gas pattern. Urinalysis showed no evidence of infection as well as her influenza A&B were negative. Preliminary blood cultures have been with no growth to date status post 48 hours. The patient was started on cefepime 1 g IV q.12h. and given IV hydration. She has also been on Xopenex nebs q.8h. round the clock and in regards to her hypertension, she was continued on her hydrochlorothiazide and propranolol. In terms of prophylactic measures, she received Lovenox subcutaneously for DVT prophylaxis. Currently today, she feels much improved with still only a mild cough. The patient has been afebrile for two days, saturating at 97% on room air with a respiratory rate of 18. Her white count on presentation was 13.6 and yesterday's white count was 10.3.,FINAL DIAGNOSIS:, Bronchitis.,DISPOSITION: , The patient will be going home.,MEDICATIONS: , Hydrochlorothiazide 12.5 mg p.o. daily, propranolol 40 mg p.o. daily. Also, Avelox 400 mg p.o. daily x10 days, guaifenesin 10 cc p.o. q.6h. p.r.n. for cough, and aspirin 81 mg p.o. daily.,DIET:, To follow a low-salt diet.,ACTIVITY:, As tolerated.,FOLLOWUP: ,To follow up with Dr. ABC in two weeks.

General Medicine

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS:, Severe degenerative joint disease of the right knee.,POSTOPERATIVE DIAGNOSIS: , Severe degenerative joint disease of the right knee.,PROCEDURE:, Right total knee arthroplasty using a Biomet cemented components, 62.5-mm right cruciate-retaining femoral component, 71-mm Maxim tibial component, and 12-mm polyethylene insert with 31-mm patella. All components were cemented with Cobalt G.,ANESTHESIA:, Spinal.,ESTIMATED BLOOD LOSS: , Minimal.,TOURNIQUET TIME: , Less than 60 minutes.,The patient was taken to the Postanesthesia Care Unit in stable condition. The patient tolerated the procedure well.,INDICATIONS: ,The patient is a 51-year-old female complaining of worsening right knee pain. The patient had failed conservative measures and having difficulties with her activities of daily living as well as recurrent knee pain and swelling. The patient requested surgical intervention and need for total knee replacement.,All risks, benefits, expectations, and complications of surgery were explained to her in great detail and she signed informed consent. All risks including nerve and vessel damage, infection, and revision of surgery as well as component failure were explained to the patient and she did sign informed consent. The patient was given antibiotics preoperatively.,PROCEDURE DETAIL: ,The patient was taken to the operating suite and placed in supine position on the operating table. She was placed in the seated position and a spinal anesthetic was placed, which the patient tolerated well. The patient was then moved to supine position again and a well-padded tourniquet was placed on the right thigh. Right lower extremity was prepped and draped in sterile fashion. All extremities were padded prior to this.,The right lower extremity, after being prepped and draped in the sterile fashion, the tourniquet was elevated and maintained for less than 60 minutes in this case. A midline incision was made over the right knee and medial parapatellar arthrotomy was performed. Patella was everted. The infrapatellar fat pad was incised and medial and lateral meniscectomy was performed and the anterior cruciate ligament was removed. The posterior cruciate ligament was intact.,There was severe osteoarthritis of the lateral compartment on the lateral femoral condyle as well as mild-to-moderate osteoarthritis in the medial femoral compartment as well severe osteoarthritis along the patellofemoral compartment. The medial periosteal tissue on the proximal tibia was elevated to the medial collateral ligament and medial collateral ligament was left intact throughout the entirety of the case.,At the extramedullary tibial guide, an extended cut was made adjusting for her alignment. Once this was performed, excess bone was removed. The reamer was placed along on the femoral canal, after which a 6-degree valgus distal cut was made along the distal femur. Once this was performed, the distal femoral size in 3 degrees external rotation, 62.5-mm cutting block was placed in 3 degrees external rotation with anterior and posterior cuts as well as anterior and posterior Chamfer cuts remained in the standard fashion. Excess bone was removed.,Next, the tibia was brought anterior and excised to 71 mm. It was then punched in standard fashion adjusting for appropriate rotation along the alignment of the tibia. Once this was performed, a 71-mm tibial trial was placed as well as a 62.5-mm femoral trial was placed with a 12-mm polyethylene insert.,Next, the patella was cut in the standard fashion measuring 31 mm and a patella bed was placed. The knee was taken for range of motion; had excellent flexion and extension as well as adequate varus and valgus stability. There was no loosening appreciated. There is no laxity appreciated along the posterior cruciate ligament.,Once this was performed, the trial components were removed. The knee was irrigated with fluid and antibiotics, after which the cement was put on the back table, this being Cobalt G, it was placed on the tibia. The tibial components were tagged in position and placed on the femur. The femoral components were tagged into position. All excess cement was removed ___ placement of patella. It was tagged in position. A 12-mm polyethylene insert was placed; knee was held in extension and all excess cement was removed. The cement hardened with the knee in full extension, after which any extra cement was removed.,The wounds were copiously irrigated with saline and antibiotics, and medial parapatellar arthrotomy was closed with #2 Vicryl. Subcutaneous tissue was approximated with #2-0 Vicryl and the skin was closed with staples. The patient was awakened from general anesthetic, transferred to the gurney, and taken into postanesthesia care unit in stable condition. 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'

REASON FOR CONSULTATION: , Neurologic consultation was requested by Dr. X to evaluate her seizure medication and lethargy.,HISTORY OF PRESENT ILLNESS: , The patient is well known to me. She has symptomatic partial epilepsy secondary to a static encephalopathy, cerebral palsy, and shunted hydrocephalus related to prematurity. She also has a history of factor V Leiden deficiency. She was last seen at neurology clinic on 11/16/2007. At that time, instructions were given to mom to maximize her Trileptal dose if seizures continue. She did well on 2 mL twice a day without any sedation. This past Friday, she had a 25-minute seizure reportedly. This consisted of eye deviation, unresponsiveness, and posturing. Diastat was used and which mom perceived was effective. Her Trileptal dose was increased to 3 mL b.i.d. yesterday.,According to mom since her shunt revision on 12/18/2007, she has been sleepier than normal. She appeared to be stable until this past Monday about six days ago, she became more lethargic and had episodes of vomiting and low-grade fevers. According to mom, she had stopped vomiting since her hospitalization. Reportedly, she was given a medication in the emergency room. She still is lethargic, will not wake up spontaneously. When she does awaken however, she is appropriate, and interacts with them. She is able to eat well; however her overall p.o. intake has been diminished. She has also been less feisty as her usual sounds. She has been seizure free since her admission.,LABORATORY DATA: , Pertinent labs obtained here showed the following: CRP is less than 0.3, CMP normal, and CBC within normal limits. CSF cultures so far is negative. Dr. Limon's note refers to a CSF, white blood cell count of 2, 1 RBC, glucose of 55, and protein of 64. There are no imaging studies in the computer. I believe that this may have been done at Kaweah Delta Hospital and reviewed by Dr. X, who indicated that there was no evidence of shunt malfunction or infection.,CURRENT MEDICATIONS: , Trileptal 180 mg b.i.d., lorazepam 1 mg p.r.n., acetaminophen, and azithromycin.,PHYSICAL EXAMINATION:,GENERAL: The patient was asleep, but easily aroused. There was a brief period of drowsiness, which she had some jerky limb movements, but not seizures. She eventually started crying and became agitated. She made attempts to sit by bending her neck forward. Fully awake, she sucks her bottle eagerly.,HEENT: She was obviously visually impaired. Pupils were 3 mm, sluggishly reactive to light.,EXTREMITIES: Bilateral lower extremity spasticity was noted. There was increased flexor tone in the right upper extremity. IV was noted on the left hand.,ASSESSMENT: ,Seizure breakthrough due to intercurrent febrile illness. Her lethargy could be secondary to a viral illness with some component of medication effect since her Trileptal dose was increased yesterday and these are probable explanations if indeed shunt malfunction has been excluded.,I concur with Dr. X's recommendations. I do not recommend any changes in Trileptal for now. I will be available while she remains hospitalized.,

Consult - History and Phy.

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

CC: ,Vertigo.,HX: ,This 61y/o RHF experienced a 2-3 minute episode of lightheadedness while driving home from the dentist in 5/92. In 11/92, while eating breakfast, she suddenly experienced vertigo. This was immediately followed by nausea and several episodes of vomiting. The vertigo lasted 2-3minutes. She retired to her room for a 2 hour nap after vomiting. When she awoke, the symptoms had resolved. On 1/13/93 she had an episode of right arm numbness lasting 4-5hours. There was no associated weakness, HA, dysarthria, dysphagia, visual change, vertigo or lightheadedness.,OUTSIDE RECORDS:, 12/16/92 Carotid Doppler (RICA 30-40%, LICA 10-20%). 12/4/92, brain MRI revealed a right cerebellar hypodensity consistent with infarct.,MEDS:, Zantac 150mg bid, Proventil MDI bid, Azmacort MDI bid, Doxycycline 100mg bid, Premarin 0.625mg qd, Provera 2.5mg qd. ASA 325mg qd.,PMH:, 1)MDD off antidepressants since 6/92. 2)asthma. 3)allergic rhinitis. 4)chronic sinusitis. 5)s/p Caldwell-Luc 1978, and nasal polypectomy. 6) GERD. 7)h/o elevated TSH. 8)hypercholesterolemia 287 on 11/20/93. 9)h/o heme positive stool: BE 11/24/92 and UGI 11/25/92 negative.,FHX: ,Father died of a thoracic aortic aneurysm, age 71. Mother died of stroke, age 81.,SHX:, Married. One son deceased. Salesperson. Denied tobacco/ETOH/illicit drug use.,EXAM,: BP (RUE)132/72 LUE (136/76). HR67 RR16 Afebrile. 59.2kg.,MS: A&O to person, place, time. Speech fluent and without dysarthria. Thought lucid.,CN: unremarkable.,Motor: 5/5 strength throughout with normal muscle bulk and tone.,Sensory: No deficits appreciated.,Coord: unremarkable.,Station: no pronator drift, truncal ataxia, or Romberg sign.,Gait: not done.,Reflexes: 2/2 throughout BUE and at patellae. 1/1 at Achilles. Plantar responses were flexor, bilaterally.,Gen Exam: Obese.,COURSE: ,CBC, GS, PT/PTT, UA were unremarkable. The patient was admitted with a working diagnosis of posterior circulation TIA and history of cerebellar stroke. She was placed on Ticlid 250mg bid. HCT,1/15/93: low density focus in the right medial and posterior cerebellar hemisphere. MRI and MRA, 1/18/93, revealed a well circumscribed lesion within the posterior aspect of the right cerebellar hemisphere suggestive of vascular malformation (e.g. cavernous angioma. An abnormal vascular blush was seen on the MRA. This area appeared to be supplied by one of the external carotid arteries (which one is was not specified). this finding maybe suggestive of a vascular malformation. 1/20/93 Cerebral Angiogram: The right cerebellar hemisphere lesion seen on MRI as a possible cavernous angioma was not seen on angiography. Upon review of the MRI and HCT the lesion was felt to probably represent an old infarction with hemosiderin deposition. The "vascular blush" seen on MRA was no visualized on angiography. The patient was discharged home on 1/25/93.

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. Hallux valgus, right foot.,2. Hallux interphalangeus, right foot.,POSTOPERATIVE DIAGNOSES:,1. Hallux valgus, right foot.,2. Hallux interphalangeus, right foot.,PROCEDURES PERFORMED:,1. Bunionectomy with distal first metatarsal osteotomy and internal screw fixation, right foot.,2. Akin bunionectomy, right toe with internal wire fixation.,ANESTHESIA: , TIVA/local.,HISTORY: ,This 51-year-old female presents to ABCD preoperative holding area after keeping herself NPO since mid night for a surgery on her painful bunion through her right foot. The patient has a history of gradual onset of a painful bunion over the past several years. She has tried conservative methods such as wide shoes, accommodative padding on an outpatient basis with Dr. X all of which have provided inadequate relief. At this time, she desires attempted surgical correction. The risks versus benefits of the procedure have been discussed with the patient in detail by Dr. X and the consent is available on the chart for review.,PROCEDURE IN DETAIL: , After IV was established by the Department of Anesthesia, the patient was taken to the operating room via cart and placed on the operative table in supine position and a safety strap was placed across her waist for her protection. Copious amounts of Webril were applied about the right ankle and a pneumatic ankle tourniquet was placed over the Webril.,After adequate IV sedation was administered by the Department of Anesthesia, a total of 15 cc of 1:1 mixture of 0.5% Marcaine plain and 1% Lidocaine plain was injected into the foot in a standard Mayo block fashion. The foot was elevated off the table. Esmarch bandages were used to exsanguinate the right foot. The pneumatic ankle tourniquet was elevated to 250 mmHg. The foot was lowered in the operative field and the sterile stockinet was reflected. A sterile Betadine was wiped away with a wet and dry sponge and one toothpick was used to test anesthesia, which was found to be adequate. Attention was directed to the first metatarsophalangeal joint, which was found to be contracted, laterally deviated, and had decreased range of motion. A #10 blade was used to make a 4 cm dorsolinear incision. A #15 blade was used to deepen the incision through the subcutaneous layer. All superficial subcutaneous vessels were ligated with electrocautery. Next, a linear capsular incision was made down the bone with a #15 blade. The capsule was elevated medially and laterally off the metatarsal head and the metatarsal head was delivered into the wound. A hypertrophic medial eminence was resected with a sagittal saw taking care not to strike the head. The medial plantar aspect of the metatarsal head had some erosive changes and eburnation. Next, a 0.45 inch Kirschner wire was placed with some access guide slightly plantar flexing the metatarsal taking care not to shorten it. A sagittal saw was used to make a long-arm Austin osteotomy in the usual fashion. Standard lateral release was also performed as well as a lateral capsulotomy freeing the fibular sesamoid complex.,The capital head was shifted laterally and impacted on the residual metatarsal head. Nice correction was achieved and excellent bone to bone contact was achieved. The bone stock was slightly decreased, but adequate. Next, a 0.45 inch Kirschner wire was used to temporarily fixate the metatarsal capital fragment. A 2.7 x 18 mm Synthes cortical screw was thrown using standard AO technique. Excellent rigid fixation was achieved. A second 2.0 x 80 mm Synthes fully threaded cortical screw was also thrown using standard AO technique at the proximal aspect of the metatarsal head. Again, an excellent rigid fixation was obtained and the screws were tight. The temporary fixation was removed. A medial overhanging bone was resected with a sagittal saw. The foot was loaded and the hallux was found to have an interphalangeus deformity present.,A sagittal saw was used to make a proximal cut in approximately 1 cm dorsal to the base of the proximal phalanx, leaving a lateral intact cortical hinge. A distal cut parallel with the nail base was performed and a standard proximal Akin osteotomy was done.,After the wedge bone was removed, the saw blade was reinserted and used to tether the osteotomy with counter-pressure used to close down the osteotomy. A #15 drill blade was used to drill two converging holes on the medial aspect of the bone. A #28 gauge monofilament wire was inserted loop to loop and pulled through the bone. The monofilament wire was twisted down and tapped into the distal drill hole. The foot was loaded again and the toe had an excellent cosmetic straight appearance and the range of motion of the first metatarsophalangeal joint was then improved. Next, reciprocating rasps were used to smooth all bony surfaces. Copious amounts of sterile saline was used to flush the joint. Next, a #3-0 Vicryl was used to reapproximate the capsular periosteal tissue layer. Next, #4-0 Vicryl was used to close the subcutaneous layer. #5-0 Vicryl was used to the close the subcuticular layer in a running fashion. Next, 1 cc of dexamethasone phosphate was then instilled in the joint. The Steri-Strips were applied followed by standard postoperative dressing consisting of Owen silk, 4 x 4s, Kling, Kerlix, and Coban. The pneumatic ankle tourniquet was released and immediate hyperemic flush was noted to the digits. The patient tolerated the above anesthesia and procedure without complications. She was transported via cart to the Postanesthesia Care Unit with vital signs stable and vascular status intact to the right foot. She is to be partial weightbearing with crutches. She is to follow with Dr. X. She was given emergency contact numbers and instructions to call if problems arise. She was given prescription for Vicodin ES #25 one p.o. q.4-6h. p.r.n. pain and Naprosyn one p.o. b.i.d. 500 mg. She was discharged in stable condition.

Orthopedic

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSES:, ,1. Spondylosis with cervical stenosis C5-C6 greater than C4-C5, C6-C7, (721.0, 723.0).,2. Neck pain with left radiculopathy, progressive (723.1/723.4).,3. Headaches, progressive (784.0).,POSTOPERATIVE DIAGNOSES:, ,1. Spondylosis with cervical stenosis C5-C6 greater than C4-C5, C6-C7, (721.0, 723.0).,2. Neck pain with left radiculopathy, progressive (723.1/723.4).,3. Headaches, progressive (784.0).,PROCEDURES:, ,1. Anterior cervical discectomy at C5-C6 for neural decompression (63075).,2. Anterior interbody fusion C5-C6 (22554) utilizing Bengal cage (22851).,3. Anterior cervical instrumentation at C5-C6 for stabilization by Uniplate construction at C5-C6 (22845); with intraoperative x-ray x2.,SERVICE: , Neurosurgery,ANESTHESIA:,

Orthopedic

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PROCEDURE: , Direct current cardioversion.,REASON FOR PROCEDURE: , Atrial fibrillation.,PROCEDURE IN DETAIL: ,The procedure was explained to the patient with risks and benefits including risk of stroke. The patient understands as well as her husband. The patient had already a transesophageal echocardiogram showing no left atrial appendage thrombus or thrombus in the left atrium. There was spontaneous echocardiogram contrast noticed. The patient was on anticoagulation with Lovenox, received already 3 mg of Versed and 25 mcg of fentanyl for the TEE followed by next 2 mg of Versed for total of 5 mg of Versed. The pads applied in the anterior and posterior approach. With synchronized biphasic waveform at 150 J, one shock was successful in restoring sinus rhythm. The patient had some occasional PACs noticed with occasional sinus tachycardia. The patient had no immediate post-procedure complications. The rhythm was maintained and 12-lead EKG was requested.,IMPRESSION: ,Successful direct current cardioversion with restoration of sinus rhythm from atrial fibrillation with no immediate complication.

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 71-year-old woman with history of coronary artery disease for which she has had coronary artery bypass grafting x2 and percutaneous coronary intervention with stenting x1. She also has a significant history of chronic renal insufficiency and severe COPD. The patient and her husband live in ABC but they have family in XYZ. She came to our office today as she is in the area visiting her family. She complains of having shortness of breath for the past month that has been increasingly getting worse. She developed a frequent nonproductive cough about 2 weeks ago. She has also had episodes of paroxysmal nocturnal dyspnea, awaking in the middle of the night, panicking from dyspnea and shortness of breath. She has also gained about 15 pounds in the past few months and has significant peripheral edema. In the office, she is obviously dyspnea and speaking in 2 to 3 word sentences.,PAST MEDICAL HISTORY: , Coronary artery disease, anemia secondary to chronic renal insufficiency, stage IV chronic kidney disease, diabetic nephropathy, hypertension, hyperlipidemia, COPD, insulin-dependent diabetes, mild mitral valve regurgitation, severe tricuspid valve regurgitation, sick sinus syndrome, gastritis, and heparin-induced thrombocytopenia.,PAST SURGICAL HISTORY: , Status post pacemaker implantation, status post CABG x4 in 1999 and status post CABG x2 in 2003, status post PCA stenting x1 to the left anterior descending artery, cholecystectomy, back surgery, bladder surgery, and colonic polypectomies.,SOCIAL HISTORY: ,The patient is married. Lives with her husband. They are retired from ABC.,MEDICATIONS:,1. Plavix 75 mg p.o. daily.,2. Aspirin 81 mg p.o. daily.,3. Isosorbide mononitrate 60 mg p.o. daily.,4. Colace 100 mg p.o. b.i.d.,5. Atenolol 50 mg p.o. daily.,6. Lantus insulin 15 units subcutaneously every evening.,7. Protonix 40 mg p.o. daily.,8. Furosemide 40 mg p.o. daily.,9. Norvasc 5 mg p.o. daily.,ALLERGIES: , SHE IS ALLERGIC TO HEPARIN AGENTS, WHICH CAUSE HEPARIN-INDUCED THROMBOCYTOPENIA.,REVIEW OF SYSTEMS,CONSTITUTIONAL: Positive for generalized fatigue and malaise.,HEAD AND NECK: Negative for diplopia, blurred vision, visual disturbances, hearing loss, tinnitus, epistaxis, vertigo, sinusitis, and gum or oral lesions.,CARDIOVASCULAR: Positive for epigastric discomfort x2 weeks, negative for palpitations, syncope or near-syncopal episodes, chest pressure, and chest pain.,RESPIRATORY: Positive for dyspnea at rest, paroxysmal nocturnal dyspnea, orthopnea, and frequent nonproductive cough. Negative for wheezing.,ABDOMEN: Negative for abdominal pain, bloating, nausea, vomiting, constipation, melena, or hematemesis.,GENITOURINARY: Negative for dysuria, polyuria, hematuria, or incontinence.,MUSCULOSKELETAL: Negative for recent trauma, stiffness, deformities, muscular weakness, or atrophy.,SKIN: Negative for rashes, petechiae, and hair or nail changes. Positive for easy bruising on forearms.,NEUROLOGIC: Negative for paralysis, paresthesias, dysphagia, or dysarthria.,PSYCHIATRIC: Negative for depression, anxiety, or mood swings.,All other systems reviewed are negative.,PHYSICAL EXAMINATION,VITAL SIGNS: Her blood pressure in the office was 188/94, heart rate 70, respiratory rate 18 to 20, and saturations 99% on room air. Her height is 63 inches. She is weighs 195 pounds and her BMI is 34.6.,CONSTITUTIONAL: A 71-year-old woman in significant distress from shortness of breath and dyspnea at rest.,HEENT: Eyes: Pupils are reactive. Sclera is nonicteric. Ears, nose, mouth, and throat.,NECK: Supple. No lymphadenopathy. No thyromegaly. Swallow is intact.,CARDIOVASCULAR: Positive JVD at 45 degrees. Heart tones are distant. S1 and S2. No murmurs.,EXTREMITIES: Have 3+ edema in the feet and ankles bilaterally that extends up to her knees. Femoral pulses are weakly palpable. Posterior tibial pulses are not palpable. Capillary refill is somewhat sluggish.,RESPIRATORY: Breath sounds are clear with some bilateral basilar diminishment. No rales and no wheezing. Speaking in 2 to 3 word sentences. Diaphragmatic excursions are limited. AP diameter is expanded.,ABDOMEN: Soft and nontender. Active bowel sounds x4 quadrants. No hepatosplenomegaly. No masses are appreciated.,GENITOURINARY: Deferred.,MUSCULOSKELETAL: Adequate range of motion along with extremities.,SKIN: Warm and dry. No lesions or ulcerations are noted.,NEUROLOGIC: Alert and oriented x3. Head is normocephalic and atraumatic. No focal, motor, or sensory deficits.,PSYCHIATRIC: Normal affect.,IMPRESSION,1. Coronary artery disease.

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. Chronic pelvic pain.,2. Endometriosis.,3. Prior right salpingo-oophorectomy.,4. History of intrauterine device perforation and exploratory surgery.,POSTOPERATIVE DIAGNOSES:,1. Endometriosis.,2. Interloop bowel adhesions.,PROCEDURE PERFORMED:,1. Total abdominal hysterectomy (TAH).,2. Left salpingo-oophorectomy.,3. Lysis of interloop bowel adhesions.,ANESTHESIA:, General.,ESTIMATED BLOOD LOSS: ,400 cc.,FLUIDS: , 2300 cc of lactated Ringers, as well as lactated Ringers for intraoperative irrigation.,URINE: , 500 cc of clear urine output.,INTRAOPERATIVE FINDINGS: , The vulva and perineum are without lesions. On bimanual exam, the uterus was enlarged, movable, and anteverted. The intraabdominal findings revealed normal liver margin, kidneys, and stomach upon palpation. The uterus was found to be normal in size with evidence of endometriosis on the uterus. The right ovary and fallopian tube were absent. The left fallopian tube and ovary appeared normal with evidence of a small functional cyst. There was evidence of left adnexal adhesion to the pelvic side wall which was filmy, unable to be bluntly dissected. There were multiple interloop bowel adhesions that were filmy in nature noted.,The appendix was absent. There did appear to be old suture in a portion of the bowel most likely from a prior procedure.,INDICATIONS: , This patient is a 45-year-old African-American gravida7, para3-0-0-3, who is here for definitive treatment of chronic pelvic pain with a history of endometriosis. She did have a laparoscopic ablation of endometriosis on a laparoscopy and also has a history of right salpingo-oophorectomy. She has tried Lupron and did stop secondary to the side effects.,PROCEDURE IN DETAIL: , After informed consent was obtained in layman's terms, the patient was taken back to the Operating Suite and placed under general anesthesia. She was then prepped and draped in the sterile fashion and placed in the dorsal supine position. An indwelling Foley catheter was placed. With the skin knife, an incision was made removing the old cicatrix. A Bovie was used to carry the tissue through to the underlying layer of the fascia which was incised in the midline and extended with the Bovie. The rectus muscle was then sharply and bluntly dissected off the superior aspect of the rectus fascia in the superior as well as the inferior aspect using the Bovie. The rectus muscle was then separated in the midline using a hemostat and the peritoneum was entered bluntly. The peritoneal incision was then extended superiorly and inferiorly with Metzenbaum scissors with careful visualization of the bladder. At this point, the intraabdominal cavity was manually explored and the above findings were noted. A Lahey clamp was then placed on the fundus of the uterus and the uterus was brought to the surgical field. The bowel was then packed with moist laparotomy sponges. Prior to this, the filmy adhesions leftover were taken down. At this point, the left round ligament was identified, grasped with two hemostats, transected, and suture ligated with #0 Vicryl. At this point, the broad ligament was dissected down and the lost portion of the bladder flap was created. The posterior aspect of the peritoneum was also dissected. At this point, the infundibulopelvic ligament was isolated and three tie of #0 Vicryl was used to isolate the pedicle. Two hemostats were then placed across the pedicle and this was transected with the scalpel. This was then suture ligated in Heaney fashion. The right round ligament was then identified and in the similar fashion, two hemostats were placed across the round ligament and using the Mayo scissors the round ligament was transected and dissected down the broad ligament to create the bladder flap anteriorly as well as dissect the posterior peritoneum and isolate the round ligament. This was then ligated with three tie of #0 Vicryl. Also incorporated in this was the remnant from the previous right salpingo-oophorectomy. At this point, the bladder flap was further created with sharp dissection as well as the moist Ray-Tech to push the bladder down off the anterior portion of the cervix.,The left uterine artery was then skeletonized and a straight Heaney was placed. In a similar fashion, the contralateral uterine artery was skeletonized and straight Heaney clamp was placed. These ligaments bilaterally were transected and suture ligated in a left Heaney stitch. At this point, curved Masterson was used to incorporate the cardinal ligament complex, thus was transected and suture ligated. Straight Masterson was then used to incorporate the uterosacrals bilaterally and this was also transected and suture ligated. Prior to ligating the uterine arteries, the uterosacral arteries were tagged bilaterally with #0 Vicryl. At this point, the roticulator was placed across the vaginal cuff and snug underneath the entire cervix. The roticulator was then clamped and removed and the staple line was in place. This was found to be hemostatic. A suture was then placed through each cuff angle bilaterally and cardinal ligament complex was found to be fixed to each apex bilaterally. At this point, McCall culdoplasty was performed with an #0 Vicryl incorporating each uterosacral as well as the posterior peritoneum. There did appear to be good support on palpation. Prior to this, the specimen was handed off and sent to pathology. At this point, there did appear to be small amount of oozing at the right peritoneum. Hemostasis was obtained using a #0 Vicryl in two single stitches. Good hemostasis was then obtained on the cuff as well as the pedicles. Copious irrigation was performed at this point with lactate Ringers. The round ligaments were then incorporated into the cuff bilaterally. Again, copious amount of irrigation was performed and good hemostasis was obtained. At this point, the peritoneum was reapproximated in a single interrupted stitch on the left and right lateral aspects to cover each pedicle bilaterally. At this point, the bowel packing as well as moist Ray-Tech was removed and while re-approximating the bowel it was noted that there were multiple interloop bowel adhesions which were taken down using the Metzenbaum scissors with good visualization of the underlying bowel. Good hemostasis was obtained of these sites as well. The sigmoid colon was then returned to its anatomic position and the omentum as well. The rectus muscle was then reapproximated with two interrupted sutures of #2-0 Vicryl. The fascia was then reapproximated with #0 Vicryl in a running fashion from lateral to medial meeting in the midline. The Scarpa's fascia was then closed with #3-0 plain in a running suture. The skin was then re-approximated with #4-0 undyed Vicryl in a subcuticular closure. This was dressed with an Op-Site. The patient tolerated the procedure well. The sponge, lap, and needle were correct x2. After the procedure, the patient was extubated and brought out of general anesthesia. She will go to the floor where she will be followed postoperatively in the hospital.

Obstetrics / Gynecology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

SUBJECTIVE:, He is a 24-year-old male who said that he had gotten into some poison ivy this weekend while he was fishing. He has had several cases of this in the past and he says that is usually takes quite awhile for him to get over it; he said that the last time he was here he got a steroid injection by Dr. Blackman; it looked like it was Depo-Medrol 80 mg. He said that it worked fairly well, although it seemed to still take awhile to get rid of it. He has been using over-the-counter Benadryl as well as cortisone cream on the areas of the rash and having a little bit of improvement, but this last weekend he must have gotten into some more poison ivy because he has got another outbreak along his chest, legs, arms and back.,OBJECTIVE:,Vitals: Temperature is 99.2. His weight is 207 pounds.,Skin: Examination reveals a raised, maculopapular rash in kind of a linear pattern over his arms, legs and chest area which are consistent with a poison ivy or a poison oak.,ASSESSMENT AND ,PLAN:, Poison ivy. Plan would be Solu-Medrol 125 mg IM X 1. Continue over-the-counter Benadryl or Rx allergy medicine that he was given the last time he was here, which is a one-a-day allergy medicine; he can not exactly remember what it is, which would also be fine rather than the over-the-counter Benadryl if he would like to use that instead.

SOAP / Chart / Progress Notes

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS: , Cataract, right eye.,POSTOPERATIVE DIAGNOSIS:, Cataract, right eye.,PROCEDURE:, Phacoemulsification with intraocular lens placement, right eye.,ANESTHESIA: , Monitored anesthesia care,ESTIMATED BLOOD LOSS: , None,COMPLICATIONS:, None,SPECIMENS:, None,PROCEDURE IN DETAIL: , The patient had previously been examined in the clinic and was found to have a visually significant cataract in the right eye. The patient had the risks and benefits of surgery discussed. After discussion, the patient decided to proceed and the consent was signed.,On the day of surgery, the patient was taken from the holding area to the operating suite by the anesthesiologist and monitors were placed. Following this, the patient was sterilely prepped and draped in the usual fashion. After this, a lid speculum was placed, preservative-free lidocaine drops were placed, and the SuperSharp blade was used to make an anterior chamber paracentesis. Preservative-free lidocaine was instilled into the anterior chamber, and then Viscoat was instilled into the eye.,The 3.0 diamond keratome was then used to make a clear corneal temporal incision. Following this, the cystotome was used to make a continuous tear-type capsulotomy. After this, BSS was used to hydrodissect and hydrodelineate the lens. The phacoemulsification unit was used to remove the cataract. The I&A unit was used to remove the residual cortical material. Following this, Provisc was used to inflate the bag. The lens, a model SA60AT of ABCD diopters, serial #1234, was inserted into the bag and rotated into position using the Lester pusher.,After this, the residual Provisc was removed. Michol was instilled and then the corneal wound was hydrated with BSS, and the wound was found to be watertight. The lid speculum was removed. Acular and Vigamox drops were placed. The patient tolerated the procedure well without complications and will be followed up in the office tomorrow.

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: , Atelectasis.,POSTOPERATIVE DIAGNOSIS: , Mucous plugging.,PROCEDURE PERFORMED: , Bronchoscopy.,ANESTHESIA: , Lidocaine topical 2%, Versed 3 mg IV. Conscious sedation.,PROCEDURE: , At bedside, a bronchoscope was passed down the tracheostomy tube under monitoring. The main carina was visualized. The trachea was free of any secretions. The right upper lobe, middle and lower lobes appeared to have some mucoid secretions but minimal and with some erythema. Left mainstem appeared patent. Left lower lobe had slight plugging in the left base, but much better that previous bronchoscopy findings. The area was lavaged with some saline and cleared. The patient tolerated the procedure well.

Cardiovascular / Pulmonary

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

EXAM: , Barium enema.,CLINICAL HISTORY: , A 4-year-old male with a history of encopresis and constipation.,TECHNIQUE: ,A single frontal scout radiograph of the abdomen was performed. A rectal tube was inserted in usual sterile fashion, and retrograde instillation of barium contrast was followed via spot fluoroscopic images. A post-evacuation overhead radiograph of the abdomen was performed.,FINDINGS:, The scout radiograph demonstrates a nonobstructive gastrointestinal pattern. There are no suspicious calcifications seen or evidence of gross free intraperitoneal air. The visualized lung bases and osseous structures are within normal limits.,The rectum and colon is of normal caliber throughout its course. There is no evidence of obstruction, as contrast is seen to flow without difficulty into the right colon and cecum. A small amount of contrast is seen to opacify small bowel loops on the post-evacuation image. There is also opacification of a normal-appearing appendix documented.,IMPRESSION: , Normal barium enema.

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: ,Carcinoma of the left upper lobe.,PROCEDURES PERFORMED:,1. Bronchoscopy with aspiration.,2. Left upper lobectomy.,PROCEDURE DETAILS: ,With patient in supine position under general anesthesia with endotracheal tube in place, the flexible bronchoscope was then placed down through the endotracheal tube to examine the carina. The carina was in the midline and sharp. Moving directly to the right side, the right upper and middle lower lobes were examined and found to be free of obstructions. Aspiration was carried out for backlog ________ examination. We then moved to left side, left upper lobe. There was a tumor mass located in the lingula of the left lobe and left lower lobe found free of obstruction. No anatomic lesions were demonstrated. The patient was prepared for left thoracotomy rotated to his right side with a double lumen endotracheal tube in place with an NG tube and a Foley catheter. After proper position, utilizing Betadine solution, they were draped. A posterolateral left thoracotomy incision was performed. Hemostasis was secured with electrocoagulation. The chest wall muscle was then divided over the sixth rib. The periosteum of the sixth rib was then removed superiorly and the pleural cavity was entered carefully. At this time, the mass was felt in the left upper lobe, which measures greater than 3 cm by palpation. We examined the superior mediastinum. No lymph nodes were demonstrated as well as in the anterior mediastinum. Direction was then moved to the fascia where by utilizing sharp and blunt dissection, lingual artery was separated into the left upper lobe. Casual dissection was carried out with superior segmental arteries and left lower lobe was examined.,Dissection was carried out around the pulmonary artery thus exposing the posterior artery to the left upper lobe. Direction was carried out to the superior pulmonary vein and utilizing sharp and blunt dissection the entire superior pulmonary vein was separated from the surrounding tissue. From the top side, the bronchus was then separated away from the pulmonary artery anteriorly, thus exposing the apical posterior artery, which was short. Tumor mass was close to the artery at this time. We then directed ourselves once again to the lingual artery which was doubly ligated and cut free. The posterior artery of the superior branch was doubly ligated and cut free also. At this time, the bronchus of the left upper lobe was encountered in the fissure on palpation to separate the upper lobe bronchus from lower lobe bronchus and the area was accomplished. We then moved anteriorly to doubly ligate the pulmonary vein using #00 silk sutures for ligation and a transection #00 silk suture was used to fixate the vein. Using sharp and blunt dissection, the bronchus through the left upper lobe was freed proximal. Using the TA 50, the bronchus was then cut free allowing the lung to fall superiorly at which time direction was carried out to the pulmonary artery where the tumor was in close proximity at this time. A Potts clamp arterial was then placed over the artery and shaving off the tumor and the apical posterior artery was then accomplished. The anterior artery was seen in the clamp also and was separated and ligated and separated. At this time, the entire tumor in the left upper lobe was then removed. ,Direction was carried to the suture where #000 silk was used as a running suture over the pulmonary artery and was here doubly run and tied in place. The clamp was then removed. No bleeding was seen at this time. Lymph nodes were then removed from the sump of the separation between the upper lobe and the lower lobe and sent for separate pathology. We then carried out incision in the inferior pulmonary ligament up to the pulmonary vein allowing the lung to reexpand to its normal position. At this time, two chest tubes #28 and #32 were placed anteriorly and posteriorly to fixate the skin using raw silk suture. The chest cavity was then closed. After reexamination, no bleeding was seen with three pericostal sutures of #1 chromic double strength. A #2-0 Polydek was then used to close the chest wall muscle the anterior as well as latissimus dorsi #000 chromic subcutaneous tissue skin clips to the skin. The chest tubes were attached to the Pleur-Evac drainage and placed on suction at this time. The patient was extubated in the room without difficulty and sent to Recovery in satisfactory.

Cardiovascular / Pulmonary

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

EXAM:,MRI CERVICAL SPINE,CLINICAL:, A57-year-old male. Received for outside consultation is an MRI examination performed on 11/28/2005.,FINDINGS:,Normal brainstem-cervical cord junction. Normal cisterna magna with no tonsillar ectopia. Normal clivus with a normal craniovertebral junction. Normal anterior atlantoaxial articulation.,C2-3: Normal intervertebral disc with no spondylosis or uncovertebral joint arthrosis. Normal central canal and intervertebral neural foramina with no cord or radicular impingement.,C3-4: There is disc desiccation with minimal annular bulging. The residual AP diameter of the central canal measures approximately 10mm. CSF remains present surrounding the cord.,C4-5: There is disc desiccation with endplate spondylosis and mild uncovertebral joint arthrosis. The residual AP diameter of the central canal measures approximately 8mm with effacement of the circumferential CSF cleft producing a borderline central canal stenosis but no cord distortion or cord edema. There is minimal uncovertebral joint arthrosis.,C5-6: There is disc desiccation with minimal posterior annular bulging and a right posterolateral preforaminal disc protrusion measuring approximately 2 x 8mm (AP x transverse). The disc protrusion produces minimal rightward ventral thecal sac flattening but no cord impingement.,C6-7: There is disc desiccation with mild loss of disc space height and posterior endplate spondylosis and annular bulging producing central canal stenosis. The residual AP diameter of the central canal measures 8 mm with effacement of the circumferential CSF cleft. There is a left posterolateral disc-osteophyte complex encroaching upon the left intervertebral neural foramen with probable radicular impingement upon the exiting left C7 nerve root.,C7-T1, T1-2: Minimal disc desiccation with no disc displacement or endplate spondylosis.,IMPRESSION:,Multilevel degenerative disc disease as described above.,C4-5 borderline central canal stenosis with mild bilateral foraminal compromise.,C5-6 disc desiccation with a borderline central canal stenosis and a right posterolateral preforaminal disc protrusion producing thecal sac distortion.,C6-7 degenerative disc disease and endplate spondylosis with a left posterolateral disc-osteophyte complex producing probable neural impingement upon the exiting left C7 nerve root with a borderline central canal stenosis.,Normal cervical cord.

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 PROBLEM:, XYZ was seen by Dr. ABC for an FCR tendinitis. We do not have his reports, but by history she has had two cortisone shots. She plays musical instruments, and it does bother her from time to time. She was considering surgery, but she takes ibuprofen and it seems to be well-controlled. She is here now for consultation. ,CLINICAL/PHYSICAL EXAMINATION: , ,General: The patient is alert and oriented times three in no acute distress. ,Skin: No skin breakdown or hyperhidrosis.,Vascular: 2+ radial and ulnar artery pulses.,Musculoskeletal: Wrist, elbow, shoulder and neck exams reveal no focal findings except for some tenderness to palpation over the FCR tendon on the scaphoid tubercle, but there is no SL instability and no signs of lunotriquetral instability or midcarpal instability. The DRUJ is stable. Flexion/extension of the fingers is all intact. Forearm, elbow and shoulder exams reveal no other focal tenderness to palpation.,Neurologic: Negative Tinel's, Phalen's and compression median nerve test. APB, EPL and first dorsal interosseous have 5/5 strength. Forearm, elbow and shoulder exams reveal no neurologic compromise.,Gait: Normal.,Neck: Negative Spurling sign. Negative signs of thoracic outlet.,HEENT: Pupils equal and reactive with no asymmetry.,CLINICAL IMPRESSION:, By history, possible FCR tendinitis.,EVALUATION/TREATMENT PLAN: At this point, we have asked her some questions again. She is not that sore at this point, and she has had a couple of cortisone shots. Without being the initial treating physician, she has FCR tendinitis that fails to respond to cortisone shots. She is a candidate for an FCR tunnel release. It has been described and is effective for those patients with that problem. My only consideration would be, if the patient should choose, to get an MRI when she is symptomatic to confirm the FCR tendinitis. She will followup with Dr. ABC as needed or come back to us when she is thinking more along the lines of surgery.

Orthopedic

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSES:,1. Senile nuclear cataract, left eye.,2. Senile cortical cataract, left eye., ,POSTOPERATIVE DIAGNOSES:,1. Senile nuclear cataract, left eye.,2. Senile cortical cataract, left eye., ,PROCEDURES: , Phacoemulsification of cataract, extraocular lens implant in left eye., ,LENS IMPLANT USED:, Alcon, model SN60WF, power of 22.5 diopters., ,PHACOEMULSIFICATION TIME:, 1 minute 41 seconds at 44.4% power., ,INDICATIONS FOR PROCEDURE: , This patient has a visually significant cataract in the affected eye with the best corrected visual acuity under moderate glare conditions worse than 20/40. The patient complains of difficulties with glare in performing activities of daily living.,INFORMED CONSENT:, The risks, benefits and alternatives of the procedure were discussed with the patient in the office prior to scheduling surgery. All questions from the patient were answered after the surgical procedure was explained in detail. The risks of the procedure as explained to the patient include, but are not limited to, pain, infection, bleeding, loss of vision, retinal detachment, need for further surgery, loss of lens nucleus, double vision, etc. Alternative of the procedure is to do nothing or seek a second opinion. Informed consent for this procedure was obtained from the patient.,OPERATIVE TECHNIQUE: , The patient was brought to the holding area. Previously, an intravenous infusion was begun at a keep vein open rate. After adequate sedation by the anesthesia department (under monitored anesthesia care conditions), a peribulbar and retrobulbar block was given around the operative eye. A total of 10 mL mixture with a 70/30 mixture of 2% Xylocaine without epinephrine and 0.75% bupivacaine without epinephrine. An adequate amount of anesthetic was infused around the eye without giving excessive tension to the eye or excessive chemosis to the periorbital area. Manual pressure and a Honan balloon were placed over the eye for approximately 2 minutes after injection and adequate akinesia and anesthesia was noted. Vital sign monitors were detached from the patient. The patient was moved to the operative suite and the same monitors were reattached. The periocular area was cleansed, dried, prepped and draped in the usual sterile manner for ocular surgery. The speculum was set into place and the operative microscope was brought over the eye. The eye was examined. Adequate mydriasis was observed and a visually significant cataract was noted on the visual axis.,A temporal clear corneal incision was begun using a crescent blade with an initial groove incision made partial thickness through the temporal clear cornea. Then a pocket incision was created without entering the anterior chamber of the eye. Two peripheral paracentesis ports were created on each side of the initial incision site. Viscoelastic was used to deepen the anterior chamber of the eye. A 2.65 mm keratome was then used to complete the corneal valve incision. A cystitome was bent and created using a tuberculin syringe needle. It was placed in the anterior chamber of the eye. A continuous curvilinear capsulorrhexis was begun. It was completed using O'Gawa Utrata forceps. A balanced salt solution on the irrigating cannula was placed through the paracentesis port of the eye to affect hydrodissection and hydrodelineation of the lens nucleus. The lens nucleus was noted to be freely mobile in the bag.,The phacoemulsification tip was placed into the anterior chamber of the eye. The lens nucleus was phacoemulsified and aspirated in a divide-and-conquer technique. All remaining cortical elements were removed from the eye using irrigation and aspiration using a bimanual technique through the paracentesis ports. The posterior capsule remained intact throughout the entire procedure. Provisc was used to deepen the anterior chamber of the eye. A crescent blade was used to expand the internal aspect of the wound. The lens was taken from its container and inspected. No defects were found. The lens power selected was compared with the surgery worksheet from Dr. X's office. The lens was placed in an inserter under Provisc. It was placed through the wound, into the capsular bag and extruded gently from the inserter. It was noted to be adequately centered in the capsular bag using a Sinskey hook. The remaining viscoelastic was removed from the eye with irrigation an aspiration through the paracentesis side ports using a bimanual technique. The eye was noted to be inflated without overinflation. The wounds were tested for leaks, none were found. Five drops dilute Betadine solution was placed over the eye. The eye was irrigated. The speculum was removed. The drapes were removed. The periocular area was cleaned and dried. Maxitrol ophthalmic ointment was placed into the interpalpebral space. A semi-pressure patch and shield was placed over the eye. The patient was taken to the floor in stable and satisfactory condition, was given detailed written instructions and asked to follow up with Dr. X tomorrow morning in the office.

Surgery

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PROCEDURE PERFORMED: , Ultrasound-guided placement of multilumen central venous line, left femoral vein.,INDICATIONS:, Need for venous access in a patient on a ventilator and on multiple IV drugs.,CONSENT: , Consent obtained from patient's sister.,PREOPERATIVE MEDICATIONS: , Local anesthesia with 1% plain lidocaine.,PROCEDURE IN DETAIL: , The ultrasound was used to localize the left femoral vein and to confirm it's patency and course. The left inguinal area was then prepped and draped in a sterile manner. The overlying soft tissues were anesthetized with 1% plain lidocaine. Under direct ultrasound visualization, the femoral vein was cannulated without difficulty, and a guidewire advanced. This was followed by a stab incision and the vein dilator in order to form a tract for the catheter itself. Finally, the multilumen catheter itself was inserted over the guidewire. Once the catheter was fully inserted, the guidewire was completely withdrawn. Placement was confirmed by the withdrawal of dark venous blood from all ports; all ports were then flushed, the catheter sewn into place, and the dressing applied. He tolerated the procedure very well, without 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'

PROCEDURE: , Endotracheal intubation.,INDICATION: , Respiratory failure.,BRIEF HISTORY: , The patient is a 52-year-old male with metastatic osteogenic sarcoma. He was admitted two days ago with small bowel obstruction. He has been on Coumadin for previous PE and currently on heparin drip. He became altered and subsequently deteriorated quite rapidly to the point where he is no longer breathing on his own and has minimal responsiveness. A code blue was called. On my arrival, the patient's vital signs are stable. His blood pressure is systolically in 140s and heart rate 80s. He however has 0 respiratory effort and is unresponsive to even painful stimuli. The patient was given etomidate 20 mg.,DESCRIPTION OF PROCEDURE: ,The patient positioned appropriate equipment at the bedside, given 20 mg of etomidate and 100 mg of succinylcholine. Mac-4 blade was used. A 7.5 ET tube placed to 24th teeth. There is good color change on the capnographer with bilateral breath sounds. Following intubation, the patient's blood pressure began to drop. He was given 2 L of bolus. I started him on dopamine drip at 10 mcg. Dr. X was at the bedside, who is the primary caregiver, he assumed the care of the patient, will be transferred to the ICU. Chest x-ray will be reviewed and Pulmonary will be consulted.

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.

General Medicine

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS: , Post infarct angina.,TYPE OF PROCEDURE: , Left cardiac catheterization with selective right and left coronary angiography.,PROCEDURE: , After informed consent was obtained, the patient was brought to the Cardiac Catheterization Laboratory, and the groin was prepped in the usual fashion. Using 1% lidocaine, the right groin was infiltrated, and using the Seldinger technique, the right femoral artery was cannulated. Through this, a moveable guidewire was then advance to the level of the diaphragm, and through it, a 6 French pigtail catheter was advanced under hemodynamic monitoring to the ascending aorta and inserted into the left ventricle. Pressure measurements were obtained and cineangiograms in the RAO and LAO positions were then obtained. Catheter was then withdrawn and a #6 French non-bleed-back sidearm sheath was then introduced, and through this, a 6 French Judkins left coronary catheter was then advanced under hemodynamic monitoring to the left coronary ostium, engaged. Cineangiograms were obtained of the left coronary system. This catheter was then exchanged for a Judkins right 4 coronary catheter of similar dimension and under hemodynamic monitoring again was advanced to the right coronary ostium, engaged. Cineangiograms were obtained, and the catheter and sheath were then withdrawn. The patient tolerated the procedure well and left the Cardiac Catheterization Laboratory in stable condition. No evidence of hematoma formation or active bleeding. ,COMPLICATIONS: , None. ,TOTAL CONTRAST: , 110 cc of Hexabrix. ,TOTAL FLUOROSCOPY TIME: ,1.8 minutes. ,MEDICATIONS: , Reglan 10 mg p.o., 5 mg p.o. Valium, Benadryl 50 mg p.o. and heparin 3,000 units IV push.

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 65-year-old female who underwent left upper lobectomy for stage IA non-small cell lung cancer. She returns for a routine surveillance visit.,She has undergone since her last visit an abdominopelvic CT, which shows an enlarging simple cyst of the left kidney. She underwent barium swallow, which demonstrates a small sliding hiatal hernia with minimal reflux. She has a minimal delayed emptying secondary tertiary contractions. PA and lateral chest x-ray from the 11/23/09 was also reviewed, which demonstrates no lesions or infiltrates. Review of systems, the patient continues to have periodic odynophagia and mid thoracic dysphagia. This most likely is secondary to tertiary contractions with some delayed emptying. She has also had increased size of the left calf without tenderness, which has not resolved over the past several months. She has had a previous DVT in 1975 and 1985. She denies weight loss, anorexia, fevers, chills, headaches, new aches or pains, cough, hemoptysis, shortness of breath at rest, or dyspnea on exertion.,MEDICATIONS: , Aspirin 81 mg p.o. q.d., Spiriva 10 mcg q.d., and albuterol p.r.n.,PHYSICAL EXAMINATION: , BP: 117/78. RR: 18. P: 93.,WT: 186 lbs. RAS: 100%.,HEENT: Mucous membranes are moist. No cervical or supraclavicular lymphadenopathy.,LUNGS: Clear to auscultation bilaterally.,CARDIAC: Regular rate and rhythm without murmurs.,EXTREMITIES: No cyanosis, clubbing or edema.,NEURO: Alert and oriented x3. Cranial nerves II through XII intact.,ASSESSMENT: , The patient has no evidence of disease now status post left upper lobectomy for stage IA non-small cell lung cancer 13 months ago.,PLAN: ,She is to return to clinic in six months with a chest CT. She was given a prescription for an ultrasound of the left lower extremity to rule out DVT. She will be called with the results. She was given a prescription for nifedipine 10 mg p.o. t.i.d. p.r.n. esophageal spasm.

Cardiovascular / Pulmonary

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS: , Left tibial tubercle avulsion fracture.,POSTOPERATIVE DIAGNOSIS:, Comminuted left tibial tubercle avulsion fracture with intraarticular extension.,PROCEDURE:, Open reduction and internal fixation of left tibia.,ANESTHESIA: , General. The patient received 10 ml of 0.5% Marcaine local anesthetic.,TOURNIQUET TIME: , 80 minutes.,ESTIMATED BLOOD LOSS:, Minimal.,DRAINS: , One JP drain was placed.,COMPLICATIONS: , No intraoperative complications or specimens. Hardware consisted of two 4-5 K-wires, One 6.5, 60 mm partially threaded cancellous screw and one 45, 60 mm partially threaded cortical screw and 2 washers.,HISTORY AND PHYSICAL:, The patient is a 14-year-old male who reported having knee pain for 1 month. Apparently while he was playing basketball on 12/22/2007 when he had gone up for a jump, he felt a pop in his knee. The patient was seen at an outside facility where he was splinted and subsequently referred to Children's for definitive care. Radiographs confirmed comminuted tibial tubercle avulsion fracture with patella alta. Surgery is recommended to the grandmother and subsequently to the father by phone. Surgery would consist of open reduction and internal fixation with subsequent need for later hardware removal. Risks of surgery include the risks of anesthesia, infection, bleeding, changes on sensation in most of the extremity, hardware failure, need for later hardware removal, failure to restore extensor mechanism tension, and need for postoperative rehab. All questions were answered, and father and grandmother agreed to the above plan.,PROCEDURE: , The patient was taken to the operating and placed supine on the operating table. General anesthesia was then administered. The patient was given Ancef preoperatively. A nonsterile tourniquet was placed on the upper aspect of the patient's left thigh. The patient's extremity was then prepped and draped in the standard surgical fashion. Midline incision was marked on the skin extending from the tibial tubercle proximally and extremities wrapped in Esmarch. Finally, the patient had tourniquet that turned in 75 mmHg. Esmarch was then removed. The incision was then made. The patient had significant tearing of the posterior retinaculum medially with proximal migration of the tibial tubercle which was located in the joint there was a significant comminution and intraarticular involvement. We were able to see the underside of the anterior horn of both medial and lateral meniscus. The intraarticular cartilage was restored using two 45 K-wires. Final position was checked via fluoroscopy and the corners were buried in the cartilage. There was a large free floating metaphyseal piece that included parts of proximal tibial physis. This was placed back in an anatomic location and fixed using a 45 cortical screw with a washer. The avulsed fragment with the patellar tendon was then fixed distally to this area using a 6.5, 60 mm cancellous screw with a washer. The cortical screw did not provide good compression and fixation at this distal fragment. Retinaculum was repaired using 0 Vicryl suture as best as possible. The hematoma was evacuated at the beginning of the case as well as the end. The knee was copiously irrigated with normal saline. The subcutaneous tissue was re-approximated using 2-0 Vicryl and the skin with 4-0 Monocryl. The wound was cleaned, dried, and dressed with Steri-Strips, Xeroform, and 4 x4s. Tourniquet was released at 80 minutes. JP drain was placed on the medium gutter. The extremity was then wrapped in Ace wrap from the proximal thigh down to the toes. The patient was then placed in a knee mobilizer. The patient tolerated the procedure well. Subsequently extubated and taken to the recovery in stable condition.,POSTOP PLAN: ,The patient hospitalized overnight to decrease swelling and as well as manage his pain. He may weightbear as tolerated using knee mobilizer. Postoperative findings relayed to the grandmother. The patient will need subsequent hardware removal. The patient also was given local anesthetic at the end of the case.

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:, Subglottic stenosis.,POSTOPERATIVE DIAGNOSIS: , Subglottic stenosis.,OPERATIVE PROCEDURES: , Direct laryngoscopy and bronchoscopy.,ANESTHESIA:, General inhalation.,DESCRIPTION OF PROCEDURE: , The patient was taken to the operating room and placed supine on the operative table. General inhalational anesthesia was administered through the patient's tracheotomy tube. The small Parsons laryngoscope was inserted and the 2.9-mm telescope was used to inspect the airway. There was an estimated 60-70% circumferential mature subglottic stenosis that extended from just under the vocal folds to approximately 3 mm below the vocal folds. The stoma showed some suprastomal fibroma. The remaining tracheobronchial passages were clear. The patient's 3.5 neonatal tracheostomy tube was repositioned and secured with Velcro ties. Bleeding was negligible. There were no untoward complications. The patient tolerated the procedure well and was transferred to recovery room in stable condition.

Cardiovascular / Pulmonary

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

REASON FOR CONSULTATION:, Pericardial effusion.,HISTORY OF PRESENT ILLNESS: , The patient is an 84-year-old female presented to emergency room with shortness of breath, fatigue, and tiredness. Low-grade fever was noted last few weeks. The patient also has chest pain described as dull aching type in precordial region. No relation to exertion or activity. No aggravating or relieving factors. A CT of the chest was done, which shows pericardial effusion. This consultation is for the same. The patient denies any lightheadedness or dizziness. No presyncope or syncope. Activity is fairly stable.,CORONARY RISK FACTORS: , History of borderline hypertension. No history of diabetes mellitus. Nonsmoker. Cholesterol status is within normal limits. No history of established coronary artery disease. Family history noncontributory.,FAMILY HISTORY: , Nonsignificant.,PAST SURGICAL HISTORY: ,Hysterectomy and bladder surgery.,MEDICATIONS AT HOME: ,Aspirin and thyroid supplementation.,ALLERGIES:, None.,PERSONAL HISTORY:, She is a nonsmoker. She does not consume alcohol. No history of recreational drug use.,PAST MEDICAL HISTORY:,1. Hypothyroidism.,2. Borderline hypertension.,3. Arthritis.,4. Presentation at this time with chest pain and shortness of breath.,REVIEW OF SYSTEMS,CONSTITUTIONAL: Weakness, fatigue, and tiredness.,HEENT: No history of cataract, blurring of vision, or glaucoma.,CARDIOVASCULAR: Chest pain. No congestive heart failure. No arrhythmia.,RESPIRATORY: No history of pneumonia in the past, valley fever.,GASTROINTESTINAL: Epigastric discomfort. No hematemesis or melena.,UROLOGICAL: Frequency. No urgency. No hematuria.,MUSCULOSKELETAL: Arthritis and muscle weakness.,CNS: No TIA. No CVA. No seizure disorder.,ENDOCRINE: Nonsignificant.,HEMATOLOGICAL: Nonsignificant.,PHYSICAL EXAMINATION,VITAL SIGNS: Pulse of 86, blood pressure 93/54, afebrile, respiratory rate 16 per minute.,HEENT: Atraumatic and normocephalic.,NECK: Supple. Neck veins flat. No significant carotid bruit.,LUNGS: Air entry bilaterally fair.,HEART: PMI displaced. S1 and S2 regular.,ABDOMEN: Soft and nontender.,EXTREMITIES: No edema. Pulses palpable. No clubbing or cyanosis.,CNS: Grossly intact.,LABORATORY DATA: ,White count of 20 and H&H 13 and 39. BUN and creatinine within normal limits. Cardiac enzyme profile negative.,RADIOGRAPHIC STUDIES: , CT of the chest preliminary report, pericardial effusion. Echocardiogram shows pericardial effusion, which appears to be chronic. There is no evidence of hemodynamic compromise.,IMPRESSION:,1. The patient is an 84-year-old female admitted with chest pain and shortness of breath, possibly secondary to pulmonary disorder. She has elevated white count, possible infection.,2. Pericardial effusion without any hemodynamic compromise, could be chronic.

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'

2-D ECHOCARDIOGRAM,Multiple views of the heart and great vessels reveal normal intracardiac and great vessel relationships. Cardiac function is normal. There is no significant chamber enlargement or hypertrophy. There is no pericardial effusion or vegetations seen. Doppler interrogation, including color flow imaging, reveals systemic venous return to the right atrium with normal tricuspid inflow. Pulmonary outflow is normal at the valve. Pulmonary venous return is to the left atrium. The interatrial septum is intact. Mitral inflow and ascending aorta flow are normal. The aortic valve is trileaflet. The coronary arteries appear to be normal in their origins. The aortic arch is left-sided and patent with normal descending aorta pulsatility.

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'

PROBLEM LIST:,1. Type 1 diabetes mellitus, insulin pump.,2. Hypertension.,3. Hyperlipidemia.,HISTORY OF PRESENT ILLNESS: , The patient is a 39-year-old woman returns for followup management of type 1 diabetes mellitus. Her last visit was approximately 4 months ago. Since that time, the patient states her health had been good and her glycemic control had been good, however, within the past 2 weeks she had a pump malfunction, had to get a new pump and was not certain of her pump settings and has been having some difficulty with glycemic control over the past 2 weeks. She is not reporting any severe hypoglycemic events, but is having some difficulty with hyperglycemia both fasting and postprandial. She is not reporting polyuria, polydipsia or polyphagia. She is not exercising at this point and has a diet that is rather typical of woman with twins and a young single child as well. She is working on a full-time basis and so eats on the run a lot, probably eats more than she should and not making the best choices, little time for physical activity. She is keeping up with all her other appointments and has recently had a good eye examination. She had lab work done at her previous visit and this revealed persistent hyperlipidemic state with a LDL of 144.,CURRENT MEDICATIONS:,1. Zoloft 50 mg p.o. once daily.,2. Lisinopril 40 mg once daily.,3. Symlin 60 micrograms, not taking at this point.,4. Folic acid 2 by mouth every day.,5. NovoLog insulin via insulin pump about 90 units of insulin per day.,REVIEW OF SYSTEMS:, She denies fever, chills, sweats, nausea, vomiting, diarrhea, constipation, abdominal pain, chest pain, shortness of breath, difficulty breathing, dyspnea on exertion or change in exercise tolerance. She is not having painful urination or blood in the urine. She is not reporting polyuria, polydipsia or polyphagia.,PHYSICAL EXAMINATION:,GENERAL: Today showed a very pleasant, well-nourished woman, in no acute distress. VITAL SIGNS: Temperature not taken, pulse 98, respirations 20, blood pressure 148/89, and weight 91.19 kg. THORAX: Revealed lungs clear, PA and lateral without adventitious sounds. CARDIOVASCULAR: Demonstrated regular rate and rhythm. S1 and S2 without murmur. No S3, no S4 auscultated. ABDOMEN: Nontender. EXTREMITIES: Showed no clubbing, cyanosis or edema. SKIN: Intact and do not appear atrophic. Deep tendon reflexes were 2+/4 without a delayed relaxation phase.,LABORATORY DATA:, Dated 10/05/08 showed a total cholesterol of 223, triglyceride 140, HDL 54, and LDL 144. The hemoglobin A1c was 6.4 and the spot urine for microalbumin was 9.2 micrograms of protein, 1 mg of creatinine. Sodium 136, potassium 4.5, chloride 102, CO2 30 mEq, BUN 11 mg/dL, creatinine 0.6 mg, estimated GFR greater than 60, blood sugar 118, calcium 9.4, and her LFTs were unremarkable. TSH is 1.07 and free T4 is 0.81.,ASSESSMENT AND PLAN:,1. This is a return visit to the endocrine clinic for the patient, a 39-year-old woman with history as noted above. Plan today is to make adjustments to her pump based on a total daily dose of 90 units of insulin. Basal rate is as follows, 12 a.m. 1.5, 02:30 a.m. 1.75, and 6 a.m. 1.5. Her correction factor is 19. Her carb/insulin ratio is 6. Her active insulin time is 5 and her targets are at 12 a.m. 110 and 6 a.m. to midnight is 100. We made adjustments to her pump and the plan will be to see her back in approximately 2 months.,2. Hyperlipidemia. The patient is not taking statin, therefore, we will prescribe Lipitor 20 mg one p.o. once daily. Have her watch for side effects from the medication and plan to do a fasting lipid panel and CMP approximately 8 weeks from now.,3. We will get a hemoglobin A1c and spot urine for albumin in 8 weeks as well.

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'

GENERAL: , Well developed, well nourished, alert, in no acute distress. GCS 50, nontoxic.,VITAL SIGNS: , Blood pressure *, pulse *, respirations *, temperature * degrees F. Pulse oximetry *%.,HEENT: , Eyes: Lids and conjunctiva. No lesions. Pupils equal, round, reactive to light and accommodation. Irises symmetrical, undilated. Funduscopic exam reveals no hemorrhages or discopathy. Ears, Nose, Mouth, and throat: External ears without lesions. Nares patent. Septum midline. Tympanic membranes without erythema, bulging or retraction. Canals without lesion. Hearing is grossly intact. Lips, teeth, gums, palate without lesion. Posterior oropharynx: No erythema. No tonsillar enlargement, crypt formation or abscess.,NECK: ,Supple and symmetric. No masses. Thyroid midline, non enlarged. No JVD. Neck is nontender. Full range of motion without pain.,RESPIRATORY: , Good respiratory effort. Clear to auscultation. Clear to percussion. Chest: Symmetrical rise and fall. Symmetrical expansion. No egophony or tactile fremitus.,CARDIOVASCULAR:, Regular rate and rhythm. No murmur, gallops, clicks, heaves or rub. Cardiac palpation within normal limits. Pulses equal at carotid. Femoral and pedal pulses: No peripheral edema.,GASTROINTESTINAL: ,No tenderness or mass. No hepatosplenomegaly. No hernia. Bowel sounds equal times four quadrants. Abdomen is nondistended. No rebound, guarding, rigidity or ecchymosis.,MUSCULOSKELETAL: , Normal gait and station. No pathology to digits or nails. Extremities move times four. No tenderness or effusion. Range of motion adequate. Strength and tone equal bilaterally, stable.,BACK: , Nontender on midline. Full range of motion with flexion, extension and sidebending.,SKIN:, Inspection within normal limits. Well hydrated. No diaphoresis. No obvious wound.,LYMPH:, Cervical lymph nodes. No lymphadenopathy.,NEUROLOGICAL: ,Cranial nerves II-XII grossly intact. DTRs symmetric 2 out of 4 bilateral upper and lower extremity, elbow, patella and ankle. Motor strength 4/4 bilateral upper and lower extremity. Straight leg raise is negative bilaterally.,PSYCHIATRIC: , Judgment and insight adequate. Alert and oriented times three. Memory and mood within normal limits. No delusions, hallucinations. No suicidal or homicidal ideation.

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 DIAGNOSES: ,1. Suspected mastoiditis ruled out.,2. Right acute otitis media.,3. Severe ear pain resolving.,HISTORY OF PRESENT ILLNESS: , The patient is an 11-year-old male who was admitted from the ER after a CT scan suggested that the child had mastoiditis. The child has had very severe ear pain and blood draining from the right ear. The child had a temperature maximum of 101.4 in the ER. The patient was admitted and started on IV Unasyn, which he tolerated well and required Morphine and Vicodin for pain control. In the first 12 hours after admission, the patient's pain decreased and also swelling of his cervical area decreased. The patient was evaluated by Dr. X from the ENT while in house. After reviewing the CT scan, it was felt that the CT scan was not consistent with mastoiditis. The child was continued on IV fluid and narcotics for pain as well as Unasyn until the time of discharge. At the time of discharge his pain is markedly decreased about 2/10 and swelling in the area has improved. The patient is also able to take p.o. well.,DISCHARGE PHYSICAL EXAMINATION:,GENERAL: The patient is alert, in no respiratory distress.,VITAL SIGNS: His temperature is 97.6, heart rate 83, blood pressure 105/57, respiratory rate 16 on room air.,HEENT: Right ear shows no redness. The area behind his ear is nontender. There is a large posterior chains node that is nontender and the swelling in this area has decreased markedly.,NECK: Supple.,CHEST: Clear breath sounds.,CARDIAC: Normal S1, S2 without murmur.,ABDOMEN: Soft. There is no hepatosplenomegaly or tenderness.,SKIN: Warm and well perfused.,DISCHARGE WEIGHT: , 38.7 kg.,DISCHARGE CONDITION: , Good.,DISCHARGE DIET:, Regular as tolerated.,DISCHARGE MEDICATIONS: ,1. Ciprodex Otic Solution in the right ear twice daily.,2. Augmentin 500 mg three times daily x10 days.,FOLLOW UP: ,1. Dr. Y in one week (ENT).,2. The primary care physician in 2 to 3 days.,TIME SPENT: , Approximate discharge time is 28 minutes.

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'

PHYSICAL EXAMINATION,GENERAL: , The patient is awake and alert, in no apparent distress, appropriate, pleasant and cooperative. No dysarthria is noted. No discomfort on presentation is noted. ,HEAD: , Atraumatic, normocephalic. Pupils are equal, round and reactive to light. Extraocular muscles are intact. Sclerae are white without injection or icterus. Fundi are without papilledema, hemorrhages or exudates with normal vessels. ,EARS: , The ear canals are patent without edema, exudate or drainage. Tympanic membranes are intact with a normal cone of light. No bulging or erythema to indicate infection is present. There is no hemotympanum. Hearing is grossly intact. ,NOSE:, Without deformity, bleeding or discharge. No septal hematoma is noted. ,ORAL CAVITY:, No swelling or abnormality to the lip or teeth. Oral mucosa is pink and moist. No swelling to the palate or pharynx. Uvula is midline. The pharynx is without exudate or erythema. No edema is seen of the tonsils. The airway is completely patent. The voice is normal. No stridor is heard. ,NECK: , No signs of meningismus. No Brudzinski or Kernig sign is present. No adenopathy is noted. No JVD is seen. No bruits are auscultated. Trachea is midline. ,CHEST: , Symmetrical with equal breath sounds. Equal excursion. No hyperresonance or dullness to percussion is noted. There is no tenderness on palpation of the chest. ,LUNGS: ,Clear to auscultation bilaterally. No rales, rhonchi or wheezes are appreciated. Good air movement is auscultated in all 4 lung fields. ,HEART:, Regular rate and rhythm. No murmur. No S3, S4 or rub is auscultated. Point of maximal impulse is strong and in normal position. Abdominal aorta is not palpable. The carotid upstroke is normal. ,ABDOMEN: ,Soft, nontender and nondistended. Normal bowel sounds are auscultated. No organomegaly is appreciated. No masses are palpated. No tympany is noted on percussion. No guarding, rigidity or rebound tenderness is seen on exam. Murphy and McBurney sign is negative. There is no Rovsing, obturator or psoas sign present. No hepatosplenomegaly and no hernias are noted. ,RECTAL:, Normal tone. No masses. Soft, brown stool in the vault. Guaiac negative. ,GENITOURINARY:, Penis is normal without lesion or urethral discharge. Scrotum is without edema. The testes are descended bilaterally. No masses are palpated. There is no tenderness. ,EXTREMITIES: , No clubbing, cyanosis or edema. Pulses are strong and equal in the femoral and dorsalis pedis arteries, bounding and equal. No deformity or signs of trauma. All joints are stable without laxity. There is good range of motion of all joints without tenderness or discomfort. Homan sign is negative. No atrophy or contractures are noted. ,SKIN: , No rashes. No jaundice. Pink and warm with good turgor. Good color. No erythema or nodules noted. No petechia, bulla or ecchymosis. ,NEUROLOGIC: , Cranial nerves II through XII are grossly intact. Muscle strength is graded 5/5 in the upper and lower extremities bilaterally. Deep tendon reflexes are symmetrical in the upper and lower extremities bilaterally. Babinski is downgoing bilaterally. Sensation is intact to light touch and vibration. Gait is normal. Romberg, finger-to-nose, rapid alternating movements and heel-to-shin are all normal. There is no ataxia seen on gait testing. Tone is normal. No pronator drift is seen. ,PSYCHIATRIC: ,The patient is oriented x4. Mood and affect are appropriate. Memory is intact with good short- and long-term memory recall. No dysarthria is noted. Remote memory is intact. Judgment and insight appear normal.,

Consult - History and Phy.

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

CHIEF COMPLAINT:, Non-healing surgical wound to the left posterior thigh.,HISTORY OF PRESENT ILLNESS: , This is a 49-year-old white male who sustained a traumatic injury to his left posterior thighthis past year while in ABCD. He sustained an injury from the patellar from a boat while in the water. He was air lifted actually up to XYZ Hospital and underwent extensive surgery. He still has an external fixation on it for the healing fractures in the leg and has undergone grafting and full thickness skin grafting closure to a large defect in his left posterior thigh, which is nearly healed right in the gluteal fold on that left area. In several areas right along the graft site and low in the leg, the patient has several areas of hypergranulation tissue. He has some drainage from these areas. There are no signs and symptoms of infection. He is referred to us to help him get those areas under control.,PAST MEDICAL HISTORY:, Essentially negative other than he has had C. difficile in the recent past.,ALLERGIES:, None.,MEDICATIONS: , Include Cipro and Flagyl.,PAST SURGICAL HISTORY: , Significant for his trauma surgery noted above.,FAMILY HISTORY: , His maternal grandmother had pancreatic cancer. Father had prostate cancer. There is heart disease in the father and diabetes in the father.,SOCIAL HISTORY:, He is a non-cigarette smoker and non-ETOH user. He is divorced. He has three children. He has an attorney.,REVIEW OF SYSTEMS:,CARDIAC: He denies any chest pain or shortness of breath.,GI: As noted above.,GU: As noted above.,ENDOCRINE: He denies any bleeding disorders.,PHYSICAL EXAMINATION:,GENERAL: He presents as a well-developed, well-nourished 49-year-old white male who appears to be in no significant distress.,HEENT: Unremarkable.,NECK: Supple. There is no mass, adenopathy, or bruit.,CHEST: Normal excursion.,LUNGS: Clear to auscultation and percussion.,COR: Regular. There is no S3, S4, or gallop. There is no murmur.,ABDOMEN: Soft. It is nontender. There is no mass or organomegaly.,GU: Unremarkable.,RECTAL: Deferred.,EXTREMITIES: His right lower extremity is unremarkable. Peripheral pulse is good. His left lower extremity is significant for the split thickness skin graft closure of a large defect in the posterior thigh, which is nearly healed. The open areas that are noted above __________ hypergranulation tissue both on his gluteal folds on the left side. There is one small area right essentially within the graft site, and there is one small area down lower on the calf area. The patient has an external fixation on that comes out laterally on his left thigh. Those pin sites look clean.,NEUROLOGIC: Without focal deficits. The patient is alert and oriented.,IMPRESSION: , Several multiple areas of hypergranulation tissue on the left posterior leg associated with a sense of trauma to his right posterior leg.,PLAN:, Plan would be for chemical cauterization of these areas. Series of treatment with chemical cauterization till these are closed.

General Medicine

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS:, Left inguinal hernia.,POSTOPERATIVE DIAGNOSIS: , Left inguinal hernia, direct.,PROCEDURE: , Left inguinal herniorrhaphy, modified Bassini.,DESCRIPTION OF PROCEDURE: ,The patient was electively taken to the operating room. In same day surgery, Dr. X applied a magnet to the pacemaker defibrillator that the patient has to change it into a fixed mode and to protect the device from the action of the cautery. Informed consent was obtained, and the patient was transferred to the operating room where a time-out process was followed and the patient under general endotracheal anesthesia was prepped and draped in the usual fashion. Local anesthesia was used as a field block and then an incision was made in the left inguinal area and carried down to the external oblique aponeurosis, which was opened. The cord was isolated and protected. It was dissected out. The lipoma of the cord was removed and the sac was high ligated. The main hernia was a direct hernia due to weakness of the floor. A Bassini repair was performed. We used a number of interrupted sutures of 2-0 Tevdek __________ in the conjoint tendon and the ilioinguinal ligament.,The external oblique muscle was approximated same as the soft tissue with Vicryl and then the skin was closed with subcuticular suture of Monocryl. The dressing was applied and the patient tolerated the procedure well, estimated blood loss was minimal, was transferred to recovery room in satisfactory 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'

OPERATION,1. Ivor-Lewis esophagogastrectomy.,2. Feeding jejunostomy.,3. Placement of two right-sided #28-French chest tubes.,4. Right thoracotomy.,ANESTHESIA: ,General endotracheal anesthesia with a dual-lumen tube.,OPERATIVE PROCEDURE IN DETAIL: , After obtaining informed consent from the patient, including a thorough explanation of the risks and benefits of the aforementioned procedure, the patient was taken to the operating room and general endotracheal anesthesia was administered. Prior to administration of general anesthesia, the patient had an epidural anesthesia placed. In addition, he had a dual-lumen endotracheal tube placed. The patient was placed in the supine position to begin the procedure. His abdomen and chest were prepped and draped in the standard surgical fashion. After applying sterile dressings, a #10-blade scalpel was used to make an upper midline incision from the level of the xiphoid to just below the umbilicus. Dissection was carried down through the linea using Bovie electrocautery. The abdomen was opened. Next, a Balfour retractor was positioned as well as a mechanical retractor. Next, our attention was turned to freeing up the stomach. In an attempt to do so, we identified the right gastroepiploic artery and arcade. We incised the omentum and retracted it off the stomach and gastroepiploic arcade. The omentum was divided using suture ligature with 2-0 silk. We did this along the greater curvature and then moved to the lesser curvature where the short gastric arteries were taken down with ligation using 2-0 silk. Next, we turned our attention to performing a Kocher maneuver. This was done and the stomach was freed up. We took down the falciform ligament as well as the caudate attachment to the diaphragm. We enlarged the diaphragmatic hiatus so as to be able to place approximately 3 fingers into the chest. We also did a portion of the esophageal dissection from the abdomen into the chest area. The esophagus and the esophageal hiatus were identified in the abdomen. We next turned our attention to the left gastric artery. The left gastric artery was identified at the base of the stomach. We first took the left gastric vein by ligating and dividing it using 0 silk ties. The left gastric artery was next taken using suture ligature with silk ties followed by 2-0 stick tie reinforcement. At this point the stomach was freely mobile. We then turned our attention to performing our jejunostomy feeding tube. A 2-0 Vicryl pursestring was placed in the jejunum approximately 20 cm distal to the ligament of Treitz. We then used Bovie electrocautery to open the jejunum at this site. We placed a 16-French red rubber catheter through this site. We tied down in place. We then used 3-0 silk sutures to perform a Witzel. Next, the loop of jejunum was tacked up to the abdominal wall using 2-0 silk ties. After doing so and pulling the feeding jejunostomy out through the skin and securing it appropriately, we turned our attention to closing the abdomen. This was done with #1 Prolene. We put in a 2nd layer of 2-0 Vicryl. The skin was closed with 4-0 Monocryl.,Next, we turned our attention to performing the thoracic portion of the procedure. The patient was placed in the left lateral decubitus position. The right chest was prepped and draped appropriately. We then used a #10 blade scalpel to make an incision in a posterolateral, non-muscle-sparing fashion. Dissection was carried down to the level of the ribs with Bovie electrocautery. Next, the ribs were counted and the 5th interspace was entered. The lung was deflated. We placed standard chest retractors. Next, we incised the peritoneum over the esophagus. We dissected the esophagus to just above the azygos vein. The azygos vein, in fact, was taken with 0 silk ligatures and reinforced with 2-0 stick ties. As mentioned, we dissected the esophagus both proximally and distally down to the level of the hiatus. After doing this, we backed our NG tube out to above the level where we planned to perform our pursestring. We used an automatic pursestring and applied. We then transected the proximal portion of the stomach with Metzenbaum scissors. We secured our pursestring and then placed a 28 anvil in the divided proximal portion of the esophagus. The pursestring was then tied down without difficulty. Next, we tabularized our stomach using a #80 GIA stapler. After doing so, we chose a portion of the stomach more distally and opened it using Bovie electrocautery. We placed our EEA stapler through it and then punched out through the gastric wall. We connected our anvil to the EEA stapler. This was then secured appropriately. We checked to make sure that there was appropriate muscle apposition. We then fired the stapler. We obtained 2 complete rings, 1 of the esophagus and 1 of the stomach, which were sent for pathology. We also sent the gastroesophageal specimen for pathology. Of note was the fact that the frozen section showed no evidence of tumor and in the proximal distal margins. We then turned our attention to closing the gastrostomy opening. This was closed with 2-0 Vicryl in a running fashion. We then buttressed this with serosal 3-0 Vicryl interrupted sutures. We returned the newly constructed gastroesophageal anastomosis into the chest and covered it by covering the pleura over it. Next, we placed two #28-French chest tubes, 1 anteriorly and 1 posteriorly, taking care not to place it near the anastomosis. We then closed the chest with #2 Vicryl in an interrupted figure-of-eight fashion. The lung was brought up. We closed the muscle layers with #0 Vicryl followed by #0 Vicryl; then we closed the subcutaneous layer with 2-0 Vicryl and the skin with 4-0 Monocryl. Sterile dressing was applied. The instrument and sponge count was correct at the end of the case. The patient tolerated the procedure well and was extubated in the operating room and transferred to the ICU in good condition.

Cardiovascular / Pulmonary

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

CC: , Headache.,HPI: , This is a 15-year-old girl presenting with occipital headache for the last six hours. She denies trauma. She has been intermittently nauseated but has not vomited and has some photophobia. Denies fever or change in vision. She has no past history of headaches. ,PMH: , None. ,MEDICATIONS: ,Tylenol for pain.,ALLERGIES:, None.,FAMILY HISTORY: , Grandmother died of cerebral aneurysm. ,ROS:, Negative.,PHYSICAL EXAM: ,Vital Signs: BP 102/60 P 70 RR 20 T 98.2 ,HEENT: Throat is clear, nasopharynx clear, TMs clear, there is no lymphadenopathy, no tenderness to palpations, sinuses nontender. ,Neck: Supple without meningismus. ,Chest: Lungs clear; heart regular without murmur.,COURSE IN THE ED: , The patient was seen in the urgent care and examined. At this time, her photophobia and nausea make migraine highly likely. She is well appearing and we'll try Tylenol with codeine for her pain. One day off school and follow up with her primary doctor. ,IMPRESSION: , Migraine headache. ,PLAN: , See above.

Emergency Room Reports

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

IDENTIFYING DATA: , The patient is a 21-year-old Caucasian male, who attempted suicide by trying to jump from a moving car, which was being driven by his mother. Additionally, he totaled his own car earlier in the day, both of which occurrences occurred approximately 72 hours before arriving at ABCD Hospital. He says he had a "panic attack leading to the car wreck" and denies that any of his behavior was suicidal in nature responding, "I was just trying to scare my mother.",CHIEF COMPLAINT: , The patient does say, "I screwed up my whole life and wrecked my car." The patient claims he is med compliant, although his mother, and stepfather saying he is off his meds. He had a two-day stay at XYZ Hospital for medical clearance after his car accident, and no injuries were found other than a sore back, which was negative by x-ray and CT scan.,PRESENT ILLNESS: ,The patient is on a 72-your involuntary hold for danger to self and grave disability. He has a history of bipolar disorder with mania and depression with anxiety and panic attacks. Today, he went to involuntary court hearing and was released by the court. He is now being discharged from second floor ABCD Psychiatric Hospital.,PAST PSYCHIATRIC HISTORY:, Listed extensively in his admission note and will not be repeated.,MEDICAL HISTORY: , Includes migraine headaches and a history of concussion. He describes "allergy" to Haldol medication.,OUTPATIENT CARE: , The patient sees a private psychiatrist, Dr. X. Followup with Dr. X is arranged in four days' time and the patient is discharged with four days of medication. This information is known to Dr. X.,DISCHARGE MEDICATIONS:,The patient is discharged with:,1. Klonopin 1 mg t.i.d. p.r.n.,2. Extended-release lithium 450 mg b.i.d.,3. Depakote 1000 mg b.i.d.,4. Seroquel 1000 mg per day.,SOCIAL HISTORY: ,The patient lives with his girlfriend on an on-and-off basis and is unclear if they will be immediately moving back in together.,SUBSTANCE ABUSE: , The patient was actively tox screen positive for benzodiazepines, cocaine, and marijuana. The patient had an inpatient stay in 2008 at ABC Lodge for drug abuse treatment.,MENTAL STATUS EXAM:, Notable for lack of primary psychotic symptoms, some agitation, and psychomotor hyperactivity, uncooperative behavior regarding his need for ongoing acute psychiatric treatment and stabilization. There is an underlying hostile oppositional message in his communications.,FORMULATION: , The patient is a 21-year-old male with a history of bipolar disorder, anxiety, polysubstance abuse, and in addition ADHD. His recent behavior is may be at least in part associated with active polysubstance abuse and also appears to be a result of noncompliance with meds.,DIAGNOSES:,AXIS I:,1. Bipolar disorder.,2. Major depression with anxiety and panic attacks.,3. Polysubstance abuse, benzodiazepines, and others street meds.,4. ADHD.,AXIS II: , Deferred at present, but consider personality disorder traits.,AXIS III:, History of migraine headaches and past history of concussion.,AXIS IV: , Stressors are moderate.,AXIS V: , GAF is 40.,PLAN: , The patient is released from the hospital secondary to court evaluation, which did not extend his involuntary stay. He has an appointment in four days with his outpatient psychiatrist, Dr. X. He has four days' worth of medications and agrees to no self-harm or harm of others. Additionally, he agrees to let staff know or authorities know if he becomes acutely unsafe. His mother and stepfather have been informed of the patient's discharge and the followup plan.

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:, Left distal radius fracture displaced.,POSTOPERATIVE DIAGNOSIS: , Left distal radius fracture displaced.,SURGERY: ,Closed reduction and placement of long-arm cast, CPT code 25605.,ANESTHESIA: ,General LMA.,FINDINGS: ,The patient was found to have a displaced fracture. She was found to be in perfect alignment after closed reduction and placement of cast. The radial deviation was well corrected.,INDICATIONS: , The patient is 5 years old. She was seen in our office today 1 week after being placed into a cast for a displaced fracture. She was noted to have significant loss of alignment especially on the lateral view. She was indicated for closed reduction and placed of the long-arm cast. Risks and benefits were discussed at length with the family. They wished to proceed.,PROCEDURE: ,The patient was brought to the operating room and placed on the operating table in supine position. General anesthesia was induced without incident. Previous cast was previously removed. An arm was approached and a closed reduction was performed. This was checked under AP and lateral projection and was found to be in adequate alignment. There was very mild residual dorsiflexion deformity noted.,A long-arm cast was then placed with plaster and molding. Repeat x-rays demonstrated adequate alignment on both views.,The cast was then reinforced with fiberglass. The patient was awakened from anesthesia and taken to recovery room in good condition. There were no complications. All instruments, sponge, and needle counts were correct at the end of case.,PLAN: ,The patient will be discharged home. She will return in 3 weeks for cast removal and clinical examination. She would likely be placed into a wrist-guard at that time. She has a prescription for Tylenol with codeine elixir.,

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: , Bilateral open mandible fracture, open left angle and open symphysis fracture.,POSTOPERATIVE DIAGNOSIS: , Bilateral open mandible fracture, open left angle and open symphysis fracture.,PROCEDURE: ,Closed reduction of mandible fracture with MMF.,ANESTHESIA: , General anesthesia via nasal endotracheal intubation.,FLUIDS: , 2 L of crystalloid.,ESTIMATED BLOOD LOSS: , Minimal.,HARDWARE: , None.,SPECIMENS: , None.,COMPLICATIONS: , None.,CONDITION: ,The patient was extubated to PACU in good condition.,INDICATIONS FOR PROCEDURE: , The patient is a 17-year-old female who is 2 days status post an altercation in which she sustained multiple blows to the face. She was worked up on Friday night, 2 days earlier at Hospital, was given palliative treatment and discharged and instructed to follow up as an outpatient with an oral surgeon and given a phone number to call. The patient was worked up initially. On initial exam, it was noted that the patient had a left V3 paresthesia. She had a gross malocclusion. On the facial CT and panoramic x-ray, it was noted to be a displaced left angle fracture and nondisplaced symphysis fracture. Alternatives were discussed with the patient and it was determined she would benefit from being taken to the operating room under general anesthesia to have a closed reduction of her fractures. Risks, benefits, and alternatives of treatment were thoroughly discussed with the patient and informed consent was obtained with the patient's mother.,DESCRIPTION OF PROCEDURE:, The patient was taken to the operating room #4 at Hospital and laid in a supine position on the operating room table. Monitor was attached and general anesthesia was induced with IV anesthetics and maintained with nasal endotracheal intubation and inhalation anesthetics. The patient was prepped and draped in the usual oromaxillofacial surgery fashion.,Surgeon approached the operating table in a sterile fashion. Approximately 10 mL of 2% lidocaine with 1:100,000 epinephrine was injected into the oral vestibule in a nerve block fashion. A moistened Ray-Tec sponge was placed in the posterior oropharynx and the mouth was prepped with Peridex mouthrinse, scrubbed with a toothbrush. The Peridex was evacuated with Yankauer suction. Erich arch bars were adapted to the maxilla from the first molar to the contralateral first molar and secured with 24-gauge surgical steel wire on the posterior teeth and 26-gauge surgical steel wire on the anterior teeth. Same was done on the mandible. The patient was then manipulated up in the maximum intercuspation and noted to be reproducible. The throat pack was then removed.,The patient was remanipulated up to the maximum intercuspation and secured with interdental elastics. At this point in time, the procedure was then determined to be over.,The patient was extubated and transferred to the PACU in good condition.

Dentistry

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge 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 35-year-old woman who reports that on the 30th of October 2008, she had a rupture of her membranes at nine months of pregnancy, and was admitted to hospital and was given an epidural anesthetic. I do not have the records from this hospital admission, but apparently the epidural was administered for approximately 14 to 18 hours. She was sitting up during the epidural.,She did not notice any difference in her lower extremities at the time she had the epidural; however, she reports that she was extremely sleepy and may not have been aware of any change in strength or sensation in her lower extremities at that time. She delivered on the 31st of October, by Cesarean section, because she had failed to progress and had pyrexia.,She also had a Foley catheter placed at that time. On the 1st of November 2008, they began to mobilize her and it was at that time that she first noticed that she could not walk. She was aware that she could not move her legs at all, and then within a few days, she was aware that she could move toes in the left foot but could not move her right foot at all. Since that time, there has been a gradual improvement in strength to the point that she now has limited movement in her left leg and severely restricted movement in her right leg. She is not able to walk by herself, and needs assistance to stand. She was discharged from hospital after the Cesarean section on the 3rd of November. Unfortunately, we do not have the records and we do not know what the discussion was between the anesthesiologist and the patient at the time of discharge. She was then seen at ABC Hospital on November 05, 2008. She had an MRI scan of her spine, which showed no evidence of an abnormality, specifically there were no cord changes and no evidence of a hematoma. She also had an EMG study at that time by Dr. X, which was abnormal but not diagnostic and this was repeated again in December. At the present time, she also complains of a pressure in both her legs and in her thighs. She complains that her right foot hurts and that she has some hyperesthesia there. She has been taking gabapentin to try to reduce the discomfort, although she is on a very low dose and the effect is minimal. She has no symptoms in her arms, her bowel and bladder function is normal, and her bulbar function is normal. There is no problem with her vision, swallowing, or respiratory function.,PAST MEDICAL HISTORY: , Unremarkable except as noted above. She has seasonal allergies.,CURRENT MEDICATIONS:, Gabapentin 300 mg b.i.d., Centrum once a day, and another multivitamin.,ALLERGIES: , She has no medication allergies, but does have seasonal allergies.,FAMILY HISTORY: , There is a family history of diabetes and hypertension. There is no family history of a neuropathy or other neurological disease. She has one child, a son, born on October 31, 2008.,SOCIAL HISTORY: , The patient is a civil engineer, who currently works from home. She is working approximately half time because of limitations imposed on her by her disability, need to attend frequent physical therapy, and also the needs of looking after her baby. She does not smoke and does not drink and has never done either.,GENERAL PHYSICAL EXAMINATION:,VITAL SIGNS: P 74, BP 144/75, and a pain score of 0.,GENERAL: Her general physical examination was unremarkable.,CARDIOVASCULAR: Normal first and second heart sound, regular pulse with normal volume.,RESPIRATORY: Unremarkable, both lung bases were clear, and respiration was normal.,GI: Unremarkable, with no organomegaly and normal bowel sounds.,NEUROLOGICAL EXAM:,MSE: The patient's orientation was normal, fund of knowledge was normal, memory was normal, speech was normal, calculation was normal, and immediate and long-term recall was normal. Executive function was normal.,CRANIAL NERVES: The cranial nerve examination II through XII was unremarkable. Both disks were normal, with normal retina. Pupils were equal and reactive to light. Eye movements were full. Facial sensation and strength was normal. Bulbar function was normal. The trapezius had normal strength.,MOTOR: Muscle tone showed a slight increase in tone in the lower extremities, with normal tone in the upper extremities. Muscle strength was 5/5 in all muscle groups in the upper extremities. In the lower extremities, the hip flexors were 1/5 bilaterally, hip extensors were 1/5 bilaterally, knee extension on the right was 1/5 and on the left was 3-/5, knee flexion was 2/5 on the right and 3-/5 on the left, foot dorsiflexion was 0/5 on the right and 1/5 on the left, foot plantar flexion was 4-/5 on the right and 4+/5 on the left, toe extension was 0/5 on the right and 4-/5 on the left, toe flexion was 4-/5 on the right and 4+/5 on the left.,REFLEXES: Reflexes in the upper extremities were 2+ bilaterally. In the lower extremities, they were 0 bilaterally at the knee and ankles. The abdominal reflexes were present above the umbilicus and absent below the umbilicus. The plantar responses were mute. The jaw reflex was normal.,SENSATION: Vibration was moderately decreased in the right great toe and was mildly decreased in the left great toe. There was a sensory level to light touch at approximately T7 posteriorly and approximately T9 anteriorly. There was a range of sensation, but clearly there was a decrease in sensation below this level but not complete loss of sensation. To pain, the sensory level is even less clear, but appeared to be at about T7 on the right side. In the lower extremities, there was a slight decrease in pin and light touch in the right great toe compared to the left. There was no evidence of allodynia or hyperesthesia. Joint position sense was mildly reduced in the right toe and normal on the left.,COORDINATION: Coordination for rapid alternating movements and finger-to-nose testing was normal. Coordination could not be tested in the lower extremities.,GAIT: The patient was unable to stand and therefore we were unable to test gait or Romberg's. There was no evidence of focal back tenderness.,REVIEW OF OUTSIDE RECORDS: , I have reviewed the records from ABC Hospital, including the letter from Dr. Y and the EMG report dated 12/17/2008 from Dr. X. The EMG report shows evidence of a lumbosacral polyradiculopathy below approximately T6. The lower extremity sensory responses are essentially normal; however, there is a decrease in the amplitude of the motor responses with minimal changes in latency. I do have the MRI of lumbar spine report from 11/06/2008 with and without contrast. This showed a minimal concentric disc bulge of L4-L5 without disc herniation, but was otherwise unremarkable. The patient brought a disc with a most recent MRI study; however, we were unable to open this on our computers. The verbal report is that the study was unremarkable except for some gadolinium enhancement in the lumbar nerve roots. A Doppler of the lower extremities showed no evidence of deep venous thrombosis in either lower extremity. Chest x-ray showed some scoliosis on the lumbar spine, curve to the left, but no evidence of other abnormalities. A CT pelvis study performed on November 07, 2008 showed some nonspecific fluid in the subcutaneous fat of the back, posterior to L4 and L5 levels; however, there were no pelvic masses or other abnormalities. We were able to obtain an update of the report from the MRI of the lumbar spine with and without contrast dated 12/30/2008. The complete study included the cervical, thoracic, and lumbar spine. There was diffuse enhancement of the nerve roots of the cauda equina that had increased in enhancement since prior exam in November. It was also reported that the patient was given intravenous methylprednisolone and this had had no effect on strength in her lower extremities.,IMPRESSION: , The patient has a condition that is temporarily related to the epidural injection she was given at the end of October 2008, prior to her Cesarean section. It appears she became aware of weakness within two days of the administration of the epidural, she was very tired during the epidural and may have missed some change in her neurological function. She was severely weak in both lower extremities, slightly worse on the right than the left. There has been some interval improvement in her strength since the beginning of November 2008. Her EMG study from the end of December is most consistent with a lumbosacral polyradiculopathy. The MRI findings of gadolinium enhancement in the lumbar nerve roots would be most consistent with an inflammatory radiculitis most likely related to the epidural anesthesia or administration of the epidural. There had been no response to IV methylprednisolone given to her at ABC. The issue of having a lumbar puncture to look for evidence of inflammatory cells or an elevated protein had been discussed with her at both ABC and by myself. The patient did not wish to consider a lumbar puncture because of concerns that this might worsen her condition. At the present time, she is able to stand with aid but is unable to walk. There is no evidence on her previous EMG of a demyelinating neuropathy.,RECOMMENDATIONS:,1. The diagnostic issues were discussed with the patient at length. She is informed that this is still early in the course of the problem and that we expect her to show some improvement in her function over the next one to two years, although it is unclear as to how much function she will regain.,2. She is strongly recommended to continue with vigorous physical therapy, and to continue with the plan to mobilize her as much as possible, with the goal of trying to get her ambulatory. If she is able to walk, she will need bilateral AFOs for her ankles, to improve her overall mobility. I am not prescribing these because at the present time she does not need them.,3. We discussed increasing the dose of gabapentin. The paresthesias that she has may indicate that she is actually regaining some sensory function, although there is a concern that as recovery continues, she may be left with significant neuropathic pain. If this is the case, I have advised her to increase her gabapentin dose from 300 mg b.i.d. gradually up to 300 mg four times a day and then to 600 mg to 900 mg four times a day. She may need other neuropathic pain medications as needed. She will determine whether her current symptoms are significant enough to require this increase in dosage.,4. The patient will follow up with Dr. Y and his team at ABC Hospital. She will also continue with physical therapy within the ABC system.

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'

NAME OF PROCEDURES,1. Selective coronary angiography.,2. Left heart catheterization.,3. Left ventriculography.,PROCEDURE IN DETAIL: ,The right groin was sterilely prepped and draped in the usual fashion. The area of the right coronary artery was anesthetized with 2% lidocaine and a 4-French sheath was placed. Conscious sedation was obtained using a combination of Versed 1 mg and fentanyl 50 mcg. A left #4, 4-French, Judkins catheter was placed and advanced through the ostium of the left main coronary artery. Because of difficulty positioning the catheter, the catheter was removed and a 6-French sheath was placed and a 6-French #4 left Judkins catheter was placed. This was advanced through the ostium of the left main coronary artery where selective angiograms were performed. Following this, the 4-French right Judkins catheter was placed and angiograms of the right coronary were performed. A pigtail catheter was placed and a left heart catheterization was performed, followed by a left ventriculogram. The left heart pullback was performed. The catheter was removed and a small injection of contrast was given to the sheath. The sheath was removed over a wire and an Angio-Seal was placed. There were no complications. Total contrast media was 200 mL of Optiray 350. Fluoroscopy time 5.3 minutes. Total x-ray dose is 1783 mGy.,HEMODYNAMICS: ,Rhythm is sinus throughout the procedure. LV pressure of 155/22 mmHg, aortic pressure of 160/80 mmHg. LV pullback demonstrates no gradient.,The right coronary artery is a nondominant vessel and free of disease. This also gives rise to the conus branch and two RV free wall branches. The left main has minor plaquing in the inferior aspect measuring no more than 10% to 15%. This vessel then bifurcates into the LAD and circumflex. The circumflex is a large caliber vessel and is dominant. This vessel gives rise to a large first marginal artery, a moderate sized second marginal branch, and additionally gives rise to a large third marginal artery and the PDA. There was a very eccentric and severe stenosis in the proximal circumflex measuring approximately 90% in severity. The origin of the first marginal artery has a severe stenosis measuring approximately 90% in severity. The distal circumflex has a 60% lesion just prior to the origin of the third marginal branch and PDA.,The proximal LAD is ectatic. The LAD gives rise to a large first diagonal artery that has a 90% lesion in its origin and a subtotal occlusion midway down the diagonal. Distal to the origin of this diagonal branch, there is another area of ectasia in the LAD, followed by an area of stenosis that in some views is approximately 50% in severity.,The left ventriculogram demonstrates hypokinesis of the distal half of the inferior wall. The overall ejection fraction is preserved. There is moderate dilatation of the aortic root. The calculated ejection fraction is 63%.,IMPRESSION,1. Left ventricular dysfunction as evidenced by increased left ventricular end diastolic pressure and hypokinesis of the distal inferior wall.,2. Coronary artery disease with high-grade and complex lesion in the proximal portion of the dominant large circumflex coronary artery. There is subtotal stenosis at the origin of the first obtuse marginal artery.,3. A 60% stenosis in the distal circumflex.,4. Ectasia of the proximal left anterior descending with 50% stenosis in the mid left anterior descending.,5. Severe stenosis at the origin of the large diagonal artery and subtotal stenosis in the mid segment of this diagonal branch.

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. Right pelvic pain.,2. Right ovarian mass.,POSTOPERATIVE DIAGNOSES:,1. Right pelvic pain.,2. Right ovarian mass.,3. 8 cm x 10 cm right ovarian cyst with ovarian torsion.,PROCEDURE PERFORMED: ,Laparoscopic right salpingooophorectomy.,ANESTHESIA: ,General with endotracheal tube.,COMPLICATIONS: , None.,ESTIMATED BLOOD LOSS: , Less than 50 cc.,TUBES: , None.,DRAINS:, None.,PATHOLOGY: , The right tube and ovary sent to pathology for review.,FINDINGS: , On exam under anesthesia, a normal-appearing vulva and vagina and normally palpated cervix, a uterus that was normal size, and a large right adnexal mass. Laparoscopic findings demonstrated a 8 cm x 10 cm smooth right ovarian cyst that was noted to be torsed twice. Otherwise, the uterus, left tube and ovary, bowel, liver margins, appendix, and gallbladder were noted all to be within normal limits. There was no noted blood in the pelvis.,INDICATIONS FOR THIS PROCEDURE:, The patient is a 26-year-old G1 P1 who presented to ABCD General Emergency Room with complaint of right lower quadrant pain since last night, which has been increasing in intensity. The pain persisted despite multiple pain medications given in the Emergency Room. The patient reports positive nausea and vomiting. There was no vaginal bleeding or discharge. There was no fevers or chills. Her cultures done in the Emergency Room were pending. The patient did have an ultrasound that demonstrated an 8 cm right ovarian cyst, questionable hemorrhagic. The uterus and left ovary were within normal limits. There was a positive flow noted to bilateral ovaries on ultrasound. Therefore, it was felt appropriate to take the patient for a diagnostic laparoscopy with a possible oophorectomy.,PROCEDURE:, After informed consent was obtained, and all questions were answered to the patient's satisfaction in layman's terms, she was taken to the operating room where general anesthesia was obtained without any difficulty. She was placed in dorsal lithotomy position with the use of Allis strips and prepped and draped in the usual sterile fashion. Her bladder was drained with a red Robinson catheter and she was examined under anesthesia and was noted to have the findings as above. She was prepped and draped in the usual sterile fashion. A weighted speculum was placed in the patient's vagina with excellent visualization of the cervix. The cervix was grasped at 12 o'clock position with a single-toothed tenaculum and pulled into the operative field. The uterus was then sounded to approximately 3.5 inches and then a uterine elevator was placed. The vulsellum tenaculum was removed. The weighted speculum was removed. Attention was then turned to the abdomen where 1 cm infraumbilical incision was made in the infraumbilical fold. The Veress step needle was then placed into the abdomen while the abdomen was being tented up with towel clamp. The CO2 was then turned on with unoccluded flow and excellent pressures. This was continued till a normal symmetrical pneumoperitoneum was obtained. Then, a #11 mm step trocar and sleeve were placed into the infraumbilical port without any difficulty and placement was confirmed by laparoscope. Laparoscopic findings are as noted above. A suprapubic incision was made with the knife and then a #12 mm step trocar and sleeve were placed in the suprapubic region under direct visualization. Then, a grasper was used to untorse the ovary. Then, a #12 mm port was placed in the right flank region under direct visualization using a LigaSure vessel sealing system. The right tube and ovary were amputated and noted to be hemostatic. The EndoCatch bag was then placed through the suprapubic port and the ovary was placed into the bag. The ovary was too large to fit completely into the bag. Therefore, a laparoscopic needle with a 60 cc syringe was used to aspirate the contents of the ovary while it was still inside the bag.,There was approximately 200 cc of fluid aspirated from the cyst. This was a clear yellow fluid. Then, the bag was closed and the ovary was removed from the suprapubic port. The suprapubic port did have to be extended somewhat to allow for the removal of the ovary. The trocar and sleeve were then placed back into the port. The abdomen was copiously irrigated with warm normal saline using the Nezhat-Dorsey suction irrigator and the incision site was noted to be hemostatic. The pelvis was clear and clean. ,Pictures were obtained. The suprapubic port was then removed under direct visualization and then using a #0-vicyrl and UR6. Two figure-of-eight sutures were placed in the fascia of suprapubic port and fascia was closed and the pneumoperitoneum was maintained after the sutures were placed. Therefore, the peritoneal surface was noted to be hemostatic. Therefore, the camera was removed. All instruments were removed. The abdomen was allowed to completely deflate and then the trocars were placed back through the sleeves of the right flank #12 port and the infraumbilical port and these were removed. The infraumbilical port was examined and noted to have a small fascial defect which was repaired with #0-Vicryl and UR6. The right flank area was palpated and there was no facial defect noted. The skin was then closed with #4-0 undyed Vicryl in subcuticular fashion. Dressings were changed. The weighted speculum was removed from the patient's cervix. The cervix noted to be hemostatic. The patient tolerated the procedure well. Sponge, lap, and needle counts were correct x2 and the patient was taken to the Recovery in stable condition.

Obstetrics / Gynecology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

CHIEF COMPLAINT:, Dog bite to his right lower leg.,HISTORY OF PRESENT ILLNESS:, This 50-year-old white male earlier this afternoon was attempting to adjust a cable that a dog was tied to. Dog was a German shepherd, it belonged to his brother, and the dog spontaneously attacked him. He sustained a bite to his right lower leg. Apparently, according to the patient, the dog is well known and is up-to-date on his shots and they wanted to confirm that. The dog has given no prior history of any reason to believe he is not a healthy dog. The patient himself developed a puncture wound with a flap injury. The patient has a flap wound also below the puncture wound, a V-shaped flap, which is pointing towards the foot. It appears to be viable. The wound is open about may be roughly a centimeter in the inside of the flap. He was seen by his medical primary care physician and was given a tetanus shot and the wound was cleaned and wrapped, and then he was referred to us for further assessment.,PAST MEDICAL HISTORY: ,Significant for history of pulmonary fibrosis and atrial fibrillation. He is status post bilateral lung transplant back in 2004 because of the pulmonary fibrosis.,ALLERGIES: ,There are no known allergies.,MEDICATIONS:, Include multiple medications that are significant for his lung transplant including Prograf, CellCept, prednisone, omeprazole, Bactrim which he is on chronically, folic acid, vitamin D, Mag-Ox, Toprol-XL, calcium 500 mg, vitamin B1, Centrum Silver, verapamil, and digoxin.,FAMILY HISTORY: , Consistent with a sister of his has ovarian cancer and his father had liver cancer. Heart disease in the patient's mother and father, and father also has diabetes.,SOCIAL HISTORY:, He is a non-cigarette smoker. He has occasional glass of wine. He is married. He has one biological child and three stepchildren. He works for ABCD.,REVIEW OF SYSTEMS:, He denies any chest pain. He does admit to exertional shortness of breath. He denies any GI or GU problems. He denies any bleeding disorders.,PHYSICAL EXAMINATION,GENERAL: Presents as a well-developed, well-nourished 50-year-old white male who appears to be in mild distress.,HEENT: Unremarkable.,NECK: Supple. There is no mass, adenopathy or bruit.,CHEST: Normal excursion.,LUNGS: Clear to auscultation and percussion.,COR: Regular. There is no S3 or S4 gallop. There is no obvious murmur.,ABDOMEN: Soft. It is nontender. Bowel sounds are present. There is no tenderness.,SKIN: He does have like a Chevron incisional scar across his lower chest and upper abdomen. It appears to be well healed and unremarkable.,GENITALIA: Deferred.,RECTAL: Deferred.,EXTREMITIES: He has about 1+ pitting edema to both legs and they have been present since the surgery. In the right leg, he has an about midway between the right knee and right ankle on the anterior pretibial area, he has a puncture wound that measures about may be centimeter around that appears to be relatively clean, and just below that about may be 3 cm below, he has a flap traumatic injury that measures about may be 4 cm to the point of the flap. The wound is spread apart about may be a centimeter all along that area and it is relatively clean. There was some bleeding when I removed the dressing and we were able to pretty much control that with pressure and some silver nitrate. There were exposed subcutaneous tissues, but there was no exposed tendons that we could see, etc. The flap appeared to be viable.,NEUROLOGIC: Without focal deficits. The patient is alert and oriented.,IMPRESSION:, A 50-year-old white male with dog bite to his right leg with a history of pulmonary fibrosis, status post bilateral lung transplant several years ago. He is on multiple medications and he is on chronic Bactrim. We are going to also add some fluoroquinolone right now to protect the skin and probably going to obtain an Infectious Disease consult. We will see him back in the office early next week to reassess his wound. He is to keep the wound clean with the moist dressing right now. He may shower several times a day.

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:, Sinus problems.,SINUSITIS HISTORY:, The problem began 2 weeks ago and is constant. Symptoms include postnasal drainage, sore throat, facial pain, coughing, headaches and congestion. Additional symptoms include snoring, nasal burning and teeth pain. The symptoms are characterized as moderate to severe. Symptoms are worse in the evening and morning.,REVIEW OF SYSTEMS:,ROS General: General health is good.,ROS ENT: As noted in history of present Illness listed above.,ROS Respiratory: Patient denies any respiratory complaints, such as cough, shortness of breath, chest pain, wheezing, hemoptysis, etc.,ROS Gastrointestinal: Patient denies any nausea, vomiting, abdominal pain, dysphagia or any altered bowel movements.,ROS Respiratory: Complaints include coughing.,ROS Neurological: Patient complains of headaches. All other systems are negative.,PAST SURGICAL HISTORY:, Gallbladder 7/82. Hernia 5/79,PAST MEDICAL HISTORY:, Negative.,PAST SOCIAL HISTORY:, Marital Status: Married. Denies the use of alcohol. Patient has a history of smoking 1 pack of cigarettes per day and for the past 15 years. There are no animals inside the home.,FAMILY MEDICAL HISTORY:, Family history of allergies and hypertension.,CURRENT MEDICATIONS:, Claritin. Dilantin.,PREVIOUS MEDICATIONS UTILIZED:, Rhinocort Nasal Spray.,EXAM:,Exam Ear: Auricles/external auditory canals reveal no significant abnormalities bilaterally. TMs intact with no middle ear effusion and are mobile to insufflation.,Exam Nose: Intranasal exam reveals moderate congestion and purulent mucus.,Exam Oropharynx: Examination of the teeth/alveolar ridges reveals missing molar (s). Examination of the posterior pharynx reveals a prominent uvula and purulent postnasal drainage. The palatine tonsils are 2+ and cryptic.,Exam Neck: Palpation of anterior neck reveals no tenderness. Examination of the posterior neck reveals mild tenderness to palpation of the suboccipital muscles.,Exam Facial: There is bilateral maxillary sinus tenderness to palpation.,X-RAY / LAB FINDINGS:, Water's view x-ray reveals bilateral maxillary mucosal thickening.,IMPRESSION:, Acute maxillary sinusitis (461.0). Snoring (786.09).,MEDICATION:, Augmentin. 875 mg bid. MucoFen 800 mg bid.,PLAN:,

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 DIAGNOSES:,1. Request for cosmetic surgery.,2. Facial asymmetry following motor vehicle accident.,POSTOPERATIVE DIAGNOSES:,1. Request for cosmetic surgery.,2. Facial asymmetry following motor vehicle accident.,PROCEDURES:,1. Endoscopic subperiosteal midface lift using the endotine midface suspension device.,2. Transconjunctival lower lid blepharoplasty with removal of a portion of the medial and middle fat pad.,ANESTHESIA: , General via endotracheal tube.,INDICATIONS FOR OPERATION: , The patient is a 28-year-old country and western performer who was involved in a motor vehicle accident over a year ago. Since that time, she is felt to have facial asymmetry, which is apparent in publicity photographs for her record promotions. She had requested a procedure to bring about further facial asymmetry. She was seen preoperatively by psychiatrist specializing in body dysmorphic disorder as well as analysis of the patient's requesting cosmetic surgery and was felt to be a psychiatrically good candidate. She did have facial asymmetry with the bit of more fullness in higher cheekbone on the right as compared to the left. Preoperative workup including CT scan failed to show any skeletal trauma. The patient was counseled with regard to the risks, benefits, alternatives, and complications of the postsurgical procedure including but not limited to bleeding, infection, unacceptable cosmetic appearance, numbness of the face, change in sensation of the face, facial nerve paralysis, need for further surgery, need for revision, hair loss, etc., and informed consent was obtained.,PROCEDURE:, The patient was taken to the operating room, placed in supine position after having been marked in the upright position while awake. General endotracheal anesthesia was induced with a #6 endotracheal tube. All appropriate measures were taken to preserve the vocal cords in a professional singer. Local anesthesia consisting of 5/6th 1% lidocaine with 1:100,000 units of epinephrine in 1/6th 0.25% Marcaine was mixed and then injected in a regional field block fashion in the subperiosteal plane via the gingivobuccal sulcus injection on either side as well as into the temporal fossa at the level of the true temporal fascia. The upper eyelids were injected with 1 cc of 1% Xylocaine with 1:100,000 units of epinephrine. Adequate time for vasoconstriction and anesthesia was allowed to be obtained. The patient was prepped and draped in the usual sterile fashion. A 4-0 silk suture was placed in the right lower lid. For traction, it was brought anteriorly. The conjunctiva was incised with the needle tip Bovie with Jaeger lid plate protecting the cornea and globe. A Q-Tip was then used to separate the orbicularis oculi muscle from the fat pad beneath and carried down to the bone. The middle and medial fat pads were identified and a small amount of fat was removed from each to take care of the pseudofat herniation, which was present. The inferior oblique muscle was identified, preserved, and protected throughout the procedure. The transconjunctival incision was then closed with buried knots of 6-0 fast absorbing gut. Contralateral side was treated in similar fashion with like results and throughout the procedure. Lacri-Lube was in the eyes in order to maintain hydration. Attention was next turned to the midface, where a temporal incision was made parallel to the nasojugal folds. Dissection was carried out with the hemostat down to the true temporal fascia and the endoscopic temporal dissection dissector was used to elevate the true temporal fascia. A 30-degree endoscope was used to visualize the fat pads, so that we knew we are in the proper plane. Subperiosteal dissection was carried out over the zygomatic arch and Whitnall's tubercle and the temporal dissection was completed.,Next, bilateral gingivobuccal sulcus incisions were made and a Joseph elevator was used to elevate the periosteum of the midface and anterior face of the maxilla from the tendon of the masseter muscle up to Whitnall's tubercle. The two dissection planes within joint in the subperiosteal fashion and dissection proceeded laterally out to the zygomatic neurovascular bundle. It was bipolar electrocauteried and the tunnel was further dissected free and opened. The endotine 4.5 soft tissue suspension device was then inserted through the temporal incision, brought down into the subperiosteal midface plane of dissection. The guard was removed and the suspension spikes were engaged into the soft tissues. The spikes were elevated superiorly such that a symmetrical midface elevation was carried out bilaterally. The endotine device was then secured to the true temporal fascia with three sutures of 3-0 PDS suture. Contralateral side was treated in similar fashion with like results in order to achieve facial symmetry and symmetry was obtained. The gingivobuccal sulcus incisions were closed with interrupted 4-0 chromic and the scalp incision was closed with staples. The sterile dressing was applied. The patient was awakened in the operating room and taken to the recovery room in good condition.

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'

PROCEDURE PERFORMED:,1. Left heart catheterization, left ventriculogram, aortogram, coronary angiogram.,2. PCI of the LAD and left main coronary artery with Impella assist device.,INDICATIONS FOR PROCEDURE: , Unstable angina and congestive heart failure with impaired LV function.,TECHNIQUE OF PROCEDURE: , After obtaining informed consent, the patient was brought to the cardiac catheterization suite in postabsorptive and nonsedated state. The right groin was prepped and draped in the usual sterile manner. Lidocaine 2% was used for infiltration anesthesia. Using modified Seldinger technique, a 7-French sheath was introduced into the right common femoral artery and a 6-French sheath was introduced into the right common femoral vein. Through the arterial sheath, angiography of the right common femoral artery was obtained. Thereafter, 6-French pigtail catheter was advanced to the level of the distal aorta where angiography of the distal aorta and the bifurcation of the right and left common iliac arteries was obtained. Thereafter, a 4-French sheath was introduced into the left common femoral artery using modified Seldinger technique. Thereafter, the pigtail catheter was advanced over an 0.035-inch J-wire into the left ventricle and LV-gram was performed in RAO view and after pullback, an aortogram was performed in the LAO view. Therefore, a 6-French JL4 and JR4 guiding catheters were used to engage the left and right coronary arteries respectively and multiple orthogonal views of the coronary arteries were obtained.,ANGIOGRAPHIC FINDINGS: ,1. LV-gram: LVEDP was 15 mmHg. LV ejection fraction 10% to 15% with global hypokinesis. Only anterior wall is contracting. There was no mitral regurgitation. There was no gradient across the aortic valve upon pullback, and on aortography, there was no evidence of aortic dissection or aortic regurgitation.,2. The right coronary artery is a dominant vessels with a mid 50% to 70% stenosis which was not treated. The left main coronary artery calcified vessel with disease.,2. The left anterior descending artery had an 80% to 90% mid-stenosis. First diagonal branch had a more than 90% stenosis.,3. The circumflex coronary artery had a patent stent.,INTERVENTION: , After reviewing the angiographic images, we elected to proceed with intervention of the left anterior descending artery. The 4-French sheath in the left common femoral artery was upsized to a 12-French Impella sheath through which an Amplatz wire and a 6-French multipurpose catheter were advanced into the left ventricle. The Amplatz wire was exchanged for an Impella 0.018-inch stiff wire. The multipurpose catheter was removed, and the Impella was advanced into the left ventricle and a performance level of 8 was achieved with a cardiac output of 2 to 2.5 l/min. Thereafter, a 7-French JL4 guiding catheter was used to engage the left coronary artery and an Asahi soft 0.014-inch wire was advanced into the left anterior descending artery and a second 0.014-inch Asahi soft wire was advanced into the diagonal branch. The diagonal branch was predilated with a 2.5 x 30-mm Sprinter balloon at nominal atmospheres and thereafter a 2.5 x 24 Endeavor stent was successfully deployed in the mid-LAD and a 3.0 x 15-mm Endeavor stent was deployed in the proximal LAD. The stent delivery balloon was used to post-dilate the overlapping segment. The LAD, the diagonal was rewires with an 0.014-inch Asahi soft wire and a 3.0 x 20-mm Maverick balloon was advanced into the LAD for post-dilatation and a 2.0 x 30-mm Sprinter balloon was advanced into the diagonal for kissing inflations which were performed at nominal atmospheres. At this point, it was noted that the left main had a retrograde dissection. A 3.5 x 18-mm Endeavor stent was successfully deployed in the left main coronary artery. The Asahi soft wire in the diagonal was removed and placed into the circumflex coronary artery. Kissing inflations of the LAD and the circumflex coronary artery were performed using 3.0 x 20 Maverick balloons x2 balloons, inflated at high atmospheres of 14.,RESULTS: , Lesion reduction in the LAD FROM 90% to 0% and TIMI 3 flow obtained. Lesion reduction in the diagonal from 90% to less than 60% and TIMI 3 flow obtained. Lesion reduction in the left maintained coronary artery from 50% to 0% and TIMI 3 flow obtained.,The patient tolerated the procedure well and the inflations well with no evidence of any hemodynamic instability. The Impella device was gradually decreased from performance level of 8 to performance level of 1 at which point it was removed into the aorta and it was turned off and the Impella was removed from the body and the 2 Perclose sutures were tightened. From the right common femoral artery, a 6-French IMA catheter was advanced and an 0.035-inch wire down into the left common femoral and superficial femoral artery, over which an 8 x 40 balloon was advanced and tamponade of the arteriotomy site of the left common femoral artery was performed from within the artery at 3 atmospheres for a total of 20 minutes. The right common femoral artery and vein sheaths were both sutured in place for further observation. Of note, the patient received Angiomax during the procedure and an ACT above 300 was maintained.,IMPRESSION:,1. Left ventricular dysfunction with ejection fraction of 10% to 15%.,2. High complex percutaneous coronary intervention of the left main coronary artery, left anterior descending artery, and diagonal with Impella circulatory support.,COMPLICATIONS: , None.,The patient tolerated the procedure well with no complications. The estimated blood loss was 200 ml. Estimated dye used was 200 ml of Visipaque. The patient remained hemodynamically stable with no hypotension and no hematomas in the groins.,PLAN: ,1. Aspirin, Plavix, statins, beta blockers, ACE inhibitors as tolerated.,2. Hydration.,3. The patient will be observed over night for any hemodynamic instability or ischemia. If she remains stable, the right common femoral artery and vein sheaths will be removed and manual pressure will be applied for hemostasis.

Cardiovascular / Pulmonary

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS:, Headaches, question of temporal arteritis.,POSTOPERATIVE DIAGNOSIS:, Headaches, question of temporal arteritis.,PROCEDURE:, Bilateral temporal artery biopsies.,DESCRIPTION OF PROCEDURE: , After obtaining an informed consent, the patient was brought to the operating room where her right temporal area was prepped and draped in the usual fashion. Xylocaine 1% was utilized and then an incision was made in front of the right ear and deepened anteriorly. The temporal artery was found and exposed in an extension of about 2 cm. The artery was proximally and distally ligated with 6-0 Prolene and also a side branch and a sample was sent for pathology. Hemostasis achieved with a cautery and the incision was closed with a subcuticular suture of Monocryl.,Then, the patient was turned and her left temporal area was prepped and draped in the usual fashion. A similar procedure was performed with 1% Xylocaine and exposed her temporal artery, which was excised in an extent to about 2 cm. This was also proximally and distally ligated with 6-0 Prolene and also side branch. Hemostasis was achieved with a cautery and the skin was closed with a subcuticular suture of Monocryl.,Dressings were applied to both areas.,The patient tolerated the procedure well. Estimated blood loss was negligible, and the patient went back to Same Day Surgery for 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'

She has an extensive past medical history of rheumatoid arthritis, fibromyalgia, hypertension, hypercholesterolemia, and irritable bowel syndrome. She has also had bilateral carpal tunnel release.,On examination, normal range of movement of C-spine. She has full strength in upper and lower extremities. Normal straight leg raising. Reflexes are 2 and symmetric throughout. No Babinski. She has numbness to light touch in her right big toe.,NERVE CONDUCTION STUDIES: The right median palmar sensory distal latencies are minimally prolonged with minimally attenuated evoked response amplitude. Bilateral tibial motor nerves could not be obtained (technical). The remaining nerves tested revealed normal distal latencies, evoked response amplitudes, conduction velocities, F-waves, and H. reflexes.,NEEDLE EMG: Needle EMG was performed on the right arm and leg and lumbosacral and cervical paraspinal muscles and the left FDI. It revealed 2+ spontaneous activity in the right APB and FDI and 1+ spontaneous activity in lower cervical paraspinals, lower and middle lumbosacral paraspinals, right extensor digitorum communis muscle, and right pronator teres. There was evidence of chronic denervation in the right first dorsal interosseous, pronator teres, abductor pollicis brevis, and left first dorsal interosseous.,IMPRESSION: This electrical study is abnormal. It reveals the following:,1. An active right C8/T1 radiculopathy. Electrical abnormalities are moderate.,2. An active right C6/C7 radiculopathy. Electrical abnormalities are mild.,3. Evidence of chronic left C8/T1 denervation. No active denervation.,4. Mild right lumbosacral radiculopathies. This could not be further localized because of normal EMG testing in the lower extremity muscles.,5. There is evidence of mild sensory carpal tunnel on the right (she has had previous carpal tunnel release).,Results were discussed with the patient. It appears that she has failed conservative therapy and I have recommended to her that she return to Dr. X for his assessment for possible surgery to her C-spine. She will continue with conservative therapy for the mild lumbosacral radiculopathies.

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:, This is a 58-year-old male who reports a six to eight-week history of balance problems with fatigue and weakness. He has had several falls recently. He apparently had pneumonia 10 days prior to the onset of the symptoms. He took a course of amoxicillin for this. He complained of increased symptoms with more and more difficulty with coordination. He fell at some point near the onset of the symptoms, but believes that his symptoms had occurred first. He fell from three to five feet and landed on his back. He began seeing a chiropractor approximately five days ago and had adjustments of the neck and lumbar spine, although he clearly had symptoms prior to this.,He has had mid and low back pain intermittently. He took a 10-day course of Cipro believing that he had a UTI. He denies, however, any bowel or bladder problems. There is no incontinence and he does not feel that he is having any difficulty voiding.,PAST SURGICAL HISTORY:, He has a history of surgery on the left kidney, when it was "rebuilt." He has had knee surgery, appendectomy and right inguinal hernia repair.,MEDICATIONS:, His only home medications had been Cipro and Aleve. However, he does take aspirin and several over the counter supplements including a multivitamin with iron, "natural" potassium, Starlix and the aspirin.,ALLERGIES:, HE HAS NO KNOWN DRUG ALLERGIES.,SOCIAL HISTORY:, He smokes one-and-one-half-packs of cigarettes per day and drinks alcohol at least several days per week. He is employed in sales, which requires quite a bit of walking, but he is not doing any lifting. He had been a golfer in the past.,PAST MEDICAL HISTORY:, He has had documented cervical spondylosis, apparently with an evaluation over 15 years ago.,PHYSICAL EXAMINATION:,VITAL SIGNS: Blood pressure 156/101, pulse was 88, respirations 18. He is afebrile.,MENTAL STATUS: He is alert.,CRANIAL NERVES: His pupils were reactive to light. He had a dense left cataract present. The right disk margin appears sharp. His eye movements were full. The face was symmetric. Pain and temperature sensation were intact over both sides of the face. The tongue was midline.,NECK: His neck was supple.,MUSCULOSKELETAL: He has intact strength and normal tone in the upper extremities. He had increased tone in both lower extremities. He had hip flexion of 4/5 on the left. He had intact strength on the right lower extremity, although had slight hammertoe deformity bilaterally.,NEUROLOGIC: His reflexes were 2+ in the upper extremities, 3+ at the knees and 1+ at the ankles. He withdrew to plantar stimulation on the left, but did not have a Babinski response clearly present. He had intact finger-to-nose testing. Marked impairment in heel-to-shin testing. He was able to sit unassisted. He stood with assistance, but had a markedly ataxic gait. On sensory exam, he had a slight distal gradient to pin and vibratory sense in both lower extremities, but also had a decrease in sensation to pin over the right lower extremity compared to the left.,CARDIOVASCULAR: He had no carotid bruits. His heart rhythm was regular.,BACK: There was no focal back pain present. He did have a slight sensory level at the upper T spine at approximately T3, both anteriorly and posteriorly.,RADIOLOGIC DATA:, MRI by my view showed essentially unremarkable T spine. The MRI of his C spine showed significant spondylosis in the mid and lower C spine with spondylolisthesis at C7-T1. There is an abnormal signal in the cord which begins at approximately this level, but descends approximately 2 cm. There is slight enhancement at the mid-portion of the lesion. This appears to be an intrinsic lesion to the cord, not clearly associated with mild to moderate spinal stenosis at the level of the spondylolisthesis.,LABORATORY: ,His initial labs were unremarkable.,IMPRESSION: ,Cervical cord lesion at the C7 to T2 level of unclear etiology. Consider a transverse myelitis, tumor, contusion or ischemic lesion.,PLAN:, Will check labs including sedimentation rate, MRI of the brain, chest x-ray. He will probably need a lumbar puncture. He also appears to have a mild peripheral neuropathy, which I suspect is an independent problem. We will request labs for this.

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'

SUBJECTIVE: , This is a 42-year-old white female who comes in today for a complete physical and follow up on asthma. She says her asthma has been worse over the last three months. She has been using her inhaler daily. Her allergies seem to be a little bit worse as well. Her husband has been hauling corn and this seems to aggravate things. She has not been taking Allegra daily but when she does take it, it seems to help somewhat. She has not been taking her Flonase which has helped her in the past. She also notes that in the past she was on Advair but she got some vaginal irritation with that.,She had been noticing increasing symptoms of irritability and PMS around her menstrual cycle. She has been more impatient around that time. Says otherwise her mood is normal during the rest of the month. It usually is worse the week before her cycle and improves the day her menstrual cycle starts. Menses have been regular but somewhat shorter than in the past. Occasionally she will get some spotting after her cycles. She denies any hot flashes or night sweats with this. In reviewing the chart it is noted that she did have 3+ blood with what appeared to be a urinary tract infection previously. Her urine has not been rechecked. She recently had lab work and cholesterol drawn for a life insurance application and is going to send me those results when available.,REVIEW OF SYSTEMS: , As above. No fevers, no headaches, no shortness of breath currently. No chest pain or tightness. No abdominal pain, no heartburn, no constipation, diarrhea or dysuria. Occasional stress incontinence. No muscle or joint pain. No concerns about her skin. No polyphagia, polydipsia or polyuria.,PAST MEDICAL HISTORY: , Significant for asthma, allergic rhinitis and cervical dysplasia.,SOCIAL HISTORY: , She is married. She is a nonsmoker.,MEDICATIONS: , Proventil and Allegra.,ALLERGIES: , Sulfa.,OBJECTIVE:,Vital signs: Her weight is 151 pounds. Blood pressure is 110/60. Pulse is 72. Temperature is 97.1 degrees. Respirations are 20.,General: This is a well-developed, well-nourished 42-year-old white female, alert and oriented in no acute distress. Affect is appropriate and is pleasant.,HEENT: Normocephalic, atraumatic. Tympanic membranes are clear. Conjunctivae are clear. Pupils are equal, round and reactive to light. Nares without turbinate edema. Oropharynx is nonerythematous.,Neck: Supple without lymphadenopathy, thyromegaly, carotid bruit or JVD.,Chest: Clear to auscultation bilaterally.,Cardiovascular: Regular rate and rhythm without murmur.,Abdomen: Soft, nontender, nondistended. Normoactive bowel sounds. No masses or organomegaly to palpation.,Extremities: Without cyanosis or edema.,Skin: Without abnormalities.,Breasts: Normal symmetrical breasts without dimpling or retraction. No nipple discharge. No masses or lesions to palpation. No axillary masses or lymphadenopathy.,Genitourinary: Normal external genitalia. The walls of the vaginal vault are visualized with normal pink rugae with no lesions noted. Cervix is visualized without lesion. She has a moderate amount of thick white/yellow vaginal discharge in the vaginal vault. No cervical motion tenderness. No adnexal tenderness or fullness.,ASSESSMENT/PLAN:,1. Asthma. Seems to be worse than in the past. She is just using her Proventil inhaler but is using it daily. We will add Flovent 44 mcg two puffs p.o. b.i.d. May need to increase the dose. She did get some vaginal irritation with Advair in the past but she is willing to retry that if it is necessary. May also need to consider Singulair. She is to call me if she is not improving. If her shortness of breath worsens she is to call me or go into the emergency department. We will plan on following up for reevaluation in one month.,2. Allergic rhinitis. We will plan on restarting Allegra and Flonase daily for the time being.,3. Premenstrual dysphoric disorder. She may have some perimenopausal symptoms. We will start her on fluoxetine 20 mg one tablet p.o. q.d.,4. Hematuria. Likely this is secondary to urinary tract infection but we will repeat a UA to document clearing. She does have some frequent dysuria but is not having it currently.,5. Cervical dysplasia. Pap smear is taken. We will notify the patient of results. If normal we will go back to yearly Pap smear. She is scheduled for screening mammogram and instructed on monthly self-breast exam techniques. Recommend she get 1200 mg of calcium and 400 U of vitamin D a day.

General Medicine

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS:, Airway obstruction secondary to laryngeal subglottic stenosis.,POSTOPERATIVE DIAGNOSIS: ,Airway obstruction secondary to laryngeal subglottic stenosis and tracheal stenosis.,OPERATION PERFORMED: , Suspension microlaryngoscopy, rigid bronchoscopy, dilation of tracheal stenosis.,INDICATIONS FOR SURGERY: ,The patient is a 56-year-old white female with a history of relapsing polychondritis, which resulted in saddle nose deformity in glottic and subglottic stenosis for which she has undergone number of procedures in the past to the upper airway. She currently is trach dependent for her airway because of glottic and subglottic stenosis, but she is having no significant problems breathing and talking around her trach tube and came for further evaluation. Endoscopic reevaluation of her tube and nature of the proposed procedure done. Risk and complications of bleeding, infection, alteration of with speech or swallowing, failure to improve her airway, and loss of voice. Cardiorespiratory anesthetic results were discussed in length. The patient states she understood and wished to proceed.,DESCRIPTION OF OPERATION:, The patient was taken to the operating room and placed in the supine position. Under adequate general endotracheal anesthesia, the patient's #5 metal tracheostomy tube was removed and a #5 laser-safe endotracheal tube was inserted. The patient was then prepared for endoscopy. The Kantor laryngoscope was then inserted. Oral cavity, hypopharynx, larynx, and nasal cavity showed good dentition with good tongue, buccal cavity, and mucosa without lesions. Larynx was then ***** short epiglottis. Larynx was suspended with significant scarring beginning in the supraglottic area with loss of laryngeal contour beginning in the supraglottis with extensive scar tissue at the level of the false cord obliteration of ventricles and true cords. This appeared to be stable, and airway was patent at the supraglottic and glottic level with some narrowing at the subglottic level with mild-to-moderate subglottic stenosis, otherwise this appeared to be stable. However, distally, the level of the trach site examined with the microscope and 0 and 30-degree telescopes. The patient noted to have marked narrowing with dense scarring posterolaterally on the left securing good visualization of the trach tube. The laryngoscope was removed, and a 5 x 30 pediatric rigid bronchoscope was then passed. The LP contact tip laser was utilized to vaporize the scar tissue and release the scar banding following which the scope was passed and further dilation carried out. Mid and distal trachea were widely patent. Trachea and mainstem bronchi were patent without obvious disease. The patient did not appear to have any relapsing polychondritis with progressive scar tissue at the level of the trach site and the posterior trachea wall was significant. This was further dilated and following which was removed and a new #5 metal tracheostomy tube inserted. The patient tolerated the procedure well without complications and was taken to recovery room in satisfactory 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'

CC:, BLE weakness.,HX:, This 82y/o RHM was referred to the Neurology service by the Neurosurgery service for evaluation of acute onset paraplegia. He was in his usual state of health until 5:30PM on 4/6/95, when he developed sudden "pressure-like" epigastric discomfort associated with bilateral lower extremity weakness, SOB, lightheadedness and diaphoresis. He knelt down to the floor and "went to sleep." The Emergency Medical Service was alert and arrived within minutes, at which time he was easily aroused though unable to move or feel his lower extremities. No associated upper extremity or bulbar dysfunction was noted. He was taken to a local hospital where an INR was found to be 9.1. He was given vitamin K 15mg, and transferred to UIHC to rule out spinal epidural hemorrhage. An MRI scan of the T-spine was obtained and the preliminary reading was "normal." The Neurology service was then asked to evaluate the patient.,MEDS:, Coumadin 2mg qd, Digoxin 0.25mg qd, Prazosin 2mg qd.,PMH:, 1)HTN. 2)A-Fib on coumadin. 3)Peripheral vascular disease:s/p left Femoral-popliteal bypass (8/94) and graft thrombosis-thrombolisis (9/94). 4)Adenocarcinoma of the prostate: s/p TURP (1992).,FHX: ,unremarkable.,SHX:, Farmer, Married, no Tobacco/ETOH/illicit drug use.,EXAM:, BP165/60 HR86 RR18 34.2C SAO2 98% on room air.,MS: A&O to person, place, time. In no acute distress. Lucid.,CN: unremarkable.,MOTOR: 5/5 strength in BUE. Flaccid paraplegia in BLE,Sensory: T6 sensory level to LT/PP, bilaterally. Decreased vibratory sense in BLE in a stocking distribution, distally.,Coord: Intact FNF and RAM in BUE. Unable to do HKS.,Station: no pronator drift.,Gait: not done.,Reflexes: 2/2 BUE, Absent in BLE, plantar responses were flexor, bilaterally.,Rectal: decreased rectal tone.,GEN EXAM: No carotid bruitts. Lungs: bibasilar crackles. CV: Irregular rate and rhythm with soft diastolic murmur at the left sternal border. Abdomen: flat, soft, non-tender without bruitt or pulsatile mass. Distal pulses were strong in all extremities.,COURSE:, Hgb 12.6, Hct 40%, WBC 11.7, Plt 154k, INR 7.6, PTT 50, CK 41, the GS was normal. EKG showed A-Fib at 75BPM with competing junctional pacemaker, essentially unchanged from 9/12/94.,It was suspected that the patient sustained an anterior-cervico-thoracic spinal cord infarction with resultant paraplegia and T6 sensory level. A CXR was done in the ER prior to admission. This revealed cardiomegaly and a widened mediastinum. He returned from the x-ray suite and suddenly became unresponsive and went into cardiopulmonary arrest. Resuscitative measures failed. Pericardiocentesis was unremarkable. Autopsy revealed a massive aortic dissection extending from the aortic root to the origin of the iliac arteries with extensive pericardial hematoma. The dissection was seen in retrospect on the MRI T-spine.

Neurology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

REASON FOR CONSULT: , Peripheral effusion on the CAT scan.,HISTORY OF PRESENT ILLNESS: , The patient is a 70-year-old Caucasian female with prior history of lung cancer, status post upper lobectomy. She was recently diagnosed with recurrent pneumonia and does have a cancer on the CAT scan, lung cancer with metastasis. The patient had a visiting nurse for Christmas and started having abdominal pain, nausea and vomiting for which, she was admitted. She had a CAT scan of the abdomen done, showed moderate pericardial effusion for which cardiology consult was requested. She had an echo done, which shows moderate pericardial effusion with early tamponade. The patient has underlying shortness of breath because of COPD, emphysema and chronic cough. However, denies any dizziness, syncope, presyncope, palpitation. Denies any prior history of coronary artery disease.,ALLERGIES: , No known drug allergies.,MEDICATIONS: , At this time, she is on hydromorphone p.r.n., erythromycin, ceftriaxone, calcium carbonate, Ambien. She is on oxygen and nebulizer.,PAST MEDICAL HISTORY: , History of COPD, emphysema, pneumonia, and lung cancer.,PAST SURGICAL HISTORY: ,Hip surgery and resection of the lung cancer 10 years ago.,SOCIAL HISTORY:, Still smokes, but less than before. Drinks socially.,FAMILY HISTORY:, Noncontributory.,REVIEW OF SYSTEMS: , Denies any syncope, presyncope, palpitations, shortness of breath, cough, nausea, vomiting, or diarrhea.,PHYSICAL EXAMINATION:,GENERAL: The patient is comfortable not in any distress.,VITAL SIGNS: Blood pressure 121/79, Pulse rate 94, respiratory rate 19, and temperature 97.6.,HEENT: Atraumatic and normocephalic.,NECK: Supple. No JVD. No carotid bruit.,CHEST: Breath sounds vesicular. Clear on auscultation.,HEART: PMI could not be localized. S2 and S2 regular. No S3, no S4. No murmur.,ABDOMEN: Soft and nontender. Positive bowel sounds.,EXTREMITIES: No cyanosis, clubbing, or edema. Pulse 2+.,CNS: Alert, awake, and oriented x3.,EKG shows normal sinus rhythm, low voltage.,LABORATORY DATA: , White cell count 7.3, hemoglobin 12.9, hematocrit 38.1, and platelet at 322,000. Sodium 135, potassium 5, BUN 6, creatinine 1.2, glucose 71, alkaline phosphatase 263, total protein 5.3, lipase 414, and amylase 57.,DIAGNOSTIC STUDIES:, Chest x-ray shows left upper lobe airspace disease consistent with pneumonia _______. CT abdomen showed diffuse replacement of the _______ metastasis, hepatomegaly, perihepatic ascites, moderate pericardial effusion, small left _______ sigmoid diverticulosis.,ASSESSMENT:,1. Moderate peripheral effusion with early tamponade, probably secondary to lung cancer.,2. Lung cancer with metastasis most likely.,3. Pneumonia.,4. COPD.,PLAN: , We will get CT surgery consult for pericardial window. Continue present medication.

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. Postdates pregnancy.,2. Failure to progress.,3. Meconium stained amniotic fluid.,POSTOPERATIVE DIAGNOSES:,1. Postdates pregnancy.,2. Failure to progress.,3. Meconium stained amniotic fluid.,OPERATION:, Primary low-transverse C-section.,ANESTHESIA:, Epidural.,DESCRIPTION OF OPERATION: ,The patient was taken to the operating room and under epidural anesthesia, she was prepped and draped in the usual manner. Anesthesia was tested and found to be adequate. Incision was made, Pfannenstiel, approximately 1.5 fingerbreadths above the symphysis pubis and carried sharply through subcutaneous and fascial layers without difficulty; the fascia being incised laterally. Bleeders were bovied. Rectus muscles were separated from the overlying fascia with blunt and sharp dissection. Muscles were separated in the midline. Peritoneum was entered sharply and incision was carried out laterally in each direction. Bladder blade was placed and bladder flap developed with blunt and sharp dissection. A horizontal _______ incision was made in the lower uterine segment and carried laterally in each direction. Allis was placed in the incision, and an uncomplicated extraction of a 7 pound 4 ounce, Apgar 9 female was accomplished and given to the pediatric service in attendance. Infant was carefully suctioned after delivery of the head and body. Cord blood was collected. _______ and endometrial cavity was wiped free of membranes and clots. Lower segment incision was inspected. There were some extensive adhesions on the left side and a figure-of-eight suture of 1 chromic was placed on both lateral cuff borders and the cuff was closed with two interlocking layers of 1 chromic. Bleeding near the left cuff required an additional suture of 1 chromic after which hemostasis was present. Cul-de-sac was suctioned free of blood and clots and irrigated. Fundus was delivered back into the abdominal cavity and lateral gutters were suctioned free of blood and clots and irrigated. Lower segment incision was again inspected and found to be hemostatic. The abdominal wall was then closed in layers, 2-0 chromic on the peritoneum, 0 Maxon on the fascia, 3-0 plain on the subcutaneous and staples on the skin. Hemostasis was present between all layers. The area was gently irrigated across the peritoneum and fascial layers. There were no intraoperative complications except blood loss. The patient was taken to the recovery room in satisfactory condition.

Surgery

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

CHIEF COMPLAINT:, Sinus problems.,SINUSITIS HISTORY:, The problem began 2 weeks ago and is constant. Symptoms include postnasal drainage, sore throat, facial pain, coughing, headaches and congestion. Additional symptoms include snoring, nasal burning and teeth pain. The symptoms are characterized as moderate to severe. Symptoms are worse in the evening and morning.,REVIEW OF SYSTEMS:,ROS General: General health is good.,ROS ENT: As noted in history of present Illness listed above.,ROS Respiratory: Patient denies any respiratory complaints, such as cough, shortness of breath, chest pain, wheezing, hemoptysis, etc.,ROS Gastrointestinal: Patient denies any nausea, vomiting, abdominal pain, dysphagia or any altered bowel movements.,ROS Respiratory: Complaints include coughing.,ROS Neurological: Patient complains of headaches. All other systems are negative.,PAST SURGICAL HISTORY:, Gallbladder 7/82. Hernia 5/79,PAST MEDICAL HISTORY:, Negative.,PAST SOCIAL HISTORY:, Marital Status: Married. Denies the use of alcohol. Patient has a history of smoking 1 pack of cigarettes per day and for the past 15 years. There are no animals inside the home.,FAMILY MEDICAL HISTORY:, Family history of allergies and hypertension.,CURRENT MEDICATIONS:, Claritin. Dilantin.,PREVIOUS MEDICATIONS UTILIZED:, Rhinocort Nasal Spray.,EXAM:,Exam Ear: Auricles/external auditory canals reveal no significant abnormalities bilaterally. TMs intact with no middle ear effusion and are mobile to insufflation.,Exam Nose: Intranasal exam reveals moderate congestion and purulent mucus.,Exam Oropharynx: Examination of the teeth/alveolar ridges reveals missing molar (s). Examination of the posterior pharynx reveals a prominent uvula and purulent postnasal drainage. The palatine tonsils are 2+ and cryptic.,Exam Neck: Palpation of anterior neck reveals no tenderness. Examination of the posterior neck reveals mild tenderness to palpation of the suboccipital muscles.,Exam Facial: There is bilateral maxillary sinus tenderness to palpation.,X-RAY / LAB FINDINGS:, Water's view x-ray reveals bilateral maxillary mucosal thickening.,IMPRESSION:, Acute maxillary sinusitis (461.0). Snoring (786.09).,MEDICATION:, Augmentin. 875 mg bid. MucoFen 800 mg bid.,PLAN:,

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: ,Blood in toilet.,HISTORY: , Ms. ABC is a 77-year-old female who is brought down by way of ambulance from XYZ Nursing Home after nursing staff had noted there to be blood in the toilet after she had been sitting on the toilet. They did not note any urine or stool in the toilet and the patient had no acute complaints. The patient is unfortunately a poor historian in that she has dementia and does not recall any of the events. The patient herself has absolutely no complaints, such as abdominal pain or back pain, urinary and GI complaints. There is no other history provided by the nursing staff from XYZ. There apparently were no clots noted within there. She does not have a history of being on anticoagulants.,PAST MEDICAL HISTORY: , Actually quite limited, includes that of dementia, asthma, anemia which is chronic, hypothyroidism, schizophrenia, positive PPD in the past.,PAST SURGICAL HISTORY: ,Unknown.,SOCIAL HISTORY: , No tobacco or alcohol.,MEDICATIONS: , Listed in the medical records.,ALLERGIES:, No known drug allergies.,PHYSICAL EXAMINATION: , VITAL SIGNS: Stable.,GENERAL: This is a well-nourished, well-developed female who is alert, oriented in all spheres, pleasant, cooperative, resting comfortably, appearing otherwise healthy and well in no acute distress.,HEENT: Visually normal. Pupils are reactive. TMs, canals, nasal mucosa, and oropharynx are intact.,NECK: No lymphadenopathy or JVD.,HEART: Regular rate and rhythm. S1, S2. No murmurs, gallops, or rubs.,LUNGS: Clear to auscultation. No wheeze, rales, or rhonchi.,ABDOMEN: Benign, flat, soft, nontender, and nondistended. Bowel sounds active. No organomegaly or mass noted.,GU/RECTAL: External rectum was normal. No obvious blood internally. There is no stool noted within the vault. There is no gross amount of blood noted within the vault. Guaiac was done and was trace positive. Visual examination anteriorly during the rectal examination noted no blood within the vaginal region.,EXTREMITIES: No significant abnormalities.,WORKUP: , CT abdomen and pelvis was negative. CBC was entirely within normal limits without any signs of anemia with an H and H of 14 and 42%. CMP also within normal limits. PTT, PT, and INR were normal. Attempts at getting the patient to give A urine were unsuccessful and the patient was very noncompliant, would not allow us to do any kind of Foley catheterization.,ER COURSE:, Uneventful. I have discussed the patient in full with Dr. X who agrees that she does not require any further workup or evaluation as an inpatient. We have decided to send the patient back to XYZ with observation by the staff there. She will have a CBC done daily for the next 3 days with results to Dr. X. They are to call him if there is any recurrences of blood or worsening of symptoms and they are to do a urinalysis at XYZ for blood.,ASSESSMENT: , Questionable gastrointestinal bleeding at this time, stable without any obvious signs otherwise of significant bleed.

Emergency Room Reports

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

HISTORY OF PRESENT ILLNESS:, This 66-year-old white male was seen in my office on Month DD, YYYY. Patient was recently discharged from Doctors Hospital at Parkway after he was treated for pneumonia. Patient continues to have severe orthopnea, paroxysmal nocturnal dyspnea, cough with greenish expectoration. His exercise tolerance is about two to three yards for shortness of breath. The patient stopped taking Coumadin for reasons not very clear to him. He was documented to have recent atrial fibrillation. Patient has longstanding history of ischemic heart disease, end-stage LV systolic dysfunction, and is status post ICD implantation. Fasting blood sugar this morning is 130.,PHYSICAL EXAMINATION: , ,VITAL SIGNS: Blood pressure is 120/60. Respirations 18 per minute. Heart rate 75-85 beats per minute, irregular. Weight 207 pounds.,HEENT: Head normocephalic. Eyes, no evidence of anemia or jaundice. Oral hygiene is good. ,NECK: Supple. JVP is flat. Carotid upstroke is good. ,LUNGS: Severe inspiratory and expiratory wheezing heard throughout the lung fields. Fine crepitations heard at the base of the lungs on both sides. ,CARDIOVASCULAR: PMI felt in fifth left intercostal space 0.5-inch lateral to midclavicular line. First and second heart sounds are normal in character. There is a II/VI systolic murmur best heard at the apex.,ABDOMEN: Soft. There is no hepatosplenomegaly.,EXTREMITIES: Patient has 1+ pedal edema.,MEDICATIONS: , ,1. Ambien 10 mg at bedtime p.r.n.,2. Coumadin 7.5 mg daily.,3. Diovan 320 mg daily.,4. Lantus insulin 50 units in the morning.,5. Lasix 80 mg daily.,6. Novolin R p.r.n.,7. Toprol XL 100 mg daily.,8. Flovent 100 mcg twice a day.,DIAGNOSES:,1. Atherosclerotic coronary vascular disease with old myocardial infarction.,2. Moderate to severe LV systolic dysfunction.,3. Diabetes mellitus.,4. Diabetic nephropathy and renal failure.,5. Status post ICD implantation.,6. New onset of atrial fibrillation.,7. Chronic Coumadin therapy.,PLAN:,1. Continue present therapy.,2. Patient will be seen again in my office in four weeks.

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 CONSULT: , Peripheral effusion on the CAT scan.,HISTORY OF PRESENT ILLNESS: , The patient is a 70-year-old Caucasian female with prior history of lung cancer, status post upper lobectomy. She was recently diagnosed with recurrent pneumonia and does have a cancer on the CAT scan, lung cancer with metastasis. The patient had a visiting nurse for Christmas and started having abdominal pain, nausea and vomiting for which, she was admitted. She had a CAT scan of the abdomen done, showed moderate pericardial effusion for which cardiology consult was requested. She had an echo done, which shows moderate pericardial effusion with early tamponade. The patient has underlying shortness of breath because of COPD, emphysema and chronic cough. However, denies any dizziness, syncope, presyncope, palpitation. Denies any prior history of coronary artery disease.,ALLERGIES: , No known drug allergies.,MEDICATIONS: , At this time, she is on hydromorphone p.r.n., erythromycin, ceftriaxone, calcium carbonate, Ambien. She is on oxygen and nebulizer.,PAST MEDICAL HISTORY: , History of COPD, emphysema, pneumonia, and lung cancer.,PAST SURGICAL HISTORY: ,Hip surgery and resection of the lung cancer 10 years ago.,SOCIAL HISTORY:, Still smokes, but less than before. Drinks socially.,FAMILY HISTORY:, Noncontributory.,REVIEW OF SYSTEMS: , Denies any syncope, presyncope, palpitations, shortness of breath, cough, nausea, vomiting, or diarrhea.,PHYSICAL EXAMINATION:,GENERAL: The patient is comfortable not in any distress.,VITAL SIGNS: Blood pressure 121/79, Pulse rate 94, respiratory rate 19, and temperature 97.6.,HEENT: Atraumatic and normocephalic.,NECK: Supple. No JVD. No carotid bruit.,CHEST: Breath sounds vesicular. Clear on auscultation.,HEART: PMI could not be localized. S2 and S2 regular. No S3, no S4. No murmur.,ABDOMEN: Soft and nontender. Positive bowel sounds.,EXTREMITIES: No cyanosis, clubbing, or edema. Pulse 2+.,CNS: Alert, awake, and oriented x3.,EKG shows normal sinus rhythm, low voltage.,LABORATORY DATA: , White cell count 7.3, hemoglobin 12.9, hematocrit 38.1, and platelet at 322,000. Sodium 135, potassium 5, BUN 6, creatinine 1.2, glucose 71, alkaline phosphatase 263, total protein 5.3, lipase 414, and amylase 57.,DIAGNOSTIC STUDIES:, Chest x-ray shows left upper lobe airspace disease consistent with pneumonia _______. CT abdomen showed diffuse replacement of the _______ metastasis, hepatomegaly, perihepatic ascites, moderate pericardial effusion, small left _______ sigmoid diverticulosis.,ASSESSMENT:,1. Moderate peripheral effusion with early tamponade, probably secondary to lung cancer.,2. Lung cancer with metastasis most likely.,3. Pneumonia.,4. COPD.,PLAN: , We will get CT surgery consult for pericardial window. Continue present medication.

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:, Volar laceration to right ring finger with possible digital nerve injury with possible flexor tendon injury.,POSTOPERATIVE DIAGNOSES:,1. Laceration to right ring finger with partial laceration to the ulnar slip of the FDS which is the flexor digitorum superficialis.,2. 25% laceration to the flexor digitorum profundus of the right ring finger and laceration 100% of the ulnar digital nerve to the right ring finger.,PROCEDURE PERFORMED:,1. Repair of nerve and tendon, right ring finger.,2. Exploration of digital laceration.,ANESTHESIA: , General.,ESTIMATED BLOOD LOSS: , Less than 10 cc.,TOTAL TOURNIQUET TIME: ,57 minutes.,COMPLICATIONS: , None.,DISPOSITION: ,To PACU in stable condition.,BRIEF HISTORY OF PRESENT ILLNESS: , This is a 13-year-old male who had sustained a laceration from glass and had described numbness and tingling in his right ring finger.,GROSS OPERATIVE FINDINGS: , After wound exploration, it was found there was a 100% laceration to the ulnar digital neurovascular bundle. The FDS had a partial ulnar slip laceration and the FDP had a 25% transverse laceration as well. The radial neurovascular bundle was found to be completely intact.,OPERATIVE PROCEDURE: ,The patient was taken to the operating room and placed in the supine position. All bony prominences were adequately padded. Tourniquet was placed on the right upper extremity after being packed with Webril, but not inflated at this time. The right upper extremity was prepped and draped in the usual sterile fashion. The hand was inspected. Palmar surface revealed approximally 0.5 cm laceration at the base of the right ring finger at the base of proximal phalanx, which was approximated with nylon suture. The sutures were removed and the wound was explored. It was found that the ulnar digital neurovascular bundle was 100% transected. The radial neurovascular bundle on the right ring finger was found to be completely intact. We explored the flexor tendon and found that there was a partial laceration of the ulnar slip of the FDS and a 25% laceration in a transverse fashion to the FDP. We copiously irrigated the wound. Repair was undertaken of the FDS with #3-0 undyed Ethibond suture. The laceration of the FDP was not felt that it need to repair due to majority of the substance in the FDP was still intact. Attention during our repair at the flexor tendon, the A1 pulley was incised for better visualization as well as better tendon excursion after repair. Attention was then drawn to the ulnar digital bundle which has been transected prior during the injury. The digital nerve was dissected proximally and distally to likely visualize the nerve. The nerve was then approximated using microvascular technique with #8-0 nylon suture. The hands were well approximated. The nerve was not under undue tension. The wound was then copiously irrigated and the skin was closed with #4-0 nylon interrupted horizontal mattress alternating with simple suture. Sterile dressing was placed and a dorsal extension Box splint was placed. The patient was transferred off of the bed and placed back on a gurney and taken to PACU in stable condition. Overall prognosis is good.

Surgery

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

HISTORY OF PRESENT ILLNESS: , This is a ** week gestational age ** delivered by ** at ** on **. Gestational age was determined by last menstrual period and consistent with ** trimester ultrasound. ** rupture of membranes occurred ** prior to delivery and amniotic fluid was clear. The baby was vertex presentation. The baby was dried, stimulated, and bulb suctioned. Apgar scores of ** at one minute and ** at five minutes.,PAST MEDICAL HISTORY,MATERNAL HISTORY:, The mother is a **-year-old, G**, P** female with blood type **. She is rubella immune, hepatitis surface antigen negative, RPR nonreactive, HIV negative. Mother was group B strep **. Mother's past medical history is **.,PRENATAL CARE: , Mother began prenatal care in the ** trimester and had at least ** documented prenatal visits. She did not smoke, drink alcohol, or use illicit drugs during pregnancy.,SURGICAL HISTORY: , **,MEDICATIONS:, Medications taken during this pregnancy were **.,ALLERGIES: , **,FAMILY HISTORY: , **,SOCIAL HISTORY: , **,PHYSICAL EXAMINATION,VITAL SIGNS: Temperature **, heart rate **, respiratory rate **. Dextrose stick **. Ballard score by the RN is ** weeks. Birth weight is ** grams, which is the ** percentile for gestational age. Length is ** centimeters which is ** percentile for gestational age. Head circumference is ** centimeters which is ** percentile for gestational age.,GENERAL: **Alert, active, nondysmorphic-appearing infant in no acute distress.,HEENT: Anterior fontanelle open and flat. Positive bilateral red reflexes.,Ears have normal shape and position with no pits or tags. Nares patent. Palate intact. Mucous membranes moist.,NECK: Full range of motion.,CARDIOVASCULAR: Normal precordium, regular rate and rhythm. No murmurs. Normal femoral pulses.,RESPIRATORY; Clear to auscultation bilaterally. No retractions.,ABDOMEN: Soft, nondistended. Normal bowel sounds. No hepatosplenomegaly. Umbilical stump is clean, dry, and intact.,GENITOURINARY: Normal tanner I **. Anus patent.,MUSCULOSKELETAL: Negative Barlow and Ortolani. Clavicles intact. Spine straight. No sacral dimple or hair tuft. Leg lengths grossly symmetric. Five fingers on each hand and five toes on each foot.,SKIN: Warm and pink with brisk capillary refill. No jaundice.,NEUROLOGICAL: Normal tone. Normal root, suck, grasp, and Moro reflexes. Moves all extremities equally.,DIAGNOSTIC STUDIES,LABORATORY DATA:, **,ASSESSMENT: , Full term, appropriate for gestational age **.,PLAN:,1. Routine newborn care.,2. Anticipatory guidance.,3. Hepatitis B immunization prior to discharge.,

General Medicine

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSES,1. Abnormal uterine bleeding.,2. Uterine fibroids.,POSTOPERATIVE DIAGNOSES,1. Abnormal uterine bleeding.,2. Uterine fibroids.,OPERATION PERFORMED: , Laparoscopic-assisted vaginal hysterectomy.,ANESTHESIA: , General endotracheal anesthesia.,DESCRIPTION OF PROCEDURE: ,After adequate general endotracheal anesthesia, the patient was placed in dorsal lithotomy position, prepped and draped in the usual manner for a laparoscopic procedure. A speculum was placed into the vagina. A single tooth tenaculum was utilized to grasp the anterior lip of the uterine cervix. The uterus was sounded to 10.5 cm. A #10 RUMI cannula was utilized and attached for uterine manipulation. The single-tooth tenaculum and speculum were removed from the vagina. At this time, the infraumbilical area was injected with 0.25% Marcaine with epinephrine and infraumbilical vertical skin incision was made through which a Veress needle was inserted into the abdominal cavity. Aspiration was negative; therefore the abdomen was insufflated with carbon dioxide. After adequate insufflation, Veress needle was removed and an 11-mm separator trocar was introduced through the infraumbilical incision into the abdominal cavity. Through the trocar sheath, the laparoscope was inserted and adequate visualization of the pelvic structures was noted. At this time, the suprapubic area was injected with 0.25% Marcaine with epinephrine. A 5-mm skin incision was made and a 5-mm trocar was introduced into the abdominal cavity for instrumentation. Evaluation of the pelvis revealed the uterus to be slightly enlarged and irregular. The fallopian tubes have been previously interrupted surgically. The ovaries appeared normal bilaterally. The cul-de-sac was clean without evidence of endometriosis, scarring or adhesions. The ureters were noted to be deep in the pelvis. At this time, the right cornu was grasped and the right fallopian tube, uteroovarian ligament, and round ligaments were doubly coagulated with bipolar electrocautery and transected without difficulty. The remainder of the uterine vessels and anterior and posterior leaves of the broad ligament, as well as the cardinal ligament was coagulated and transected in a serial fashion down to level of the uterine artery. The uterine artery was identified. It was doubly coagulated with bipolar electrocautery and transected. A similar procedure was carried out on the left with the left uterine cornu identified. The left fallopian tube, uteroovarian ligament, and round ligaments were doubly coagulated with bipolar electrocautery and transected. The remainder of the cardinal ligament, uterine vessels, anterior, and posterior sheaths of the broad ligament were coagulated and transected in a serial manner to the level of the uterine artery. The uterine artery was identified. It was doubly coagulated with bipolar electrocautery and transected. The anterior leaf of the broad ligament was then dissected to the midline bilaterally, establishing a bladder flap with a combination of blunt and sharp dissection. At this time, attention was made to the vaginal hysterectomy. The laparoscope was removed and attention was made to the vaginal hysterectomy. The RUMI cannula was removed and the anterior and posterior leafs of the cervix were grasped with Lahey tenaculum. A circumferential injection with 0.25% Marcaine with epinephrine was made at the cervicovaginal portio. A circumferential incision was then made at the cervicovaginal portio. The anterior and posterior colpotomies were accomplished with a combination of blunt and sharp dissection without difficulty. The right uterosacral ligament was clamped, transected, and ligated with #0 Vicryl sutures. The left uterosacral ligament was clamped, transected, and ligated with #0 Vicryl suture. The parametrial tissue was then clamped bilaterally, transected, and ligated with #0 Vicryl suture bilaterally. The uterus was then removed and passed off the operative field. Laparotomy pack was placed into the pelvis. The pedicles were evaluated. There was no bleeding noted; therefore, the laparotomy pack was removed. The uterosacral ligaments were suture fixated into the vaginal cuff angles with #0 Vicryl sutures. The vaginal cuff was then closed in a running fashion with #0 Vicryl suture. Hemostasis was noted throughout. At this time, the laparoscope was reinserted into the abdomen. The abdomen was reinsufflated. Evaluation revealed no further bleeding. Irrigation with sterile water was performed and again no bleeding was noted. The suprapubic trocar sheath was then removed under laparoscopic visualization. The laparoscope was removed. The carbon dioxide was allowed to escape from the abdomen and the infraumbilical trocar sheath was then removed. The skin incisions were closed with #4-0 Vicryl in subcuticular fashion. Neosporin and Band-Aid were applied for dressing and the patient was taken to the recovery room in satisfactory condition. Estimated blood loss was approximately 100 mL. There were no complications. The instrument, sponge, and needle counts were correct.

Obstetrics / Gynecology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

OPERATION,1. Insertion of a left subclavian Tesio hemodialysis catheter.,2. Surgeon-interpreted fluoroscopy.,OPERATIVE PROCEDURE IN DETAIL: , After obtaining informed consent from the patient, including a thorough explanation of the risks and benefits of the aforementioned procedure, patient was taken to the operating room and MAC anesthesia was administered. Next, the patient's chest and neck were prepped and draped in the standard surgical fashion. Lidocaine 1% was used to infiltrate the skin in the region of the procedure. Next a #18-gauge finder needle was used to locate the left subclavian vein. After aspiration of venous blood, Seldinger technique was used to thread a J wire through the needle. This process was repeated. The 2 J wires and their distal tips were confirmed to be in adequate position with surgeon-interpreted fluoroscopy. Next, the subcutaneous tunnel was created. The distal tips of the individual Tesio hemodialysis catheters were pulled through to the level of the cuff. A dilator and sheath were passed over the individual J wires. The dilator and wire were removed, and the distal tip of the Tesio hemodialysis catheter was threaded through the sheath, which was simultaneously withdrawn. The process was repeated. Both distal tips were noted to be in good position. The Tesio hemodialysis catheters were flushed and aspirated without difficulty. The catheters were secured at the cuff level with a 2-0 nylon. The skin was closed with 4-0 Monocryl. Sterile dressing was applied. The patient tolerated the procedure well and was transferred to the PACU in good condition.

Surgery

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

ADENOIDECTOMY,PROCEDURE:, The patient was brought into the operating room suite, anesthesia administered via endotracheal tube. Following this the patient was draped in standard fashion. The Crowe-Davis mouth gag was inserted in the oral cavity. The palate and tonsils were inspected, the palate was suspended with a red rubber catheter passed through the right nostril. Following this, the mirror was used to visualize the adenoid pad and an adenoid curet was seated against the vomer. The adenoid pad was removed without difficulty. The nasopharynx was packed. Following this, the nasopharynx was unpacked, several discrete bleeding sites were gently coagulated with electrocautery and the nasopharynx and oral cavity were irrigated. The Crowe-Davis was released.,The patient tolerated the procedure without difficulty and was in stable condition on transfer to recovery.

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'

SUBJECTIVE:, The patient is a 78-year-old female with the problem of essential hypertension. She has symptoms that suggested intracranial pathology, but so far work-up has been negative.,She is taking hydrochlorothiazide 25-mg once a day and K-Dur 10-mEq once a day with adequate control of her blood pressure. She denies any chest pain, shortness of breath, PND, ankle swelling, or dizziness.,OBJECTIVE:, Heart rate is 80 and blood pressure is 130/70. Head and neck are unremarkable. Heart sounds are normal. Abdomen is benign. Extremities are without edema.,ASSESSMENT AND PLAN:, The patient reports that she had an echocardiogram done in the office of Dr. Sample Doctor4 and was told that she had a massive heart attack in the past. I have not had the opportunity to review any investigative data like chest x-ray, echocardiogram, EKG, etc. So, I advised her to have a chest x-ray and an EKG done before her next appointment, and we will try to get hold of the echocardiogram on her from the office of Dr. Sample Doctor4. In the meantime, she is doing quite well, and she was advised to continue her current medication and return to the office in three months for followup.

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'

EXAMINATION: , Cardiac catheterization.,PROCEDURE PERFORMED: , Left heart catheterization, LV cineangiography, selective coronary angiography, and right heart catheterization with cardiac output by thermodilution technique with dual transducer.,INDICATION: , Syncope with severe aortic stenosis.,COMPLICATIONS:, None.,DESCRIPTION OF PROCEDURE: , After informed consent was obtained from the patient, the patient was brought to the cardiac catheterization laboratory in a post observed state. The right groin was prepped and draped in the usual sterile fashion. After adequate conscious sedation and local anesthesia was obtained, a 6-French sheath was placed in the right common femoral artery and a 8-French sheath was placed in the right common femoral vein. Following this, a 7.5-French Swan-Ganz catheter was advanced into the right atrium where the right atrial pressure was 10/7 mmHg. The catheter was then manipulated into the right ventricle where the right ventricular pressure was 37/10/4 mmHg. The catheter was then manipulated into the wedge position where the wedge pressure was noted to be 22 mmHg. The pulmonary arterial pressures were noted to be 31/14/21 mmHg. Following this, the catheter was removed, the sheath was flushed and a 6-French JL4 diagnostic catheter was the advanced over the guidewire and the left main coronary artery was cannulated and selective angiogram was obtained in orthogonal views. Following this, the catheter was exchanged over the guidewire for 6-French JR4 diagnostic catheter. We were unable to cannulate the right coronary artery. Therefore, we exchanged for a Williams posterior catheter and we were able to cannulate the right coronary artery and angiographs were performed in orthogonal views. Following this, this catheter was exchanged over a guidewire for a 6-French Langston pigtail catheter and the left ventricle was entered and left ventriculography was performed. Following this, the catheters were removed. Sheath angiograms revealed the sheath to be in the right common femoral artery and the right common femoral arteriotomy was sealed using a 6-French Angio-Seal device. The patient tolerated the procedure well. There were no complications.,DESCRIPTION OF FINDINGS: , The left main coronary artery is a large vessel, which bifurcates into the left anterior descending artery and left circumflex artery and has moderate diffuse luminal irregularities with no critical lesions. The left circumflex artery is a short vessel, which gives off one major obtuse marginal artery and has moderate diffuse luminal irregularities with no critical lesions. The left anterior descending artery has moderate diffuse luminal irregularities and gives off two major diagonal branches. There is a 70% ostial lesion in the first diagonal branch and the second diagonal branch has mild-to-moderate luminal irregularities. The right coronary artery is a very large dominant vessel with a 60% to 70% lesion in its descending mid-portion. The remainder of the vessel has moderate diffuse luminal irregularities with no critical lesions. The left ventricle appears to be normal sized. The aortic valve is heavily calcified. The estimated ejection fraction is approximately 60%. There was 4+ mitral regurgitation noted. The mean gradient across the aortic valve was noted to be 33 mmHg yielding an aortic valve area of 0.89 cm2.,CONCLUSION:,1. Moderate-to-severe coronary artery disease with a high-grade lesion seen at the ostium of the first diagonal artery as well as a 60% to 70% lesion seen at the mid portion of the right coronary artery.,2. Moderate-to-severe aortic stenosis with an aortic valve area of 0.89 cm2.,3. 4+ mitral regurgitation.,PLAN: , The patient will most likely need a transesophageal echocardiogram to better evaluate the valvular architecture and the patient will be referred to Dr Kenneth Fang for possible aortic valve replacement as well as mitral valve repair/replacement and possible surgical revascularization.

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: , Appendicitis.,POSTOPERATIVE DIAGNOSIS:, Appendicitis, nonperforated.,PROCEDURE PERFORMED:, Appendectomy.,ANESTHESIA: , General endotracheal.,PROCEDURE: , After informed consent was obtained, the patient was brought to the operative suite and placed supine on the operating table. General endotracheal anesthesia was induced without incident. The patient was prepped and draped in the usual sterile manner.,A transverse right lower quadrant incision was made directly over the point of maximal tenderness. Sharp dissection utilizing Bovie electrocautery was used to expose the external oblique fascia. The fascia of the external oblique was incised in the direction of the fibers, and the muscle was spread with a clamp. The internal oblique fascia was similarly incised and its muscular fibers were similarly spread. The transversus abdominis muscle, transversalis fascia and peritoneum were incised sharply gaining entrance into the abdominal cavity without incident. Upon entering the peritoneal cavity, the peritoneal fluid was noted to be clean.,The cecum was then grasped along the taenia with a moist gauze sponge and was gently mobilized into the wound. After the appendix was fully visualized, the mesentery was divided between Kelly clamps and ligated with 2-0 Vicryl ties. The base of the appendix was crushed with a clamp and then the clamp was reapplied proximally on the appendix. The base was ligated with 2-0 Vicryl tie over the crushed area, and the appendix amputated along the clamp. The stump of the appendix was cauterized and the cecum was returned to the abdomen.,The peritoneum was irrigated with warm sterile saline. The mesoappendix and cecum were examined for hemostasis which was present. The wound was closed in layers using 2-0 Vicryl for the peritoneum and 0 Vicryl for the internal oblique and external oblique layers. The skin incision was approximated with 4-0 Monocryl in a subcuticular fashion. The skin was prepped with benzoin, and Steri-Strips were applied. A dressing was placed on the wound. All surgical counts were reported as correct.,Having tolerated the procedure well, the patient was subsequently extubated and taken to the recovery room in good and stable condition.

Surgery

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

HISTORY OF PRESENT ILLNESS:, The patient has a known case of marginal B-cell lymphoma for which he underwent splenectomy two years ago. The patient, last year, developed a diffuse large B-cell lymphoma which was treated with CHOP/reduction. The patient again went into complete remission. The patient has been doing well until recently, few days ago, late last week, when he developed swelling of the left testicle. The patient states he has been having fever and chills for the last few days. The patient felt weak and felt unwell. The patient with these complaints came to the emergency room. The patient has been having fever and chills and the patient states that the pain in the left testicle is rather severe. No history of trauma to the testicle.,PAST MEDICAL HISTORY:,1. Status post splenectomy.,2. History of marginal B-cell lymphoma.,3. History of diffuse large cell lymphoma.,ALLERGIES: , None.,PERSONAL HISTORY: , Used to smoke and drink alcohol but at present does not.,FAMILY HISTORY:, Noncontributory.,REVIEW OF SYSTEMS:,HEENT: Has slight headache.,CARDIOVASCULAR: No history of hypertension, MI, etc.,RESPIRATORY: No history of cough, asthma, TB, shortness of breath.,GI: Unremarkable.,GU: As above, has developed painful swelling of the left testicle over the last few days.,ENDOCRINE: Known case of type II diabetes mellitus.,PHYSICAL EXAMINATION:,HEENT: No conjunctival pallor or icterus.,NECK: No adenopathy. No carotid bruits.,LUNGS: Clear.,HEART: No gallop or murmur.,ABDOMEN:

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'

Sample Address,Re: Mrs. Sample Patient,Dear Sample Doctor:,I had the pleasure of seeing your patient, Mrs. Sample Patient , in my office today. Mrs. Sample Patient is a 48-year-old, African-American female with a past medical history of hypertension and glaucoma, who was referred to me to be evaluated for intermittent rectal bleeding. The patient denies any weight loss, does have a good appetite, no nausea and no vomiting.,PAST MEDICAL HISTORY:, Significant for hypertension and diabetes.,PAST SURGICAL HISTORY:, The patient denies any past surgical history.,MEDICATIONS:, The patient takes Cardizem CD 240-mg. The patient also takes eye drops.,ALLERGIES:, The patient denies any allergies.,SOCIAL HISTORY:, The patient smokes about a pack a day for more than 25 years. The patient drinks alcohol socially.,FAMILY HISTORY:, Significant for hypertension and strokes.,REVIEW OF SYSTEMS:, The patient does have a good appetite and no weight loss. She does have intermittent rectal bleeding associated with irritation in the rectal area. The patient denies any nausea, any vomiting, any night sweats, any fevers or any chills.,The patient denies any shortness of breath, any chest pain, any irregular heartbeat or chronic cough.,The patient is chronically constipated.,PHYSICAL EXAMINATION:, This is a 48 year-old lady who is awake, alert and oriented x 3. She does not seem to be in any acute distress. Her vital signs are blood pressure is 130/70 with a heart rate of 75 and respirations of 16. HEENT is normocephalic, atraumatic. Sclerae are non-icteric. Her neck is supple, no bruits, no lymph nodes. Lungs are clear to auscultation bilaterally, no crackles, no rales and no wheezes. The cardiovascular system has a regular rate and rhythm, no murmurs. The abdomen is soft and non-tender. Bowel sounds are positive and no organomegaly. Extremities have no edema.,IMPRESSION:, This is a 48-year-old female presenting with painless rectal bleeding not associated with any weight loss. The patient is chronically constipated.,1. Rule out colon cancer.,2. Rule out colon polyps. ,3. Rule out hemorrhoids, which is the most likely diagnosis.,RECOMMENDATIONS:, Because of the patient's age, the patient will need to have a complete colonoscopy exam.,The patient will also need to have a CBC check and monitor.,The patient will be scheduled for the colonoscopy at Sample Hospital and the full report will be forwarded to your office.,Thank you very much for allowing me to participate in the care of your patient.,Sincerely yours,,Sample Doctor, MD

Gastroenterology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

CC:, Headache,HX: ,This 16 y/o RHF was in good health, until 11:00PM, the evening of 11/27/87, when she suddenly awoke from sleep with severe headache. Her parents described her as holding her head between her hands. She had no prior history of severe headaches. 30 minutes later she felt nauseated and vomited. The vomiting continued every 30 minutes and she developed neck stiffness. At 2:00AM on 11/28/97, she got up to go to the bathroom and collapsed in her mother's arms. Her mother noted she appeared weak on the left side. Shortly after this she experienced fecal and urinary incontinence. She was taken to a local ER and transferred to UIHC.,PMH/FHX/SHX:, completely unremarkable FHx. Has boyfriend and is sexually active.,Denied drug/ETOH/Tobacco use.,MEDS:, Oral Contraceptive pill QD.,EXAM:, BP152/82 HR74 RR16 T36.9C,MS: Somnolent and difficult to keep awake. Prefer to lie on right side because of neck pain/stiffness. Answers appropriately though when questioned.,CN: No papilledema noted. Pupils 4/4 decreasing to 2/2. EOM Intact. Face: ?left facial weakness. The rest of the CN exam was unremarkable.,Motor: Upper extremities: 5/3 with left pronator drift. Lower extremities: 5/4 with LLE weakness evident throughout.,Coordination: left sided weakness evident.,Station: left pronator drift.,Gait: left hemiparesis.,Reflexes: 2/2 throughout. No clonus. Plantars were flexor bilaterally.,Gen Exam: unremarkable.,COURSE: ,The patient underwent emergent CT Brain. This revealed a perimesencephalic subarachnoid hemorrhage and contrast enhancing structures in the medial aspect of the parietotemporal region. She then underwent a 4-vessel cerebral angiogram. This study was unremarkable except for delayed transit of the contrast material through the vascular system of the brain and poor opacification of the straight sinus. This suggested straight sinus thromboses. MRI Brain was then done; this was unremarkable and did not show sign of central venous thrombosis. CBC/Blood Cx/ESR/PT/PTT/GS/CSF Cx/ANA were negative.,Lumbar puncture on 12/1/87 revealed an opening pressure of 55cmH20, RBC18550, WBC25, 18neutrophils, 7lymphocytes, Protein25mg/dl, Glucose47mg/dl, Cx negative.,The patient was assumed to have had a SAH secondary to central venous thrombosis due to oral contraceptive use. She recovered well, but returned to Neurology at age 32 for episodic blurred vision and lightheadedness. EEG was compatible with seizure tendency (right greater than left theta bursts from the mid-temporal regions), and she was recommended an anticonvulsant which she refused.

Radiology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

SUBJECTIVE:, The patient returns to the Pulmonary Medicine Clinic for followup evaluation of COPD and emphysema. She was last seen in the clinic in March 2004. Since that time, she has been hospitalized for psychiatric problems and now is in a nursing facility. She is very frustrated with her living situation and would like to return to her own apartment, however, some believes she is to ill to care for herself.,At the present time, respiratory status is relatively stable. She is still short of breath with activity, but all-in-all her pulmonary disease has not changed significantly since her last visit. She does have occasional cough and a small amount of sputum production. No fever or chills. No chest pains.,CURRENT MEDICATIONS:, The patient’s current medications are as outlined.,ALLERGIES TO MEDICATIONS:, Erythromycin.,REVIEW OF SYSTEMS:, Significant for problems with agitated depression. Her respiratory status is unchanged as noted above.,EXAMINATION:,General: The patient is in no acute distress.,Vital signs: Blood pressure is 152/80, pulse 80 and respiratory rate 16.,HEENT: Nasal mucosa was mild-to-moderately erythematous and edematous. Oropharynx was clear.,Neck: Supple without palpable lymphadenopathy.,Chest: Chest demonstrates decreased breath sounds throughout all lung fields, coarse but relatively clear.,Cardiovascular: Distant heart tones. Regular rate and rhythm.,Abdomen: Soft and nontender.,Extremities: Without edema.,Oxygen saturation was checked today on room air, at rest it was 90%.,ASSESSMENT:,1. Chronic obstructive pulmonary disease/emphysema, severe but stable.,2. Mild hypoxemia, however, oxygen saturation at rest is stable without supplemental oxygen.,3. History of depression and schizophrenia.,PLAN:, At this point, I have recommended that she continue current respiratory medicine. I did suggest that she would not use her oxygen when she is simply sitting, watching television or reading. I have recommended that she use it with activity and at night. I spoke with her about her living situation. Encouraged her to speak with her family, as well as primary care physician about making efforts for her to return to her apartment. Follow up evaluation is planned in Pulmonary Medicine Clinic in approximately three months or sooner if need be.

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: , Left elbow pain.,HISTORY OF PRESENT ILLNESS: ,This 17-year-old male was fighting with some other kids in Juvenile Hall when he felt some pain in his left elbow, causing sudden pain. He also has pain in his left ankle, but he is able to walk normally. He has had previous pain in his left knee. He denies any passing out, any neck pain at this time even though he did get hit in the head. He has no chest or abdominal pain. Apparently, no knives or guns were involved.,PAST MEDICAL HISTORY: , He has had toe problems and left knee pain in the past.,REVIEW OF SYSTEMS: , No coughing, sputum production, dyspnea or chest pain. No vomiting or abdominal pain. No visual changes. No neurologic deficits other than some numbness in his left hand.,SOCIAL HISTORY: , He is in Juvenile Hall for about 25 more days. He is a nonsmoker.,ALLERGIES: , MORPHINE.,CURRENT MEDICATIONS: ,Abilify.,PHYSICAL EXAMINATION: , VITAL SIGNS: Stable. HEENT: PERRLA. EOMI. Conjunctivae anicteric. Skull is normocephalic. He is not complaining of bruising. HEENT: TMs and canals are normal. There is no Battle sign. NECK: Supple. He has good range of motion. Spinal processes are normal to palpation. LUNGS: Clear. CARDIAC: Regular rate. No murmurs or rubs. EXTREMITIES: Left elbow is tender. He does not wish to move it at all. Shoulder and clavicle are within normal limits. Wrist is normal to inspection. He does have some pain to palpation. Hand has good capillary refill. He seems to have decreased sensation in all three dermatomes. He has moderately good abduction of all fingers. He has moderate opponens strength with his thumb. He has very good extension of all of his fingers with good strength.,We did an x-ray of his elbow. He has a spiral fracture of the distal one-third of the humerus, about 13 cm in length. The proximal part looks like it is in good position. The distal part has about 6 mm of displacement. There is no significant angulation. The joint itself appears to be intact. The fracture line ends where it appears above the joint. I do not see any extra blood in the joint. I do not see any anterior or posterior Siegert sign.,I spoke with Dr. X. He suggests we go ahead and splint him up and he will follow the patient up. At this point, it does not seem like there needs to be any surgical revision. The chance of a compartment syndrome seems very low at this time.,Using 4-inch Ortho-Glass and two assistants, we applied a posterior splint to immobilize his fingers, hand, and wrist all the way up to his elbow to well above the elbow.,He had much better comfort once this was applied. There was good color to his fingers and again, much better comfort.,Once that was on, I took some 5-inch Ortho-Glass and put in extra reinforcement around the elbow so he would not be moving it, straightening it or breaking the fiberglass.,We then gave him a sling.,We gave him #2 Vicodin p.o. and #4 to go. Gave him a prescription for #15 more and warned him to take it only at nighttime and use Tylenol or Motrin, and ice in the daytime.,I gave him the name and telephone number of Dr. X whom they can follow up with. They were warned to come back here if he has increasing neurologic deficits in his hands or any new problems.,DIAGNOSES:,1. Fracture of the humerus, spiral.,2. Possible nerve injuries to the radial and median nerve, possibly neurapraxia.,3. Psychiatric disorder, unspecified.,DISPOSITION: The patient will follow up as mentioned above. They can return here anytime as needed.

Consult - History and Phy.

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

SUBJECTIVE:, The patient is a 62-year-old white female with multiple chronic problems including hypertension and a lipometabolism disorder. She follows with Dr. XYZ on her hypertension, as well as myself. She continues to gain weight. Diabetes is therefore a major concern. In fact, her dad had diabetes and she has a brother who has diabetes. The patient also has several additional concerns she brings up today. One is that her left knee continues to bother her and it hurts. She cannot really isolate where the pain is, it just seems to hurt through her knee. She has had this for some time now and in fact as we reviewed her records, her left knee has been x-rayed in 1999. There was some minimal narrowing of the weightbearing joint with some minor hypertrophic spurring medially. She would like to have this x-rayed again today. She is certainly not interested in any surgery. She has noted that it particularly hurts to kneel. In addition, she complains of her stools being a baby-yellow. She has rectal bleeding off and on. It is bright red. She had a colonoscopy done in 1999. She does have a family history of colon cancer questionable in her mother, who is deceased. She complains of some diffuse abdominal pain off and on. She has given up fast foods and her pop and this has not seemed to help. She does admit however, that she is not eating right. Sometimes her stools are hard. Sometimes they are runny. The blood does not really seem to be related to necessarily a hard stool. It is always bright red and will sometimes drip into the toilet. Over the last couple of days, she had also been sneezing and has had an itchy throat. She tried some Claritin and this did not help. She has had some body aches. She is finally feeling better today with this. She also is questioning whether she has some sleep apnea. She will awaken suddenly in the middle of the night. She was told that she does snore. She does not smoke. As stated, she has gained significant weight.,GYNECOLOGICAL HISTORY: , She does not bleed. She has both ovaries, as well as her uterus and cervix. She is on no hormonal therapy.,PREVENTATIVE HISTORY:, She is not exercising. She does not do self breast examinations. She has recently had her mammogram and it was unremarkable. She does take her low-dose aspirin daily as well as her multivitamin. She does wear her seatbelt. As previously noted, she does not smoke or drink alcohol.,PAST MEDICAL, FAMILY AND SOCIAL HISTORY:, Per health summary sheet, unchanged.,REVIEW OF SYSTEMS:, Unremarkable with the exception of that above. ,ALLERGIES: , No known drug allergies.,CURRENT MEDICATIONS:, Benicar 20 mg daily; multivitamin; glucosamine; vitamin B complex; vitamin E and a low-dose aspirin.,OBJECTIVE:,General: Well-nourished, well-developed, a very pleasant 61-year-old in no acute distress.,Vitals: Her weight today is 246 pounds. In March of 2002 she weighed 231 pounds. In March 2001 she weighed 203 pounds. Her blood pressure is 160/78. Pulse is 84. Respiratory rate of 20. She is afebrile.,HEENT: Head is of normocephalic, atraumatic. PERLA. Conjunctivae clear. TMs are unremarkable and canals are patent. Nasal mucosa is slightly reddened. Nares are patent. Throat shows some clear posterior pharyngeal drainage. Throat is slightly reddened. Non-exudative. No oral lesions or dental caries noted.,Neck: Supple, No adenopathy. Thyroid without any nodules or enlargements, no JVD or carotid bruits.,Heart: Regular rate and rhythm without murmurs, clicks or rubs. PMI is nondisplaced.,Lungs: Clear to A&P. No CVA tenderness.,Breast exam: Negative for any axillary nodes, skin changes, discrete nodules or nipple discharge. Breasts were examined both lying and sitting.,Abdomen: Soft, nondistended, normoactive bowel sounds, no hepatosplenomegaly or masses. Non tender.,Pelvic exam: BUS unremarkable. Speculum exam shows normal physiologic discharge. There are some atrophic vaginal changes. Cervix visualized, no gross abnormalities. Pap smear obtained. Bimanual is negative for any adnexal masses or tenderness. Rectal exam is negative for any adnexal masses or tenderness. No rectal masses. She does have some external hemorrhoids, none of which are inflamed at this time. No palpable rectal masses.,Neuromusculoskeletal exam: Cranial nerves II-XII are grossly intact. No cerebellar signs are noted. No evidence of a gait disturbance. DTRs are 1+/4+ and equal throughout. Good uptoeing. Skin: Inspection of her skin, subcuticular tissues negative for any concerning skin lesions, rashes or subcuticular masses.,ASSESSMENT:,1. Weight-gain.,2. Hypertension.,3. Lipometabolism disorder.,4. Rectal bleeding.,5. Left knee pain.,6. Question of sleep apnea.,7. Upper respiratory infection, improving.,8. Gynecological examination is unremarkable for her age.,PLAN:, We discussed at length, the issue of sleep apnea and its negative sequela. I have recommended that she be referred for a sleep study. She is certainly at risk for sleep apnea. She refuses this. I do not think that her upper respiratory tract infection needs any further treatment at this time since she is feeling better. I did x-ray her knee and with the exception of some degenerative changes, it was unremarkable. I reviewed this with her. I do think that since she is having rectal bleeding, while this is not real unusual for her, with her family history of colon cancer, I am going to have her discuss this further with Dr. XYZ and leave further studies up to them. I will dictate Dr. XYZ a note. I am not going to order any further studies at this time in terms of her yellow stools and right upper quadrant discomfort. She has had a gallbladder sonogram done in the past, this has been unremarkable and these symptoms really have not changed for her. This however, has been some time ago. I suspect she has an element of irritable bowel syndrome. I have strongly encouraged weight reduction, both through diet and exercise. I would like to see her back in the office in six months. I did retake her blood pressure today and it was 130/70. She is fasting this morning, so we will get a fasting blood sugar, chem-12, lipid profile, and CPK. I will her mail the results. I have strongly encouraged medication management if her lipids are elevated. I think she is amenable to this. Her DEXA scan is up to date having been done on 04/09/03. I do not recommend one this year.

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'

ENDOVASCULAR BRACHYTHERAPY (EBT),The patient is to undergo a course of angioplasty for in-stent restenosis. The radiotherapy will be planned using simulation films when the Novoste system catheter markers are placed on either side of the coronary artery injury site. After this, a calculation will take place to determine the length of time at which the strontium sources will be left in place to deliver an adequate dose given the reference vessel diameter. The rationale for this treatment is based on radiobiological principles that make this type of therapy more effective than blade atherectomy or laser atherectomy. The does per fraction is individualized for each patient according to radiobiological principles and reference vessel diameter. Given that this is a very high dose rate source and the chances of severe acute toxicity such as cardiac ischemia and machine malfunction are present, it is imperative that the patient be followed closely by myself and monitored for ST segment elevation and correct machine function.

Radiology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS: , Blood loss anemia.,POSTOPERATIVE DIAGNOSES:,1. Diverticulosis coli.,2. Internal hemorrhoids.,3. Poor prep.,PROCEDURE PERFORMED:, Colonoscopy with photos.,ANESTHESIA: , Conscious sedation per Anesthesia.,SPECIMENS:, None.,HISTORY:, The patient is an 85-year-old female who was admitted to the hospital with a markedly decreased hemoglobin and blood loss anemia. She underwent an EGD and attempted colonoscopy; however, due to a very poor prep, only a flexible sigmoidoscopy was performed at that time. A coloscopy is now being performed for completion.,PROCEDURE:, After proper informed consent was obtained, the patient was brought to the Endoscopy Suite. She was placed in the left lateral position and was given sedation by the Anesthesia Department. A digital rectal exam was performed and there was no evidence of mass. The colonoscope was then inserted into the rectum. There was some solid stool encountered. The scope was maneuvered around this. There was relatively poor prep as the scope was advanced through the sigmoid colon and portions of the descending colon. The scope was then passed through the transverse colon and ascending colon to the cecum. No masses or polyps were noted. Visualization of the portions of the colon was however somewhat limited. There were scattered diverticuli noted in the sigmoid.,The scope was slowly withdrawn carefully examining all walls. Once in the rectum, the scope was retroflexed and nonsurgical internal hemorrhoids were noted. The scope was then completely withdrawn. The patient tolerated the procedure well and was transferred to recovery room in stable condition. She will be placed on a high-fiber diet and Colace and we will continue to monitor her hemoglobin.

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'

She was evaluated this a.m. and was without any significant clinical change. Her white count has been improving and down to 12,000. A chest x-ray obtained today showed some bilateral infiltrates, but no acute cardiopulmonary change. There was a suggestion of a bilateral lower lobe pneumonitis or pneumonia.,She has been on Zosyn for the infection.,Throughout her hospitalization, we have been trying to adjust her pain medications. She states that the methadone did not work for her. She was "immune" to oxycodone. She had been on tramadol before and was placed back on that. There was some question that this may have been causing some dizziness. She also was on clonazepam and alprazolam for the underlying bipolar disorder.,Apparently, her husband was in this afternoon. He had a box of her pain medications. It is unclear whether she took a bunch of these or precisely what happened. I was contacted that she was less responsive. She periodically has some difficulty to arouse due to pain medications, which she has been requesting repeatedly, though at times does not appear to have objective signs of ongoing pain. The nurse found her and was unable to arouse her at this point. There was a concern that she had taken some medications from home. She was given Narcan and appeared to come around some. Breathing remained somewhat labored and she had some diffuse scattered rhonchi, which certainly changed from this a.m. Additional Narcan was given as well as some medications to reverse a possible benzodiazepine toxicity. With O2 via mask, oxygenation was stable at 90% to 95% after initial hypoxia was noted. A chest x-ray was obtained at this time. An ECG was obtained, which shows a sinus tachycardia, noted to have ischemic abnormalities.,In light of the acute decompensation, she was then transferred to the ICU. We will continue the IV Zosyn. Respiratory protocol with respiratory management. Continue alprazolam p.r.n., but avoid if she appears sedated. We will attempt to avoid additional pain medications, but we will continue with the Dilaudid for time being. I suspect she will need something to control her bipolar disorder.,Pulmonary Medicine Associates have been contacted to consult in light of the ICU admission. At this juncture, she does not appear to need an intubation. Pending chest x-ray, she may require additional IV furosemide.

Cardiovascular / Pulmonary

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

HISTORY OF PRESENT COMPLAINT: ,Ms. Abc initially visited our office for the purpose of consultation and examination on December 1, 2004. Ms. Abc states that on November 16, 2004, she was in a parking lot, she was walking to her car, and stepped into a pothole. The patient reports that she fell backwards. The patient landed on her back and hit her head as well. The patient reports sudden, severe left ankle pain and low back pain as well as neck pain in the back of her head. The patient was unable to get up due to severe pain. The patient was afraid that she broke her left ankle. The patient eventually got up and went to her car. The patient went home and symptoms got worse. A few days later, the patient went to the hospital on November 21, 2004. The patient had x-rays of the lumbar spine, left ankle, and left foot. The patient was seen at Healthcare System. She was next seen by Rapid Rehabilitation on December 1, 2004.,

Chiropractic

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

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.

Dermatology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

EYES: , The conjunctivae are clear. The lids are normal appearing without evidence of chalazion or hordeolum. The pupils are round and reactive. The irides are without any obvious lesions noted. Funduscopic examination shows sharp disk margins. There are no exudates or hemorrhages noted. The vessels are normal appearing.,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.,NECK:, The neck is nontender and supple. The trachea is midline. The thyroid is without any evidence of thyromegaly. No obvious adenopathy is noted to the neck.,RESPIRATORY: , The patient has normal respiratory effort. There is normal lung excursion. Percussion of the chest is without any obvious dullness. There is no tactile fremitus or egophony noted. There is no tenderness to the chest wall or ribs. There are no obvious abnormalities. The lungs are clear to auscultation. There are no wheezes, rales or rhonchi heard. There are no obvious rubs noted.,CARDIOVASCULAR: , There is a normal PMI on palpation. I do not hear any obvious abnormal sounds. There are no obvious murmurs. There are no rubs or gallops noted. The carotid arteries are without bruit. No obvious thrill is palpated. There is no evidence of enlarged abdominal aorta to palpation. There is no abdominal mass to suggest enlargement of the aorta. Good strong femoral pulses are palpated. The pedal pulses are intact. There is no obvious edema noted to the extremities. There is no evidence of any varicosities or phlebitis noted.,GASTROINTESTINAL: , The abdomen is soft. Bowel sounds are present in all quadrants. There are no obvious masses. There is no organomegaly, and no liver or spleen is palpable. No obvious hernia is noted. The perineum and anus are normal in appearance. There is good sphincter tone and no obvious hemorrhoids are noted. There are no masses. On digital examination, there is no evidence of any tenderness to the rectal vault; no lesions are noted. Stool is brown and guaiac negative.,GENITOURINARY (FEMALE): , The external genitalia is normal appearing with no obvious lesions, no evidence of any unusual rash. The vagina is normal in appearance with normal-appearing mucosa. The urethra is without any obvious lesions or discharge. The cervix is normal in color with no obvious cervical discharge. There are no obvious cervical lesions noted. The uterus is nontender and small, and there is no evidence of any adnexal masses or tenderness. The bladder is nontender to palpation. It is not enlarged.,GENITOURINARY (MALE): , Normal scrotal contents are noted. The testes are descended and nontender. There are no masses and no swelling to the epididymis noted. The penis is without any lesions. There is no urethral discharge. Digital examination of the prostate reveals a nontender, non-nodular prostate.,BREASTS:, The breasts are normal in appearance. There is no puckering noted. There is no evidence of any nipple discharge. There are no obvious masses palpable. There is no axillary adenopathy. The skin is normal appearing over the breasts.,LYMPHATICS: , There is no evidence of any adenopathy to the anterior cervical chain. There is no evidence of submandibular nodes noted. There are no supraclavicular nodes palpable. The axillae are without any abnormal nodes. No inguinal adenopathy is palpable. No obvious epitrochlear nodes are noted.,MUSCULOSKELETAL/EXTREMITIES: , The patient has normal gait and station. The patient has normal muscle strength and tone to all extremities. There is no obvious evidence of any muscle atrophy. The joints are all stable. There is no evidence of any subluxation or laxity to any of the joints. There is no evidence of any dislocation. There is good range of motion of all extremities without any pain or tenderness to the joints or extremities. There is no evidence of any contractures or crepitus. There is no evidence of any joint effusions. No obvious evidence of erythema overlying any of the joints is noted. There is good range of motion at all joints. There are normal-appearing digits. There are no obvious lesions to any of the nails or nail beds.,SKIN:, There is no obvious evidence of any rash. There are no petechiae, pallor or cyanosis noted. There are no unusual nodules or masses palpable.,NEUROLOGIC: , The cranial nerves II XII are tested and are intact. Deep tendon reflexes are symmetrical bilaterally. The toes are downgoing with normal Babinskis. Sensation to light touch is intact and symmetrical. Cerebellar testing reveals normal finger nose, heel shin. Normal gait. No ataxia.,PSYCHIATRIC: ,The patient is oriented to person, place and time. The patient is also oriented to situation. Mood and affect are appropriate for the present situation. The patient can remember 3 objects after 3 minutes without any difficulties. Remote memory appears to be intact. The patient seems to have normal judgment and insight into the situation.

Consult - History and Phy.

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

HISTORY OF PRESENT ILLNESS:, The patient is a 17-year-old female, who presents to the emergency room with foreign body and airway compromise and was taken to the operating room. She was intubated and fishbone.,PAST MEDICAL HISTORY: , Significant for diabetes, hypertension, asthma, cholecystectomy, and total hysterectomy and cataract.,ALLERGIES: ,No known drug allergies.,CURRENT MEDICATIONS: , Prevacid, Humulin, Diprivan, Proventil, Unasyn, and Solu-Medrol.,FAMILY HISTORY: , Noncontributory.,SOCIAL HISTORY: , Negative for illicit drugs, alcohol, and tobacco.,PHYSICAL EXAMINATION: ,Please see the hospital chart.,LABORATORY DATA: , Please see the hospital chart.,HOSPITAL COURSE: , The patient was taken to the operating room by Dr. X who is covering for ENT and noted that she had airway compromise and a rather large fishbone noted and that was removed. The patient was intubated and it was felt that she should be observed to see if the airway would improve upon which she could be extubated. If not she would require tracheostomy. The patient was treated with IV antibiotics and ventilatory support and at the time of this dictation, she has recently been taken to the operating room where it was felt that the airway sufficient and she was extubated. She was doing well with good p.o.s, good airway, good voice, and desiring to be discharged home. So, the patient is being prepared for discharge at this point. We will have Dr. X evaluate her before she leaves to make sure I do not have any problem with her going home. Dr. Y feels she could be discharged today and will have her return to see him in a week.

Emergency Room Reports

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

ADMITTING DIAGNOSIS:, A nonhealing right below-knee amputation.,DISCHARGE DIAGNOSIS:, A nonhealing right below-knee amputation.,SECONDARY DIAGNOSES:, Include:,1. Peripheral vascular disease, bilateral carotid artery stenosis status post bilateral carotid endarterectomies.,2. Peripheral vascular disease status post aortobifemoral bypass and bilateral femoropopliteal bypass grafting.,3. Hypertension.,4. Diverticulosis.,5. Hypothyroidism.,6. Chronic renal insufficiency.,7. Status post open incision and drainage of an intestinal abscess at an unknown point.,DETERMINATION: , Status post right below-knee amputation.,OPERATIONS PERFORMED:,1. Extensive debridement of right below-knee amputation with debridement of skin, subcutaneous tissue, muscle, and bone on July 17, 2008.,2. Irrigation and debridement of right below-knee amputation wound on July 21, 2008, July 24, 2008, July 28, 2008, and August 1, 2008.,HISTORY OF PRESENT ILLNESS: , The patient is an 89-year-old gentleman with multiple medical conditions including coronary artery disease, hypothyroidism, and severe peripheral vascular disease status post multiple revascularizations, and a right below-knee amputation in June 2008 following a thrombosis of his right femoropopliteal bypass graft. Following his amputation, he had poor wound healing. He presented to the ED with pain in his right lower extremity on July 9, 2008. Due to concern for infection at that time, he was started on oral Keflex and instructed to follow up with the Vascular Clinic as scheduled. At his follow-up appointment, it was decided to re-admit The patient for debridement and revision of his stump wound.,HOSPITAL COURSE:, Briefly, The patient underwent extensive debridement of his right below-knee amputation wound on July 17, 2008. He underwent debridement of skin, subcutaneous tissue, muscle, and bone to remove the necrotic tissue from the stump. A wound VAC. was also placed to help accelerate wound healing. The patient's postoperative course was complicated initially by acute blood-loss anemia, requiring blood transfusion. He returned to the OR on Monday, July 21, 2008 for irrigation and debridement of his right below-knee amputation and a wound VAC change. Again, on July 24, 2008, and then again on July 28, 2008, The patient returned to the operating room for irrigation and debridement of his wound and wound VAC change. Following his procedure on July 28, 2008, The patient began having recurrent episodes of diarrhea, prompting stool cultures and C. difficile assay to be sent. He was also started on Flagyl, empirically. C. difficile assay returned positive and the decision was made to continue Flagyl for a full 14-day course. On July 31, 2008, the patient began experiencing shortness of breath and wheezing after standing to be weighed. His vital signs remained stable. However, his oxygen saturation dropped to 93%, improving only to 97% after an addition of 2 liters by nasal cannula. A chest x-ray revealed bilateral pleural effusions and bibasilar atelectasis in addition to some pulmonary edema diffusely. The patient's IV fluids were decreased. He was given p.r.n. albuterol and infusion of Lasix, resulting in significant urine output. His symptoms of shortness of breath gradually improved. On August 1, 2008, he returned to the OR for final irrigation and debridement of his below-knee amputation. Again, a wound VAC was placed. Postoperatively, he did well. His Foley catheter was removed. His vital signs remained stable, and his respiratory status also remained stable. Arrangements were made for home health and wound VAC care upon discharge.,DISCHARGE CONDITION: , The patient is resting comfortably. He denies shortness of breath or chest pain. He has mild bibasilar wheezing, but breathing is otherwise nonlabored. All other exams normal.,DISCHARGE MEDICATIONS:,1. Acetaminophen 325 mg daily.,2. Albuterol 2 puffs every six hours as needed.,3. Vitamin C 500 mg one to two times daily.,4. Aspirin 81 mg daily.,5. Symbicort 1 puff every morning and 1 puff every evening.,6. Tums p.r.n.,7. Calcium 600 mg plus vitamin D daily.,8. Plavix 75 mg daily.,9. Clorazepate dipotassium 7.5 mg every six hours as needed.,10. Lexapro 10 mg daily at bedtime.,11. Hydrochlorothiazide 25 mg one-half tablet daily.,12. Ibuprofen 200 mg three pills as needed.,13. Imdur 30 mg daily.,14. Levoxyl 112 mcg daily.,15. Ativan 0.5 mg one-half tablet every six hours as needed.,16. Lopressor 50 mg one-half tablet twice daily.,17. Flagyl 500 mg every six hours for 10 days.,18. Multivitamin daily.,19. Nitrostat 0.4 mg to take as directed.,20. Omeprazole 20 mg daily.,21. Oxycodone-acetaminophen 5/325 mg every four to six hours as needed for pain.,22. Lyrica 25 mg daily at bedtime.,23. Zocor 40 mg one-half tablet daily at bedtime.

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:,1. Intrauterine pregnancy at 33 weeks, twin gestation.,2. Active preterm labor.,3. Advanced dilation.,4. Multiparity.,5. Requested sterilization.,POSTOPERATIVE DIAGNOSIS:,1. Intrauterine pregnancy at 33 weeks, twin gestation.,2. Active preterm labor.,3. Advanced dilation.,4. Multiparity.,5. Requested sterilization.,6. Delivery of a viable female A weighing 4 pounds 7 ounces, Apgars were 8 and 9 at 1 and 5 minutes respectively and female B weighing 4 pounds 9 ounces, Apgars 6 and 7 at 1 and 5 minutes respectively.,7. Uterine adhesions and omentum adhesions.,OPERATION PERFORMED: , Repeat low-transverse C-section, lysis of omental adhesions, lysis of uterine adhesions with repair of uterine defect, and bilateral tubal ligation.,ANESTHESIA: , General.,ESTIMATED BLOOD LOSS: , 500 mL.,DRAINS:, Foley.,This is a 25-year-old white female gravida 3, para 2-0-0-2 with twin gestation at 33 weeks and previous C-section. The patient presents to Labor and Delivery in active preterm labor and dilated approximately 4 to 6 cm. The decision for C-section was made.,PROCEDURE:, The patient was taken to the operating room and placed in a supine position with a slight left lateral tilt and she was then prepped and draped in usual fashion for a low transverse incision. The patient was then given general anesthesia and once this was completed, first knife was used to make a low transverse incision extending down to the level of the fascia. The fascia was nicked in the center and extended in a transverse fashion with the use of curved Mayo scissors. The edges of the fascia were grasped with Kocher and both blunt and sharp dissection was then completed both caudally and cephalically. The abdominal rectus muscle was divided in the center and extended in a vertical fashion. Peritoneum was entered at a high point and extended in a vertical fashion as well. The bladder blade was put in place. The bladder flap was created with the use of Metzenbaum scissors and dissected away caudally. The second knife was used to make a low transverse incision with care being taken to avoid the presenting part of the fetus. The first fetus was vertex. The fluid was clear. The head was delivered followed by the remaining portion of the body. The cord was doubly clamped and cut. The newborn handed off to waiting pediatrician and nursery personnel. The second fluid was ruptured. It was the clear fluid as well. The presenting part was brought down to be vertex. The head was delivered followed by the rest of the body and the cord was doubly clamped and cut, and newborn handed off to waiting pediatrician in addition of the nursery personnel. Cord pH blood and cord blood was obtained from both of the cords with careful identification of A and B. Once this was completed, the placenta was delivered and handed off for further inspection by Pathology. At this time, it was noted at the uterus was adhered to the abdominal wall by approximately of 3 cm x 3 cm thick uterine adhesion and this was needed to be released by sharp dissection. Then, there were multiple omental adhesions on the surface of the uterus itself. This needed to be released as well as on the abdominal wall and then the uterus could be externalized. The lining was wiped clean of any remaining blood and placental fragments and the edges of the uterus were grasped in four quadrants with Kocher and continuous locking stitch of 0 chromic was used to re-approximate the uterine incision, with the second layer used to imbricate the first. The bladder flap was re-approximated with 3-0 Vicryl and Gelfoam underneath. The right fallopian tube was grasped with a Babcock, it was doubly tied off with 0 chromic and the knuckle portion was then sharply incised and cauterized. The same technique was completed on the left side with the knuckle portion cut off and cauterized as well. The defect on the uterine surface was reinforced with 0 Vicryl in a baseball stitch to create adequate Hemostasis. Interceed was placed over this area as well. The abdominal cavity was irrigated with copious amounts of saline and the uterus was placed back in its anatomical position. The gutters were wiped clean of any remaining blood. The edges of the peritoneum were grasped with hemostats and a continuous locking stitch was used to re-approximate abdominal rectus muscles as well as the peritoneal edges. The abdominal rectus muscle was irrigated. The corners of the fascia grasped with hemostats and continuous locking stitch of 0 Vicryl started on both corners and overlapped on the center. The subcutaneous tissue was irrigated. Cautery was used to create adequate hemostasis and 3-0 Vicryl was used to re-approximate the subcutaneous tissue. Skin edges were re-approximated with sterile staples. Sterile dressing was applied. Uterus was evacuated of any remaining blood vaginally. The patient was taken to the recovery room in stable condition. Instrument count, needle count, and sponge counts were all correct.

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: , Multiple pelvic adhesions.,POSTOPERATIVE DIAGNOSIS: , Multiple pelvic adhesions.,PROCEDURE PERFORMED: ,Lysis of pelvic adhesions.,ANESTHESIA: , General with local.,SPECIMEN: , None.,COMPLICATIONS: , None.,HISTORY: , The patient is a 32-year-old female who had an 8 cm left ovarian mass, which was evaluated by Dr. X. She had a ultrasound, which demonstrated the same. The mass was palpable on physical examination and was tender. She was scheduled for an elective pelvic laparotomy with left salpingooophorectomy. During the surgery, there were multiple pelvic adhesions between the left ovarian cyst and the sigmoid colon. These adhesions were taken down sharply with Metzenbaum scissors.,PROCEDURE: , A pelvic laparotomy had been performed by Dr. X. Upon exploration of the abdomen, multiple pelvic adhesions were noted as previously stated. A 6 cm left ovarian cyst was noted with adhesions to the sigmoid colon and mesentery. These adhesions were taken down sharply with Metzenbaum scissors until the sigmoid colon was completely freed from the ovarian cyst. The ureter had been identified and isolated prior to the adhesiolysis. There was no evidence of bleeding. The remainder of the case was performed by Dr. X and this will be found in a separate operative report.

Obstetrics / Gynecology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS: , Prostate cancer.,POSTOPERATIVE DIAGNOSIS: , Prostate cancer.,OPERATION: , Cystoscopy and removal of foreign objects from the urethra.,BRACHYTHERAPY:, Iodine 125.,ANESTHESIA: , General endotracheal. The patient was given Levaquin 500 mg IV preoperatively.,Total seeds were 59. Activity of 0.439, 30 seeds in the periphery with 10 needles and total of 8 seeds at the anterior of the fold, 4 needles. Please note that the total needles placed on the top were actually 38 seeds and 22 seeds were returned back.,BRIEF HISTORY: , This is a 72-year-old male who presented to us with elevated PSA and prostate biopsy with Gleason 6 cancer on the right apex. Options such as watchful waiting, brachytherapy, radical prostatectomy, cryotherapy, and external beam radiation were discussed. Risk of anesthesia, bleeding, infection, pain, MI, DVT, PE, incontinence, erectile dysfunction, urethral stricture, dysuria, burning pain, hematuria, future procedures, and failure of the procedure were all discussed. The patient understood all the risks, benefits, and options and wanted to proceed with the procedure. The patient wanted to wait until he came back from his summer vacations, so a one dose of Zoladex was given. Prostate size measured about 15 g in the OR and about 22 g about two months ago. Consent was obtained.,DETAILS OF THE OPERATION: ,The patient was brought to the OR and anesthesia was applied. The patient was placed in dorsal lithotomy position. The patient had a Foley catheter placed sterilely. The scrotum was taped up using Ioban. Transrectal ultrasound was done. The prostate was measured 15 g. Multiple images were taken. A volume study was done. This was given to the physicist, Dr. X was present who is radiation oncologist who helped with implanting of the seeds. Total of 38 seeds were placed in the patient with 10 peripheral needles and then 4 internal needles. Total of 30 seeds were placed in the periphery and total of 8 seeds were placed in the inside. They were done directly under transrectal ultrasound vision. The seeds were placed directly under ultrasound guidance. There was a nice distribution of the seeds. A couple of more seeds were placed on the right side due to the location of the prostate cancer. Subsequently at the end of the procedure, fluoroscopy was done. Couple of images were obtained. Cystoscopy was done at the end of the procedure where a seed was visualized right in the urethra, which was grasped and pulled out using grasper, which was difficult to get the seed off of the spacers, which was actually pulled out. There were no further seeds visualized in the bladder. The bladder appeared normal. At the end of the procedure, a Foley catheter was kept in place of 18 French and the patient was brought to recovery in stable condition.

Urology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

POSTOPERATIVE DAY #1, TOTAL ABDOMINAL HYSTERECTOMY,SUBJECTIVE: , The patient is alert and oriented x3 and sitting up in bed. The patient has been ambulating without difficulty. The patient is still NPO. The patient denies any new symptomatology from 6/10/2009. The patient has complaints of incisional tenderness. The patient was given a full explanation about her clinical condition and all her questions were answered.,OBJECTIVE:,VITAL SIGNS: Afebrile now. Other vital signs are stable.,GU: Urinating through Foley catheter.,ABDOMEN: Soft, negative rebound.,EXTREMITIES: Without Homans, nontender.,BACK: Without CVA tenderness.,GENITALIA: Vagina, slight spotting. Wound dry and intact.,ASSESSMENT:, Normal postoperative course.,PLAN:,1. Follow clinically.,2. Continue present therapy.,3. Ambulate with nursing assistance only.,

Obstetrics / Gynecology

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS: , Internal derangement, left knee.,POSTOPERATIVE DIAGNOSIS: , Internal derangement, left knee.,PROCEDURE PERFORMED:, Arthroscopy of the left knee with medial meniscoplasty.,ANESTHESIA: ,LMA.,GROSS FINDINGS: , Displaced bucket-handle tear of medial meniscus, left knee.,PROCEDURE: , After informed consent was obtained, the patient was taken to ABCD General Hospital Operating Room #1 where anesthesia was administered by the Department of Anesthesiology. The patient was then transferred to the operating room table in supine position with Johnson knee holder well-padded. Tourniquet was placed around the left upper thigh. The limb was then prepped and draped in usual sterile fashion. Standard anteromedial and anterolateral arthroscopy portals were obtained and a systematic examination of the knee was then performed. Patellofemoral joint showed frequent chondromalacia. Examination of the medial compartment showed a displaced bucket-handle tear of the medial meniscus involving the entire posterior, parietal, and portion of his anterior portion of the medial meniscus. The medial femoral condyle and medial tibial plateau were unaffected. Intercondylar notch examination revealed an intact ACL and PCL stable to drawer testing and probing and the lateral compartment showed an intact lateral meniscus. The femoral condyle and tibial plateau were all stable to probing. Attention was then directed back to the medial compartment where the detached portion of the meniscus was excised using arthroscopy scissors. A shaver was then used to smooth all the edges until the margins were stable to probing.,The knee was then flushed with normal saline and suctioned dry. 20 cc of 0.25% Marcaine was injected into the knee and into the arthroscopy portals. A dressing consisting of Adaptic, 4x4s, ABDs, and Webril were applied followed by a TED hose. The patient was then transferred to the recovery room in stable condition.

Surgery

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

LONG-TERM GOALS:, Both functional and cognitive-linguistic ability to improve safety and independence at home and in the community. This goal has been met based on the patient and husband reports the patient is able to complete all activities, which she desires to do at home. During the last reevaluation, the patient had a significant progress and all cognitive domains evaluated, which are attention, memory, executive functions, language, and visuospatial skill. She continues to have an overall mild cognitive-linguistic deficit, but this is significantly improved from her initial evaluation, which showed severe impairment., ,The patient does no longer need a skilled speech therapy because she has accomplished all of her goals and her progress has plateaued. The patient and her husband both agreed with the patient's discharge.

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 VISIT:, The patient is an 11-month-old with a diagnosis of stage 2 neuroblastoma here for ongoing management of his disease and the visit is supervised by Dr. X.,HISTORY OF PRESENT ILLNESS: , The patient is an 11-month-old with neuroblastoma, which initially presented on the left when he was 6 weeks old and was completely resected. It was felt to be stage 2. It was not N-Myc amplified and had favorable Shimada histology. In followup, he was found to have a second primary in his right adrenal gland, which was biopsied and also consistent with neuroblastoma with favorable Shimada histology. He is now being treated with chemotherapy per protocol P9641 and not on study. He last received chemotherapy on 05/21/07, with carboplatin, cyclophosphamide, and doxorubicin. He received G-CSF daily after his chemotherapy due to neutropenia that delayed his second cycle. In the interval since he was last seen, his mother reports that he had a couple of days of nasal congestion, but it is now improving. He is not acted ill or had any fevers. He has had somewhat diminished appetite, but it seems to be improving now. He is peeing and pooping normally and has not had any diarrhea. He did not have any appreciated nausea or vomiting. He has been restarted on fluconazole due to having redeveloped thrush recently.,REVIEW OF SYSTEMS: , The following systems reviewed and negative per pathology except as noted above. Eyes, ears, throat, cardiovascular, GI, genitourinary, musculoskeletal skin, and neurologic., PAST MEDICAL HISTORY:, Reviewed as above and otherwise unchanged.,FAMILY HISTORY:, Reviewed and unchanged.,SOCIAL HISTORY: , The patient's parents continued to undergo a separation and divorce. The patient spends time with his father and his family during the first part of the week and with his mother during the second part of the week.,MEDICATIONS: ,1. Bactrim 32 mg by mouth twice a day on Friday, Saturday, and Sunday.,2. G-CSF 50 mcg subcutaneously given daily in his thighs alternating with each dose.,3. Fluconazole 37.5 mg daily.,4. Zofran 1.5 mg every 6 hours as needed for nausea.,ALLERGIES: , No known drug allergies.,FINDINGS: , A detailed physical exam revealed a very active and intractable, well-nourished 11-month-old male with weight 10.5 kilos and height 76.8 cm. Vital Signs: Temperature is 35.3 degrees Celsius, pulse is 121 beats per minute, respiratory rate 32 breaths per minute, blood pressure 135/74 mmHg. Eyes: Conjunctivae are clear, nonicteric. Pupils are equally round and reactive to light. Extraocular muscle movements appear intact with no strabismus. Ears: TMs are clear bilaterally. Oral Mucosa: No thrush is appreciated. No mucosal ulcerations or erythema. Chest: Port-a-Cath is nonerythematous and nontender to VP access port. Respiratory: Good aeration, clear to auscultation bilaterally. Cardiovascular: Regular rate, normal S1 and S2, no murmurs appreciated. Abdomen is soft, nontender, and no organomegaly, unable to appreciate a right-sided abdominal mass or any other masses. Skin: No rashes. Neurologic: The patient walks without assistance, frequently falls on his bottom.,LABORATORY STUDIES: , CBC and comprehensive metabolic panel were obtained and they are significant for AST 51, white blood cell count 11,440, hemoglobin 10.9, and platelets 202,000 with ANC 2974. Medical tests none. Radiologic studies are none.,ASSESSMENT: , This patient's disease is life threatening, currently causing moderately severe side effects.,PROBLEMS DIAGNOSES: ,1. Neuroblastoma of the right adrenal gland with favorable Shimada histology.,2. History of stage 2 left adrenal neuroblastoma, status post gross total resection.,3. Immunosuppression.,4. Mucosal candidiasis.,5. Resolving neutropenia.,PROCEDURES AND IMMUNIZATIONS:, None.,PLANS: ,1. Neuroblastoma. The patient will return to the Pediatric Oncology Clinic on 06/13/07 to 06/15/07 for his third cycle of chemotherapy. I will plan for restaging with CT of the abdomen prior to the cycle.,2. Immunosuppression. The patient will continue on his Bactrim twice a day on Thursday, Friday, and Saturday. Additionally, we will tentatively plan to have him continue fluconazole since this is his second episode of thrush.,3. Mucosal candidiasis. We will continue fluconazole for thrush. I am pleased that the clinical evidence of disease appears to have resolved. For resolving neutropenia, I advised Gregory's mother about it is okay to discontinue the G-CSF at this time. We will plan for him to resume G-CSF after his next chemotherapy and prescription has been sent to the patient's pharmacy.,PEDIATRIC ONCOLOGY ATTENDING: , I have reviewed the history of the patient. This is an 11-month-old with neuroblastoma who received chemotherapy with carboplatin, cyclophosphamide, and doxorubicin on 05/21/07 for cycle 2 of POG-9641 due to his prior history of neutropenia, he has been on G-CSF. His ANC is nicely recovered. He will have a restaging CT prior to his next cycle of chemotherapy and then return for cycle 3 chemotherapy on 06/13/07 to 06/15/07. He continues on fluconazole for recent history of thrush. Plans are otherwise documented above.

Consult - History and Phy.

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

HISTORY OF PRESENT ILLNESS: , The patient presents today for followup, history of erectile dysfunction, last visit started on Cialis 10 mg. He indicates that he has noticed some mild improvement of his symptoms, with no side effect. On this dose, he is having firm erection, able to penetrate, lasting for about 10 or so minutes. No chest pain, no nitroglycerin usage, no fever, no chills. No dysuria, gross hematuria, fever, chills. Daytime frequency every three hours, nocturia times 0, good stream. He does have a history of elevated PSA and biopsy June of this year was noted for high grade PIN, mid left biopsy, with two specimens being too small to evaluate. PSA 11.6. Dr. X's notes are reviewed.,IMPRESSION: ,1. Some improvement of erectile dysfunction, on low dose of Cialis, with no side effects. The patient has multiple risk factors, but denies using any nitroglycerin or any cardiac issues at this time. We reviewed options of increasing the medication, versus trying other medications, options of penile prosthesis, Caverject injection use as well as working pump is reviewed.,2. Elevated PSA in a patient with a recent biopsy showing high-grade PIN, as well as two specimens not being large enough to evaluate. The patient tells me he has met with his primary care physician and after discussion, he is in consideration of repeating a prostate ultrasound and biopsy. However, he would like to meet with Dr. X to discuss these prior to biopsy.,PLAN: , Following detailed discussion, the patient wishes to proceed with Cialis 20 mg, samples are provided as well as Levitra 10 mg, may increase this to 20 mg and understand administration of each and contraindication as well as potential side effects are reviewed. The patient not to use them at the same time. Will call if any other concern. In the meantime, he is scheduled to meet with Dr. X, with a prior PSA in consideration of a possible repeating prostate ultrasound and biopsy. He declined scheduling this at this time. All questions answered.

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'

GENERAL: Negative for any nausea, vomiting, fevers, chills, or weight loss.,NEUROLOGIC: Negative for any blurry vision, blind spots, double vision, facial asymmetry, dysphagia, dysarthria, hemiparesis, hemisensory deficits, vertigo, ataxia.,HEENT: Negative for any head trauma, neck trauma, neck stiffness, photophobia, phonophobia, sinusitis, rhinitis.,CARDIAC: Negative for any chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, peripheral edema.,PULMONARY: Negative for any shortness of breath, wheezing, COPD, or TB exposure.,GASTROINTESTINAL: Negative for any abdominal pain, nausea, vomiting, bright red blood per rectum, melena.,GENITOURINARY: Negative for any dysuria, hematuria, incontinence.,INTEGUMENTARY: Negative for any rashes, cuts, insect bites.,RHEUMATOLOGIC: Negative for any joint pains, photosensitive rashes, history of vasculitis or kidney problems.,HEMATOLOGIC: Negative for any abnormal bruising, frequent infections or bleeding.

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'

CHIEF COMPLAINT: , Right distal ureteral calculus.,HISTORY OF PRESENT ILLNESS: ,The patient had hematuria and a CT urogram at ABC Radiology on 01/04/07 showing a 1 cm non-obstructing calcification in the right distal ureter. He had a KUB also showing a teardrop shaped calcification apparently in the right lower ureter. He comes in now for right ureteroscopy, Holmium laser lithotripsy, right ureteral stent placement.,PAST MEDICAL HISTORY:,1. Prostatism.,2. Coronary artery disease.,PAST SURGICAL HISTORY:,1. Right spermatocelectomy.,2. Left total knee replacement in 1987.,3. Right knee in 2005.,MEDICATIONS:,1. Coumadin 3 mg daily.,2. Fosamax.,3. Viagra p.r.n.,ALLERGIES: , NONE.,REVIEW OF SYSTEMS:, CARDIOPULMONARY: No shortness of breath or chest pain. GI: No nausea, vomiting, diarrhea or constipation. GU: Voids well. MUSCULOSKELETAL: No weakness or strokes.,FAMILY HISTORY: , Noncontributory.,PHYSICAL EXAMINATION:,GENERAL APPEARANCE: An alert male in no distress.,HEENT: Grossly normal.,NECK: Supple.,LUNGS: Clear.,HEART: Normal sinus rhythm. No murmur or gallop.,ABDOMEN: Soft. No masses.,GENITALIA: Normal penis. Testicles descended bilaterally.,RECTAL: Examination benign.,EXTREMITIES: No edema.,IMPRESSION: , Right distal ureteral calculus.,PLAN: , Right ureteroscopy, ureteral lithotripsy. Risks and complications discussed with the patient. He signed a true informed consent. No guarantees or warrantees were given.

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:, Open left angle comminuted angle of mandible, 802.35, and open symphysis of mandible, 802.36.,POSTOPERATIVE DIAGNOSIS:, Open left angle comminuted angle of mandible, 802.35, and open symphysis of mandible, 802.36.,PROCEDURE:, Open reduction, internal fixation (ORIF) of bilateral mandible fractures with multiple approaches, CPT code 21470, and surgical extraction of teeth #17, CPT code 41899.,ANESTHESIA: , General anesthesia via nasal endotracheal intubation.,FLUIDS: , 1800 mL of LR.,ESTIMATED BLOOD LOSS: , 150 mL.,HARDWARE: ,A 2.3 titanium locking reconstruction plate from Leibinger on the symphysis and a 2.0 reconstruction plate on the left angle.,SPECIMEN: , None.,COMPLICATIONS: , None.,CONDITION: , The patient was extubated to the PACU, breathing spontaneously in excellent good condition.,INDICATIONS FOR THE PROCEDURE: , The patient is a 55-year-old male that he is 12 hour status post interpersonal violence in which he sustained bilateral mandible fractures and positive loss of consciousness. He reported to the Hospital the day after his altercation complaining of mall occlusion and sore left shoulder. He was worked up by the emergency department. His head CT was cleared and his left shoulder was clear of any fractures or soft tissue damage. Oral maxillary facial surgery was consulted to manage the mandible fracture. After review of the CT and examination it was determined that the patient would benefit from open reduction, internal fixation of bilateral mandible fractures. Risks, benefits, and alternative to treatment were thoroughly discussed with the patient and consent was obtained.,DESCRIPTION OF PROCEDURE:, The patient was brought to the operating room #2 at Hospital. He was laid in supine position on the operating room table. ASA monitors were attached and stated general anesthesia was induced with IV anesthetic and maintained with nasal endotracheal intubation and inflation anesthetics.,The patient was prepped and draped in the usual oral maxillofacial surgery fashion. The surgeon approached the operating room table in a sterile fashion. Approximately 10 mL of 1% lidocaine with 1:100,000 epinephrine was injected into oral vestibule in a nerve block fashion. Erich arch bars were adapted to the maxilla and mandible, secured in the posterior teeth with 24-gauge surgical steel wire and 26-gauge surgical steel wire in the anterior. This was done from second molar to second molar on both the maxilla and the mandible secondary to the patient missing multiple teeth. The patient was manipulated up into maximum intercuspation. He has a malocclusion with severe bruxism and so wear facets were lined up. This was secured with 26-gauge surgical steel wire. Attention was then directed to the symphysis extraorally. Approximately 5 mL of 1% lidocaine with epinephrine was injected into the area of incision which paralleled the inferior border of the mandible 2 cm below the inferior border of the mandible.,After waiting appropriate time for local anesthesia using a 15 blade, a skin and platysma incision was made. Then using a series of blunt and sharp dissections, the dissection was carried to the inferior border of the mandible. The periosteum was incised and reflected with the periosteal elevator. The fracture was noted and it was displaced. Manipulation of the segments and checking with the occlusion intraorally, the fracture was aligned. This was secured with 7-hole 2.3 titanium locking reconstruction plate with bicortical screws. The wound was then packed with moist Ray-Tec and attention was directed intraorally to the left angle fracture. Approximately 5 mL of 1% lidocaine with 1:100,000 epinephrine was injected into the left vestibule. After waiting appropriate time for local anesthesia to take effect, using Bovie electrocautery, a sagittal split incision was made and the fracture was identified. It was noted that the fracture went through tooth #17 and this needed to be extracted. Taking a round bur, a buckle trough was made and the tooth was elevated and removed both distal and mesial roots. The fracture was then reduced and lateral superior border plate 2-0 4 whole with monocortical screws was placed. The fracture was noted to be well reduced. The wound was then irrigated with copious amount of sterile water. The patient was released for excellent intercuspation. He was then manipulated up into the occlusion easily. Wound was then closed with running 3-0 chromic gut suture. Attention was then directed extraorally. This was irrigated with copious amount of sterile water and closed in a layer fashion with 3-0 Vicryl, 4-0 Vicryl, and 5-0 Prolene on skin. Attention was then again directed into the mouth. The throat pack was removed and orogastric tube was placed and stomach content was evacuated. The patient was then manipulated back up to maximum intercuspation and secured with interdental elastics and a pressure dressing was applied to the extraoral incisions. At this point, the procedure was then determined to be over.,The patient was extubated and breathing spontaneously, transported to the PACU in excellent condition.

Dentistry

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge 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: , Kyphosis.,HISTORY OF PRESENT ILLNESS: , The patient is a 13-year-old new patient is here for evaluation of thoracic kyphosis. The patient has a family history in a maternal aunt and grandfather of kyphosis. She was noted by her parents to have round back posture. They have previously seen another orthopedist who recommended observation at this time. She is here for a second opinion in regards to kyphosis. The patient denies any pain in her back or any numbness, tingling, or weakness in her upper or lower extremities. No problems with her bowels or bladder.,PAST MEDICAL HISTORY: , None.,PAST SURGICAL HISTORY: , Bilateral pinning of her ears.,SOCIAL HISTORY: ,She is currently an eighth grader at Middle School and is interested in basketball. She lives with both of her parents and has a 9-year-old brother. She had menarche beginning in September.,FAMILY HISTORY: ,Of kyphosis in great grandmother and second cousin.,REVIEW OF SYSTEMS: , She is in her usual state of health and is negative except otherwise as mentioned in the history of present illness.,MEDICATIONS: , She is currently on Zyrtec, Flonase, and Ceftin for an ear infection.,ALLERGIES: , No known drug allergies.,FINDINGS: , On physical exam, she is alert, oriented, and in no acute distress standing 63 inches tall. In regards to her back, her skin is intact with no rashes, lesions, and/or no dimpling or hair spots. No cafe au lait spots. She is not tender to palpation from her occiput to her sacrum. There is no evidence of paraspinal muscle spasm. On forward bending, there is a mild kyphosis. She is not able to touch her toes indicating her hamstring tightness. She has a full 5 out of 5 in all muscle groups. Her lower extremities including iliopsoas, quadriceps, gastroc-soleus, tibialis anterior, and extensor hallucis longus. Her sensation intact to light touch in L1 through L2 dermatomal distributions. She has symmetric limb lengths as well bilaterally from both the coronal and sagittal planes.,X-rays today included PA and lateral sclerosis series. She has approximately 46 degree kyphosis.,ASSESSMENT: , Kyphosis.,PLANS: ,The patient's kyphosis is quite mild. While this is likely in the upper limits of normal or just it is normal for an adolescent and still within normal range as would be expected return at home. At this time, three options were discussed with the parents including observation, physical therapy, and bracing. At this juncture, given that she has continued to grow, they are Risser 0. She may benefit from continued observation with physical therapy, bracing would be a more aggressive option certainly that thing would be lost with following at this time. As such, she was given a prescription for physical therapy for extension based strengthening exercises, flexibility range of motion exercises, postural training with no forward bending. We will see her back in 3 months' time for repeat radiographs at that time including PA and lateral standing of scoliosis series. Should she show evidence of continued progression of her kyphotic deformity, discussions of bracing would be held at time. We will see her back in 3 months' time for repeat evaluation.

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:, Right middle lobe lung cancer.,POSTOPERATIVE DIAGNOSIS: , Right middle lobe lung cancer.,PROCEDURES PERFORMED:,1. VATS right middle lobectomy.,2. Fiberoptic bronchoscopy thus before and after the procedure.,3. Mediastinal lymph node sampling including levels 4R and 7.,4. Tube thoracostomy x2 including a 19-French Blake and a 32-French chest tube.,5. Multiple chest wall biopsies and excision of margin on anterior chest wall adjacent to adherent tumor.,ANESTHESIA: ,General endotracheal anesthesia with double-lumen endotracheal tube.,DISPOSITION OF SPECIMENS: , To pathology both for frozen and permanent analysis.,FINDINGS:, The right middle lobe tumor was adherent to the anterior chest wall. The adhesion was taken down, and the entire pleural surface along the edge of the adhesion was sent for pathologic analysis. The final frozen pathology on this entire area returned as negative for tumor. Additional chest wall abnormalities were biopsied and sent for pathologic analysis, and these all returned separately as negative for tumor and only fibrotic tissue. Several other biopsies were taken and sent for permanent analysis of the chest wall. All of the biopsy sites were additionally marked with Hemoclips. The right middle lobe lesion was accompanied with distal pneumonitis and otherwise no direct involvement of the right upper lobe or right lower lobe.,ESTIMATED BLOOD LOSS: , Less than 100 mL.,CONDITION OF THE PATIENT AFTER SURGERY: , Stable.,HISTORY OF PROCEDURE:, This patient is well known to our service. He was admitted the night before surgery and given hemodialysis and had close blood sugar monitoring in control. The patient was subsequently taken to the operating room on April 4, 2007, was given general anesthesia and was endotracheally intubated without incident. Although, he had markedly difficult airway, the patient had fiberoptic bronchoscopy performed all the way down to the level of the subsegmental bronchi. No abnormalities were noted in the entire tracheobronchial tree, and based on this, the decision was made to proceed with the surgery. The patient was kept in the supine position, and the single-lumen endotracheal tube was removed and a double-lumen tube was placed. Following this, the patient was placed into the left lateral decubitus position with the right side up and all pressure points were padded. Sterile DuraPrep preparation on the right chest was placed. A sterile drape around that was also placed. The table was flexed to open up the intercostal spaces. A second bronchoscopy was performed to confirm placement of the double-lumen endotracheal tube. Marcaine was infused into all incision areas prior to making an incision. The incisions for the VATS right middle lobectomy included a small 1-cm incision for the auscultatory incision approximately 4 cm inferior to the inferior tip of the scapula. The camera port was in the posterior axillary line in the eighth intercostal space through which a 5-mm 30-degree scope was used. Third incision was an anterior port, which was approximately 2 cm inferior to the inframammary crease and the midclavicular line in the anterior sixth intercostal space, and the third incision was a utility port, which was a 4 cm long incision, which was approximately one rib space below the superior pulmonary vein. All of these incisions were eventually created during the procedure. The initial incision was the camera port through which, under direct visualization, an additional small 5-mm port was created just inferior to the anterior port. These two ports were used to identify the chest wall lesions, which were initially thought to be metastatic lesions. Multiple biopsies of the chest wall lesions were taken, and the decision was made to also insert the auscultatory incision port. Through these three incisions, the initial working of the diagnostic portion of the chest wall lesion was performed. Multiple biopsies were taken of the entire chest wall offers and specimens came back as negative. The right middle lobe was noted to be adherent to the anterior chest wall. This area was taken down and the entire pleural surface along this area was taken down and sent for frozen pathologic analysis. This also returned as negative with only fibrotic tissue and a few lymphocytes within the fibrotic tissue, but no tumor cells. Based on this, the decision was made to not proceed with chest wall resection and continue with right middle lobectomy. Following this, the anterior port was increased in size and the utility port was made and meticulous dissection from an anterior to posterior direction was performed. The middle lobe branch of the right superior pulmonary vein was initially dissected and stapled with vascular load 45-mm EndoGIA stapler. Following division of the right superior pulmonary vein, the right middle lobe bronchus was easily identified. Initially, this was thought to be the main right middle lobe bronchus, but in fact it was the medial branch of the right middle lobe bronchus. This was encircled and divided with a blue load stapler with a 45-mm EndoGIA. Following division of this, the pulmonary artery was easily identified. Two branches of the pulmonary artery were noted to be going into the right middle lobe. These were individually divided with a vascular load after encircling with a right angle clamp. The vascular staple load completely divided these arterial branches successfully from the main pulmonary artery trunk, and following this, an additional branch of the bronchus was noted to be going to the right middle lobe. A fiberoptic bronchoscopy was performed intraoperatively and confirmed that this was in fact the lateral branch of the right middle lobe bronchus. This was divided with a blue load stapler 45 mm EndoGIA. Following division of this, the minor and major fissures were completed along the edges of the right middle lobe separating the right upper lobe from the right middle lobe as well as the right middle lobe from the right lower lobe. Following complete division of the fissure, the lobe was put into an EndoGIA bag and taken out through the utility port. Following removal of the right middle lobe, a meticulous lymph node dissection sampling was performed excising the lymph node package in the 4R area as well as the 7 lymph node package. Node station 8 or 9 nodes were easily identified, therefore none were taken. The patient was allowed to ventilate under water on the right lung with no obvious air leaking noted. A 19-French Blake was placed into the posterior apical position and a 32-French chest tube was placed in the anteroapical position. Following this, the patient's lung was allowed to reexpand fully, and the patient was checked for air leaking once again. Following this, all the ports were closed with 2-0 Vicryl suture used for the deeper tissue, and 3-0 Vicryl suture was used to reapproximate the subcutaneous tissue and 4-0 Monocryl suture was used to close the skin in a running subcuticular fashion. The patient tolerated the procedure well, was extubated in the operating room and taken to the recovery room in stable condition.

Cardiovascular / Pulmonary

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

XYZ Street,City, State,Dear Dr. CD:,Thank you for seeing Mr. XYZ, a pleasant 19-year-old male who has seen you in 2005 for suspected seizure activity. He comes to my office today continuing on Dilantin 300 mg daily and has been seizure episode free for the past 2 1/2 years. He is requesting to come off the Dilantin at this point. Upon reviewing your 2005 note there was some discrepancy as to the true nature of his episodes to the emergency room and there was consideration to reconsider medication use. His physical exam, neurologically, is normal at this time. His Dilantin level is slightly low at 12.5.,I will appreciate your evaluation and recommendation as to whether we need to continue the Dilantin at this time. I understand this will probably entail repeating his EEG and so please coordinate this through Health Center. I await your response and whether we should continue this medication. If you require any laboratory, we use ABC Diagnostic and any further testing that is needed should be coordinated at Health Center prior to scheduling.

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'

REASON FOR VISIT: , Followup of laparoscopic fundoplication and gastrostomy.,HISTORY OF PRESENT ILLNESS: , The patient is a delightful baby girl, who is now nearly 8 months of age and had a tracheostomy for subglottic stenosis. Laparoscopic fundoplication and gastrostomy was done because of the need for enteral feeding access and to protect her airway at a time when it is either going to heal enough to improve and allow decannulation or eventually prove that she will need laryngotracheoplasty. Dr. X is following The patient for this and currently plans are to perform a repeat endoscopic exam every couple of months to assist the status of her airway caliber.,The patient had a laparoscopic fundoplication and gastrostomy on 10/05/2007. She has done well since that time. She has had some episodes of retching intermittently and these seemed to be unpredictable. She also had some diarrhea and poor feeding tolerance about a week ago but that has also resolved. The patient currently takes about 1 ounce to 1.5 ounce of her feedings by mouth and the rest is given by G-tube. She seems otherwise happy and is not having an excessive amount of stools. Her parents have not noted any significant problems with the gastrostomy site.,The patient's exam today is excellent. Her belly is soft and nontender. All of her laparoscopic trocar sites are healing with a normal amount of induration, but there is no evidence of hernia or infection. We removed The patient's gastrostomy button today and showed her parents how to reinsert one without difficulty. The site of the gastrostomy is excellent. There is not even a hint of granulation tissue or erythema, and I am very happy with the overall appearance.,IMPRESSION: , The patient is doing exceptionally well status post laparoscope fundoplication and gastrostomy. Hopefully, the exquisite control of acid reflux by fundoplication will help her airway heal, and if she does well, allow decannulation in the future. If she does require laryngotracheoplasty, the protection from acid reflux will be important to healing of that procedure as well.,PLAN: ,The patient will follow up as needed for problems related to gastrostomy. We will see her when she comes in the hospital for endoscopic exams and possibly laryngotracheoplasty in the future.

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'

EXAM: , MRI of lumbar spine without contrast.,HISTORY:, A 24-year-old female with chronic back pain.,TECHNIQUE: , Noncontrast axial and sagittal images were acquired through the lumbar spine in varying degrees of fat and water weighting.,FINDINGS: , The visualized cord is normal in signal intensity and morphology with conus terminating in proper position. Visualized osseous structures are normal in marrow signal intensity and morphology without evidence for fracture/contusion, compression deformity, or marrow replacement process. There are no paraspinal masses.,Disc heights, signal, and vertebral body heights are maintained throughout the lumbar spine.,L5-S1: Central canal, neural foramina are patent.,L4-L5: Central canal, neural foramina are patent.,L3-L4: Central canal, neural foramen is patent.,L2-L3: Central canal, neural foramina are patent.,L1-L2: Central canal, neural foramina are patent.,The visualized abdominal aorta is normal in caliber. Incidental note has been made of multiple left-sided ovarian, probable physiologic follicular cysts.,IMPRESSION: , No acute disease in the lumbar spine.

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'

Her past medical history includes a presumed diagnosis of connective tissue disorder. She has otherwise, good health. She underwent a shoulder ligament repair for joint laxity.,She does not take any eye medications and she takes Seasonale systemically. She is allergic to penicillin.,The visual acuity today, distance with her current prescription was 20/30 on the right and 20/20 on the left eye. Over refraction on the right eye showed -0.50 sphere with acuity of 20/20 OD. She is wearing -3.75 +1.50 x 060 on the right and -2.50 +0.25 x 140, OS. Intraocular pressures are 13 OU and by applanation. Confrontation, visual fields, extraocular movement, and pupils are normal in both eyes. Gonioscopy showed normal anterior segment angle morphology in both eyes. She does have some fine iris strength crossing the angle, but the angle is otherwise open 360 degrees in both eyes.,The lids were normal in both eyes. Conjunctivae were quite, OU. Cornea were clear in both eyes. The anterior chamber is deep and quiet, OU. She has clear lenses, which are in good position, OU. Dilated fundus exam shows moderately optically clear vitreous, OU. The optic nerves are normal in size. The cup-to-disc ratios were approximately 0.4, OU. The nerve fiber layers are excellent, OU. The macula, vessels, and periphery were normal in both eyes. No evidence of peripheral retinal degeneration is present in either eye.,Ms. ABC has optically clear vitreous. She does not have any obvious risk factors for retinal detachment at present such as peripheral retinal degeneration and her anterior chamber angles are normal in both eyes.,She does have moderate myopia, however.,This combination of findings suggests and is consistent with her systemic connective tissue disorder such as a Stickler syndrome or a variant of Stickler syndrome.,I discussed with her the symptoms of retinal detachment and advised her to contact us immediately if they occur. Otherwise, I can see her in 1 to 2 years.

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'

INDICATIONS FOR PROCEDURE:, Impending open heart surgery for closure of ventricular septal defect in a 4-month-old girl.,Procedures were done under general anesthesia. The patient was already in the operating room under general anesthesia. Antibiotic prophylaxis with cefazolin and gentamicin was already given prior to beginning the procedures.,PROCEDURE #1:, Insertion of transesophageal echocardiography probe.,DESCRIPTION OF PROCEDURE #1: , The probe was well lubricated and with digital manipulation, was passed into the esophagus without resistance. The probe was placed so that the larger diameter was in the anterior-posterior position during insertion. The probe was used by the pediatric cardiologist for preoperative and postoperative diagnostic echocardiography. At the end, it was removed without trauma and there was no blood tingeing. It is to be noted that approximately 30 minutes after removing the cannula, I inserted a 14-French suction tube to empty the stomach and there were a few mL of blood secretions that were suctioned. There was no overt bleeding.,PROCEDURE #2: , Attempted and unsuccessful insertion of arterial venous lines.,DESCRIPTION OF PROCEDURE #2:, Both groins were prepped and draped. The patient was placed at 10 degrees head-up position. A Cook 4-French double-lumen 8-cm catheter kit was opened. Using the 21-gauge needle that comes with the kit, several attempts were made to insert central venous and then an arterial line in the left groin. There were several successful punctures of these vessels, but I was unable to advance Seldinger wire. After removal of the needles, the area was compressed digitally for approximately 5 minutes. There was a small hematoma that was not growing. Initially, the left leg was mildly mottled with prolonged capillary refill of approximately 3 seconds. Using 1% lidocaine, I infiltrated the vessels of the groin both medial and lateral to the vascular sheath. Further observation, the capillary refill and circulation of the left leg became more than adequate. The O2 saturation monitor that was on the left toe functioned well throughout the procedures, from the beginning to the end. At the end of the procedure, the circulation of the leg was intact.,

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:, Foul-smelling urine and stomach pain after meals.,HISTORY OF PRESENT ILLNESS:, Stomach pain with most meals x one and a half years and urinary symptoms for same amount of time. She was prescribed Reglan, Prilosec, Pepcid, and Carafate at ED for her GI symptoms and Bactrim for UTI. This visit was in July 2010.,REVIEW OF SYSTEMS:, HEENT: No headaches. No visual disturbances, no eye irritation. No nose drainage or allergic symptoms. No sore throat or masses. Respiratory: No shortness of breath. No cough or wheeze. No pain. Cardiac: No palpitations or pain. Gastrointestinal: Pain and cramping. Denies nausea, vomiting, or diarrhea. Has some regurgitation with gas after meals. Genitourinary: "Smelly" urine. Musculoskeletal: No swelling, pain, or numbness.,MEDICATION ALLERGIES:, No known drug allergies.,PHYSICAL EXAMINATION:,General: Unremarkable.,HEENT: PERRLA. Gaze conjugate.,Neck: No nodes. No thyromegaly. No masses.,Lungs: Clear.,Heart: Regular rate without murmur.,Abdomen: Soft, without organomegaly, without guarding or tenderness.,Back: Straight. No paraspinal spasm.,Extremities: Full range of motion. No edema.,Neurologic: Cranial nerves II-XII intact. Deep tendon reflexes 2+ bilaterally.,Skin: Unremarkable.,LABORATORY STUDIES:, Urinalysis was done, which showed blood due to her period and moderate leukocytes.,ASSESSMENT:,1. UTI.,2. GERD.,3. Dysphagia.,4. Contraception consult.,PLAN:,1. Cipro 500 mg b.i.d. x five days. Ordered BMP, CBC, and urinalysis with microscopy.,2. Omeprazole 20 mg daily and famotidine 20 mg b.i.d.,3. Prescriptions same as #2. Also referred her for a barium swallow series to rule out a stricture.,4. Ortho Tri-Cyclen Lo.,

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'

PROBLEM LIST:,1. Type 1 diabetes mellitus, insulin pump.,2. Hypertension.,3. Hyperlipidemia.,HISTORY OF PRESENT ILLNESS: , The patient is a 39-year-old woman returns for followup management of type 1 diabetes mellitus. Her last visit was approximately 4 months ago. Since that time, the patient states her health had been good and her glycemic control had been good, however, within the past 2 weeks she had a pump malfunction, had to get a new pump and was not certain of her pump settings and has been having some difficulty with glycemic control over the past 2 weeks. She is not reporting any severe hypoglycemic events, but is having some difficulty with hyperglycemia both fasting and postprandial. She is not reporting polyuria, polydipsia or polyphagia. She is not exercising at this point and has a diet that is rather typical of woman with twins and a young single child as well. She is working on a full-time basis and so eats on the run a lot, probably eats more than she should and not making the best choices, little time for physical activity. She is keeping up with all her other appointments and has recently had a good eye examination. She had lab work done at her previous visit and this revealed persistent hyperlipidemic state with a LDL of 144.,CURRENT MEDICATIONS:,1. Zoloft 50 mg p.o. once daily.,2. Lisinopril 40 mg once daily.,3. Symlin 60 micrograms, not taking at this point.,4. Folic acid 2 by mouth every day.,5. NovoLog insulin via insulin pump about 90 units of insulin per day.,REVIEW OF SYSTEMS:, She denies fever, chills, sweats, nausea, vomiting, diarrhea, constipation, abdominal pain, chest pain, shortness of breath, difficulty breathing, dyspnea on exertion or change in exercise tolerance. She is not having painful urination or blood in the urine. She is not reporting polyuria, polydipsia or polyphagia.,PHYSICAL EXAMINATION:,GENERAL: Today showed a very pleasant, well-nourished woman, in no acute distress. VITAL SIGNS: Temperature not taken, pulse 98, respirations 20, blood pressure 148/89, and weight 91.19 kg. THORAX: Revealed lungs clear, PA and lateral without adventitious sounds. CARDIOVASCULAR: Demonstrated regular rate and rhythm. S1 and S2 without murmur. No S3, no S4 auscultated. ABDOMEN: Nontender. EXTREMITIES: Showed no clubbing, cyanosis or edema. SKIN: Intact and do not appear atrophic. Deep tendon reflexes were 2+/4 without a delayed relaxation phase.,LABORATORY DATA:, Dated 10/05/08 showed a total cholesterol of 223, triglyceride 140, HDL 54, and LDL 144. The hemoglobin A1c was 6.4 and the spot urine for microalbumin was 9.2 micrograms of protein, 1 mg of creatinine. Sodium 136, potassium 4.5, chloride 102, CO2 30 mEq, BUN 11 mg/dL, creatinine 0.6 mg, estimated GFR greater than 60, blood sugar 118, calcium 9.4, and her LFTs were unremarkable. TSH is 1.07 and free T4 is 0.81.,ASSESSMENT AND PLAN:,1. This is a return visit to the endocrine clinic for the patient, a 39-year-old woman with history as noted above. Plan today is to make adjustments to her pump based on a total daily dose of 90 units of insulin. Basal rate is as follows, 12 a.m. 1.5, 02:30 a.m. 1.75, and 6 a.m. 1.5. Her correction factor is 19. Her carb/insulin ratio is 6. Her active insulin time is 5 and her targets are at 12 a.m. 110 and 6 a.m. to midnight is 100. We made adjustments to her pump and the plan will be to see her back in approximately 2 months.,2. Hyperlipidemia. The patient is not taking statin, therefore, we will prescribe Lipitor 20 mg one p.o. once daily. Have her watch for side effects from the medication and plan to do a fasting lipid panel and CMP approximately 8 weeks from now.,3. We will get a hemoglobin A1c and spot urine for albumin in 8 weeks as well.

SOAP / Chart / Progress Notes

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

PREOPERATIVE DIAGNOSIS:, Right occipital arteriovenous malformation.,POSTOPERATIVE DIAGNOSIS:, Right occipital arteriovenous malformation.,PROCEDURE PERFORMED:, CT-guided frameless stereotactic radiosurgery for the right occipital arteriovenous malformation using dynamic tracking.,Please note no qualified resident was available to assist in the procedure.,INDICATION: , The patient is a 30-year-old male with a right occipital AVM. He was referred for stereotactic radiosurgery. The risks of the radiosurgical treatment were discussed with the patient including, but not limited to, failure to completely obliterate the AVM, need for additional therapy, radiation injury, radiation necrosis, headaches, seizures, visual loss, or other neurologic deficits. The patient understands these risks and would like to proceed.,PROCEDURE IN DETAIL: , The patient arrived to Outpatient CyberKnife Suite one day prior to the treatment. He was placed on the treatment table. The Aquaplast mask was constructed. Initial imaging was obtained by the CyberKnife system. The patient was then transported over to the CT scanner at Stanford. Under the supervision of Dr. X, 125 mL of Omnipaque 250 contrast was administered. Dr. X then supervised the acquisition of 1.2-mm contiguous axial CT slices. These images were uploaded over the hospital network to the treatment planning computer, and the patient was discharged home.,Treatment plan was then performed by me. I outlined the tumor volume. Inverse treatment planning was used to generate the treatment plan for this patient. This resulted in a total dose of 20 Gy delivered to 84% isodose line using a 12.5 mm collimator. The maximum dose within this center of treatment volume was 23.81 Gy. The volume treated was 2.972 mL, and the treated lesion dimensions were 1.9 x 2.7 x 1.6 cm. The volume treated at the reference dose was 98%. The coverage isodose line was 79%. The conformality index was 1.74 and modified conformality index was 1.55. The treatment plan was reviewed by me and Dr. Y of Radiation Oncology, and the treatment plan was approved.,On the morning of May 14, 2004, the patient arrived at the Outpatient CyberKnife Suite. He was placed on the treatment table. The Aquaplast mask was applied. Initial imaging was used to bring the patient into optimal position. The patient underwent stereotactic radiosurgery to deliver the 20 Gy to the AVM margin. He tolerated the procedure well. He was given 8 mg of Decadron for prophylaxis and discharged home.,Followup will consist of an MRI scan in 6 months. The patient will return to our clinic once that study is completed.,I was present and participated in the entire procedure on this patient consisting of CT-guided frameless stereotactic radiosurgery for the right occipital AVM.,Dr. X was present during the entire procedure and will be dictating his own operative note.

Neurosurgery

Given a medical transcription, predict a single label representing the most appropriate medical specialty from the list: 'Surgery', 'Allergy / Immunology', 'Sleep Medicine', 'Pediatrics - Neonatal', 'SOAP / Chart / Progress Notes', 'Bariatrics', 'Pain Management', 'Lab Medicine - Pathology', 'Dermatology', 'Orthopedic', 'Dentistry', 'Psychiatry / Psychology', 'General Medicine', 'Office Notes', 'Letters', 'Neurosurgery', 'Radiology', 'Cosmetic / Plastic Surgery', 'Nephrology', 'Diets and Nutritions', 'Chiropractic', 'Gastroenterology', 'Cardiovascular / Pulmonary', 'Speech - Language', 'Hospice - Palliative Care', 'Autopsy', 'Endocrinology', 'Emergency Room Reports', 'Discharge Summary', 'ENT - Otolaryngology', 'Urology', 'Physical Medicine - Rehab', 'Neurology', 'Podiatry', 'Ophthalmology', 'Rheumatology', 'IME-QME-Work Comp etc.', 'Hematology - Oncology', 'Consult - History and Phy.', 'Obstetrics / Gynecology'

EXAM:,MRI RIGHT ANKLE,CLINICAL:,This is a 51 year old female who first came into the office 3/4/05 with right ankle pain. She stepped on ice the evening prior and twisted her ankle. PF's showed no frank fracture, dislocation, or subluxations.,FINDINGS:,Received for interpretation is an MRI examination performed on 4/28/2005.,There is a "high ankle sprain" of the distal tibiofibular syndesmotic ligamentous complex involving the anterior tibiofibular ligament with marked ligamentous inflammatory thickening and diffuse interstitial edema. There is osteoarthritic spur formation at the anterior aspect of the fibula with a small 2mm osseous structure within the markedly thickened anterior talofibular ligament suggesting a small ligamentous osseous avulsion. The distal tibiofibular syndesmotic ligamentous complex remains intact without a complete rupture. There is no widening of the ankle mortis. The posterior talofibular ligament remains intact.,There is marked ligamentous thickening of the anterior talofibular ligament of the lateral collateral ligamentous complex suggesting the sequela of a remote lateral ankle sprain. There is thickening of the posterior talofibular and calcaneofibular ligaments.,There is a flat retromalleolar sulcus.,There is a full-thickness longitudinal split tear of the peroneus brevis tendon within the retromalleolar groove. The tear extends to the level of the inferior peroneal retinaculum. There is anterior displacement of the peroneus longus tendon into the split peroneus tendon tear.,There is severe synovitis of the peroneus longus tendon sheath with prominent fluid distention. The synovitis extends to the level of the inferior peroneal retinaculum.,There is a focal area of chondral thinning of the hyaline cartilage of the medial talar dome with a focal area of subchondral plate cancellous marrow resorption consistent with and area of prior talar dome contusion but there is no focal osteochondral impaction or osteochondral defect.,There is minimal fluid within the tibiotalar articulation.,There is minimal fluid within the posterior subtalar articulation with mild anterior capsular prolapse. Normal talonavicular and calcaneocuboid articulations. The anterior superior calcaneal process is normal.,There is mild tenosynovitis of the posterior tibialis tendon sheath but an intrinsically normal tendon. There is an os navicularis (Type II synchondrosis) with an intact synchondrosis and no active marrow stress phenomenon.,Normal flexor digitorum longus tendon.,There is prominent fluid distention of the flexor hallucis longus tendon sheath with capsular distention proximal to the posterior talar processes with prominent fluid distention of the synovial sheath.,There is a loculated fluid collection within Kager’s fat measuring approximately 1 x 1 x 2.5cm in size, extending to the posterior subtalar facet joint consistent with a ganglion of either posterior subtalar facet origin or arising from the flexor hallucis longus tendon sheath.,There is mild tenosynovitis of the Achilles tendon with mild fusiform enlargement of the non-insertional Watershed zone of the Achilles tendon but there is no demonstrated tendon tear or tenosynovitis. There is a low-lying soleus muscle that extends to within 4cm of the teno-osseous insertion of the Achilles tendon. There is no Haglund’s deformity.,There is a plantar calcaneal spur measuring approximately 6mm in size, without a reactive marrow stress phenomenon. Normal plantar fascia.,IMPRESSION:,Partial high ankle sprain with diffuse interstitial edema of the anterior tibiofibular ligament with a ligamentous chip avulsion but without a disruption of the anterior tibiofibular ligament.,Marked ligamentous thickening of the lateral collateral ligamentous complex consistent with the sequela of a remote lateral ankle sprain.,Full-thickness longitudinal split tear of the peroneus brevis tendon with severe synovitis of the peroneal tendon sheath.,Post-traumatic deformity of the medial talar dome consistent with a prior osteochondral impaction injury but no osteochondral defect. Residual subchondral plate cancellous marrow edema.,Severe synovitis of the flexor hallucis longus tendon sheath with prominent fluid distention of the synovial sheath proximal to the posterior talar processes.,Septated cystic structure within Kager’s fat triangle extending along the superior aspect of the calcaneus consistent with a ganglion of either articular or synovial sheath origin.,Plantar calcaneal spur but no reactive marrow stress phenomenon.,Mild tendinosis of the Achilles tendon but no tendinitis or tendon tear.,Os navicularis (Type II synchondrosis) without an active marrow stress phenomenon.

Orthopedic