Medical Specialty: Surgery
Sample Name: Eyelid Squamous Cell Carcinoma Excision

PREOPERATIVE DIAGNOSIS: , Right upper eyelid squamous cell carcinoma.,POSTOPERATIVE DIAGNOSIS: , Right upper eyelid squamous cell carcinoma.,PROCEDURE PERFORMED: , Excision of right upper eyelid squamous cell carcinoma with frozen section and full-thickness skin grafting from the opposite eyelid.,COMPLICATIONS:  ,None.,BLOOD LOSS: , Minimal.,ANESTHESIA:,  Local with sedation.,INDICATION:,  The patient is a 65-year-old male with a large squamous cell carcinoma on his right upper eyelid, which had previous radiation.,DESCRIPTION OF PROCEDURE: , The patient was taken to the operating room, laid supine, administered intravenous sedation, and prepped and draped in a sterile fashion.  He was anesthetized with a combination of 2% lidocaine and 0.5% Marcaine with Epinephrine on both upper eyelids.  The area of obvious scar tissue from the radiation for the squamous cell carcinoma on the right upper eyelid was completely excised down to the eyelid margin including resection of a few of the upper eye lashes.  This was extended essentially from the punctum to the lateral commissure and extended up on to the upper eyelid.  The resection was carried down through the orbicularis muscle resecting the pretarsal orbicularis muscle and the inferior portion of the preseptal orbicularis muscle leaving the tarsus intact and leaving the orbital septum intact.  Following complete resection, the patient was easily able to open and close his eyes as the levator muscle insertion was left intact to the tarsal plate.  The specimen was sent to pathology, which revealed only fibrotic tissue and no evidence of any residual squamous cell carcinoma.  Meticulous hemostasis was obtained with Bovie cautery and a full-thickness skin graft was taken from the opposite upper eyelid in a fashion similar to a blepharoplasty of the appropriate size for the defect in the right upper eyelid.  The left upper eyelid incision was closed with 6-0 fast-absorbing gut interrupted sutures, and the skin graft was sutured in place with 6-0 fast-absorbing gut interrupted sutures.  An eye patch was placed on the right side, and the patient tolerated the procedure well and was taken to PACU in good condition.
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DESCRIPTION: Excision of right upper eyelid squamous cell carcinoma with frozen section and full-thickness skin grafting from the opposite eyelid.

surgery, frozen section, full-thickness skin grafting, squamous cell carcinoma, eyelid, orbicularis,

The situation involves the surgical excision of squamous cell carcinoma from the eyelid, a procedure that entails careful removal of the cancer along with a reconstruction step using a skin graft from the opposite eyelid. The surgery is intricate because it deals with the eye, a sensitive and complex area, and requires meticulous technique to ensure functional and aesthetic outcomes. Although the procedure was completed without complications and the patient tolerated it well, surgeries around crucial areas like the eye involve considerable risks related to vision, aesthetics, and overall function, making this a high-stakes situation. However, given the absence of complications and minimal blood loss, it isn't at the absolute highest level of stakes.


You are an LLM as part of a medical assistant system, interacting with medical practitioners to improve efficiency.

Medical Specialty: Nephrology
Sample Name: Renal Transplant - Cadaveric

HISTORY OF PRESENT ILLNESS:  ,The patient is a 50-year-old African American female with past medical history significant for hypertension and endstage renal disease, on hemodialysis secondary to endstage renal disease, last hemodialysis was on June 22, 2007.  The patient presents with no complaints for cadaveric renal transplant.  After appropriate cross match and workup of HLA typing of both recipient and cadaveric kidneys, the patient was deemed appropriate for operative intervention and transplantation of kidney.,PREOPERATIVE DIAGNOSIS:,  Endstage renal disease.,POSTOPERATIVE DIAGNOSIS: , Endstage renal disease.,PROCEDURE:,  Cadaveric renal transplant to right pelvis.,ESTIMATED BLOOD LOSS: , 400 mL.,FLUIDS:  ,One liter of normal saline and one liter of 5% of albumin.,ANESTHESIA:  ,General endotracheal.,SPECIMEN:  ,None.,DRAIN: , None.,COMPLICATIONS: , None.,The patient tolerated the procedure without any complication.,PROCEDURE IN DETAIL:  ,The patient was brought to the operating room, prepped and draped in sterile fashion.  After adequate anesthesia was achieved, a curvilinear incision was made in the right pelvic fossa approximately 9 cm in length extending from the 1.5 cm medial of the ASIS down to the suprapubic space.  After this was taken down with a #10 blade, electrocautery was used to take down tissue down to the layer of the subcutaneous fat.  Camper's and Scarpa's were dissected with electrocautery.  Hemostasis was achieved throughout the tissue plains with electrocautery.  The external oblique aponeurosis was identified with musculature and was entered with electrocautery.  Then hemostats were entered in and dissection continued down with electrocautery down through the external internal obliques and the transversalis fascia.  Additionally, the rectus sheath was entered in a linear fashion.  After these planes were entered using electrocautery, the retroperitoneum was dissected free from the transversalis fascia using blunt dissection.  After the peritoneum and peritoneal structures were moved medially and superiorly by blunt dissection, the dissection continued down bluntly throughout the tissue planes removing some alveolar tissue over the right iliac artery.  Upon entering through the transversalis fascia, the epigastric vessels were identified and doubly ligated and tied with #0 silk ties.  After the ligation of the epigastric vessels, the peritoneum was bluntly dissected and all peritoneal structures were bluntly dissected to a superior and medial plane.  This was done without any complication and without entering the peritoneum grossly.  The round ligament was identified and doubly ligated at this time with #0 silk ties as well.  The dissection continued down now to layer of the alveolar tissue covering the right iliac artery.  This alveolar tissue was cleared using blunt dissection as well as electrocautery.  After the external iliac artery was identified, it was cleared circumferentially all the way around and noted to have good flow and had good arterial texture.  The right iliac vein was then identified, and this was cleared again using electrocautery and blunt dissection.  After the right iliac vein was identified and cleared off all the alveolar tissue, it was circumferentially cleared as well.  An additional perforating branch was noted at the inferior pole of the right iliac vein.  This was tied with a #0 silk tie and secured.  Hemostasis was achieved at this time and the tie had adequate control.  The dissection continued down and identified all other vital structures in this area.  Careful preservation of all vital structures was carried out throughout the dissection.  At this time, Satinsky clamp was placed over the right iliac vein.  This was then opened using a #11 blade, approximately 1 cm in length.  The heparinized saline was placed and irrigated throughout the inside of the vein, and the kidney was pulled into the abdominal field still covered in its protective socking with the superior pole marked.  The renal vein was then elevated and identified in this area.  A 5-0 double-ended Prolene stitch was used to secure the renal vein, both superiorly and inferiorly, and after appropriately being secured with 5-0 Prolene, these were tied down and secured.  The renal vein was then anastomosed to the right iliac vein in a circumferential manner in a running fashion until secured at both superior and inferior poles.  The dissection then continued down and the iliac artery was then anastomosed to the renal artery at this time using a similar method with 5-0 Prolene securing both superior and inferior poles.  After such time the 5-0 Prolene was run around in a circumferential manner until secured in both superior and inferior poles once again.  After this was done and the artery was secured, the Satinsky clamp was removed and a bulldog placed over.  The flow was then opened on the arterial side and then opened on the venous side to allow for proper flow.  The bulldog was then placed back on the renal vein and allowed for the hyperperfusion of the kidney.  The kidney pinked up nicely and had a good appearance to it and had appearance of good blood flow.  At this time, all Satinsky clamps were removed and all bulldog clamps were removed.  The dissection then continued down to the layer of the bladder at which time the bladder was identified.  Appropriate area on the dome the bladder was identified for entry.  This was entered using electrocautery and approximately 1 cm length after appropriately sizing and incising of the ureter using the Metzenbaum scissors in a linear fashion.  Before this was done, #0 chromic catgut stitches were placed and secured laterally and inferiorly on the dome of the bladder to elevate the area of the bladder and then the bladder was entered using the electrocautery approximately 1 cm in length.  At this time, a renal stent was placed into the ureter and secured superiorly and the stent was then placed into the bladder and secured as well.  Subsequently, the superior and inferior pole stitches with 5-0 Prolene were used to secure the ureter to the bladder.  This was then run mucosa-to-mucosa in a circumferential manner until secured in both superior and inferior poles once again.  Good flow was noted from the ureter at the time of operation.  Additional Vicryl stitches were used to overlay the musculature in a seromuscular stitch over the dome of the bladder and over the ureter itself.  At this time, an Ethibond stitch was used to make an additional seromuscular closure and rolling of the bladder musculature over the dome and over the anastomosis once again.  This was inspected and noted for proper control.  Irrigation of the bladder revealed that the bladder was appropriately filled and there were no flows and no defects.  At this time, the anastomoses were all inspected, hemostasis was achieved and good closure of the anastomosis was noted at this time.  The kidney was then placed back into its new position in the right pelvic fossa, and the area was once again inspected for hemostasis which was achieved.  A 1-0 Prolene stitch was then used for mass closure of the external, internal, and transversalis fascias and musculature in a running fashion from superior to inferior.  This was secured and knots were dumped.  Subsequently, the area was then checked and inspected for hemostasis which was achieved with electrocautery, and the skin was closed with 4-0 running Monocryl.  The patient tolerated procedure well without evidence of complication, transferred to the Dunn ICU where he was noted to be stable.  Dr. A was present and scrubbed through the entire procedure.
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DESCRIPTION: Cadaveric renal transplant to right pelvis - endstage renal disease.

nephrology, endstage renal disease, ethibond, satinsky clamp, aponeurosis, cadaveric, cross match, curvilinear incision, hemodialysis, iliac vein, pelvic fossa, peritoneum, recipient, renal transplant, transplant, transversalis fascia, superior and inferior poles, endstage renal, renal disease, vein, electrocautery, bladder, renal, intervention,

A cadaveric renal transplant is a significant medical procedure that can have life-changing effects on the patient. Given the patient's history of endstage renal disease, dependence on hemodialysis, and the complexity of the surgery involved, the situation is inherently high-stakes. The successful transplantation can extend the patient's life and improve their quality of life, whereas complications could have serious consequences. The detailed description of the surgical process also emphasizes the critical nature of the procedure.

Filled in based on scale_labels and scale_label_confidence


Medical Specialty: Consult - History and Phy.
Sample Name: Gen Med Consult - 26

CHIEF COMPLAINT:, Abdominal pain and discomfort for 3 weeks.,HISTORY OF PRESENT ILLNESS:, ,The patient is a 38 year old white female with no known medical problems who presents complaining of abdominal pain and discomfort for 3 weeks. She had been in her normal state of health when she started having this diffuse abdominal pain and discomfort which is mostly located in the epigastrium and right upper quadrant. She also complains of indigestion and right scapular pain during this same period. None of these complaints are alleviated or aggravated by food. She denies any NSAIDs use. The patient went to an outside hospital where a right upper quadrant ultrasound showed no gallbladder disease, but was suspicious for a liver mass. A CT and MRI of the abdomen and pelvis showed a 12.5 X 10.9 X 11.1 cm right suprarenal mass and a 7.1 X 5.4 X 6.5 cm intrahepatic mass in the region of the dome of the liver. CT of the chest revealed multiple small (<5 mm) bilateral lung nodules. Total body bone scan had no abnormal uptake. She was transferred to Methodist for further care.,The patient reports having a good appetite and denies any weight loss. She denies having any fever or chills. She has noticed increasing dyspnea with moderate exercise, but not at rest. She denies having palpitations. She occasionally has nausea, but no vomiting, constipation, or diarrhea. Over the last 2 months, she has noticed increasing facial hair and a mustache.,There is an extensive family history of colon and other cancers in her family. She was told there is a genetic defect in her family but cannot recall the name of the syndrome. She had a colonoscopy and a polyp removed at the age of 14 years old. Her last colonoscopy was 2 months ago and was unremarkable.,PAST MEDICAL HISTORY :, None.  No history of hypertension, diabetes, heart disease, liver disease or cancer.,PAST SURGICAL HISTORY:, Bilateral tubal ligation in 2001, colon polyp removed at 14 years old.,GYN HISTORY:, Gravida 2, Para 2, Ab 0. Menstrual periods have been regular, last menstrual period almost 1 month ago. No menorrhagia. Never had a mammogram. Has yearly Pap smears which have all been normal.,FAMILY HISTORY:, Mother is 61 years old and brother is 39 years old, both alive and well. Father died at 48 of colon cancer and questionable pancreatic cancer. One paternal uncle died at 32 of colon cancer and bile duct cancer. One paternal uncle had colon cancer in his 40s. Thirty cancers are noted on the father’s side of the family, many are colon; two women had breast cancer. The family was told that there is a genetic syndrome in the family, but no one remembers the name of the syndrome.,SOCIAL HISTORY:, No tobacco, alcohol or illicit drug use. Patient is born and raised in Oklahoma . No known exposures. Married with 2 children.,MEDICATION:,  None.,REVIEW OF SYSTEMS:,  No headaches. No visual, hearing, or swallowing difficulties. No cough or hemoptysis. No chest pain, PND, orthopnea. No changes in bowel or urinary habits. Otherwise, as stated in HPI.,PHYSICAL EXAM:,VS: T 97.6 BP 121/85 P 84 R 18 O2 Sat 100% on room air,GEN: Pleasant, thin woman in mild distress secondary to abdominal pain and discomfort.,HEENT: Pupils equally round and reactive to light. Extra-ocular movements intact. Anicteric. Sclerae clear. Pink conjunctiva. Moist mucous membranes. No oropharyngeal lesions.,NECK: Supple, no masses, jugular venous distention or bruits.,LUNGS: Clear to auscultation bilaterally.,HEART: Regular rate and rhythm. No murmurs, gallops, rubs.,BREASTS: Symmetric, no skin changes, no discharge, no masses,ABDOMEN: Soft with active bowel sounds. There is minimal diffuse tenderness on examination. No masses palpated. There is fullness in the right upper quadrant with negative Murphy’s sign. No rebound or guarding. The liver span is 12 cm by percussion, but not palpable below the costal margin. No splenomegaly.,PELVIC: not done,EXT: No clubbing, cyanosis, or edema. 2+ pulses bilaterally.,NEURO: Cranial nerves intact. 2+ DTRs bilaterally and symmetrically. Motor strength and sensation within the normal limits.,LYMPH: No cervical, axillary, or inguinal lymph nodes palpated,SKIN: warm, no rashes, no lesions; no tattoos,STUDIES:,CT Chest:  Multiple bilateral small (<5 mm) pulmonary nodules, no mediastinal mass or hilar adenopathy.,MRI Abdomen: 12.5 x 10.9 x 11.1 cm suprarenal mass, 7.1 x 5.4 x 6.5 cm intrahepatic lesion in the region of the dome of the liver, abnormal signal intensity within the inferior vena cava at the level of porta hepatic worrisome for thrombus.,Total Body Bone Scan: No abnormal uptake.,HOSPITAL COURSE:, ,The patient was transferred from an outside hospital for further workup and management. She was taken to the Operating Room for abdominal exploration. A liver biopsy was done.
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DESCRIPTION: Patient presents complaining of abdominal pain and discomfort for 3 weeks.

The situation involves a 38-year-old patient with no known prior medical issues, presenting with abdominal pain that has lasted for 3 weeks, accompanied by other symptoms such as indigestion and increasing facial hair. The findings from imaging suggest the presence of significant masses in the abdominal area and possible lung involvement. The presence of a 12.5 cm suprarenal mass, a liver lesion, and multiple lung nodules raises the concern for a serious underlying condition, potentially malignant, especially given her extensive family history of cancer. These findings coupled with the genetic predisposition make the situation high-stakes as it could involve a life-threatening cancer diagnosis requiring immediate and comprehensive treatment planning.


Medical Specialty: Surgery
Sample Name: Anterior Cervical Discectomy - 1

PREOPERATIVE DIAGNOSIS: , Cervical spondylosis at C3-C4 with cervical radiculopathy and spinal cord compression.,POSTOPERATIVE DIAGNOSIS:,  Cervical spondylosis at C3-C4 with cervical radiculopathy and spinal cord compression.,OPERATION PERFORMED,1.  Anterior cervical discectomy of C3-C4.,2.  Removal of herniated disc and osteophytes.,3.  Bilateral C4 nerve root decompression.,4.  Harvesting of bone for autologous vertebral bodies for creation of arthrodesis.,5.  Grafting of fibular allograft bone for creation of arthrodesis.,6.  Creation of arthrodesis via an anterior technique with fibular allograft bone and autologous bone from the vertebral bodies.,7.  Placement of anterior spinal instrumentation using the operating microscope and microdissection technique.,INDICATIONS FOR PROCEDURE: , This 62-year-old man has progressive and intractable right C4 radiculopathy with neck and shoulder pain.  Conservative therapy has failed to improve the problem.  Imaging studies showed severe spondylosis of C3-C4 with neuroforaminal narrowing and spinal cord compression.,A detailed discussion ensued with the patient as to the nature of the procedure including all risks and alternatives.  He clearly understood it and had no further questions and requested that I proceed.,PROCEDURE IN DETAIL: , The patient was placed on the operating room table and was intubated using a fiberoptic technique.  The methylprednisolone spinal cord protocol was instituted with bolus and continuous infusion doses.  The neck was carefully prepped and draped in the usual sterile manner.,A transverse incision was made on a skin crease on the left side of the neck.  Dissection was carried down through the platysmal musculature and the anterior spine was exposed.  The medial borders of the longus colli muscles were dissected free from their attachments to the spine.  A needle was placed and it was believed to be at the C3-C4 interspace and an x-ray properly localized this space.  Castoff self-retaining pins were placed into the body of the C3 and C4.  Self-retaining retractors were placed in the wound keeping the blades of the retractors underneath the longus colli muscles.,The annulus was incised and a discectomy was performed.  Quite a bit of overhanging osteophytes were identified and removed.  As I worked back to the posterior lips of the vertebral body, the operating microscope was utilized.,There was severe overgrowth of spondylitic spurs.  A high-speed diamond bur was used to slowly drill these spurs away.  I reached the posterior longitudinal ligament and opened it and exposed the underlying dura.,Slowly and carefully I worked out towards the C3-C4 foramen.  The dura was extremely thin and I could see through it in several areas.  I removed the bony compression in the foramen and identified soft tissue and veins overlying the root.  All of these were not stripped away for fear of tearing this very tissue-paper-thin dura.  However, radical decompression was achieved removing all the bony compression in the foramen, out to the pedicle, and into the foramen.  An 8-mm of the root was exposed although I left the veins over the root intact.,The microscope was angled to the left side where a similar procedure was performed.,Once the decompression was achieved, a high-speed cortisone bur was used to decorticate the body from the greater posterior shelf to prevent backward graft migration.  Bone thus from the drilling was preserved for use for the arthrodesis.,Attention was turned to creation of the arthrodesis.  As I had drilled quite a bit into the bodies, I selected a large 12-mm graft and distracted the space maximally.  Under distraction the graft was placed and fit well.  An x-ray showed good graft placement.,Attention was turned to spinal instrumentation.  A Synthes Short Stature plate was used with four 3-mm screws.  Holes were drilled with all four screws were placed with pretty good purchase.  Next, the locking screws were then applied.  An x-ray was obtained which showed good placement of graft, plate, and screws.  The upper screws were near the upper endplate of C3.  The C3 vertebral body that remained was narrow after drilling off the spurs.  Rather than replace these screws and risk that the next holes would be too near the present holes I decided to leave these screws intact because their position is still satisfactory as they are below the disc endplate.,Attention was turned to closure.  A Hemovac drain was placed in the anterior vertebral body space and brought out through a separate stab wound incision in the skin.  The wound was then carefully closed in layers.  Sterile dressings were applied along with a rigid Philadelphia collar.  The operation was then terminated.,The patient tolerated the procedure well and left for the recovery room in excellent condition.  The sponge and needle counts were reported as correct and there were no intraoperative complications.,Specimens were sent to Pathology consisted of bone and soft tissue as well as C3-C4 disc material.
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DESCRIPTION: Anterior cervical discectomy, removal of herniated disc and osteophytes, bilateral C4 nerve root decompression, harvesting of bone for autologous vertebral bodies for creation of arthrodesis, grafting of fibular allograft bone for creation of arthrodesis, creation of arthrodesis via an anterior technique with fibular allograft bone and autologous bone from the vertebral bodies, and placement of anterior spinal instrumentation using the operating microscope and microdissection technique.

surgery, herniated, osteophytes, nerve root decompression, harvesting, autologous, vertebral, arthrodesis, anterior technique, anterior cervical discectomy, spinal cord compression, fibular allograft bone, creation of arthrodesis, cervical discectomy, spinal instrumentation, cord compression, vertebral body, vertebral bodies, spinal cord, bone, instrumentation, cervical, anterior, grafting, spinal, discectomy, allograft,

The described scenario is a complex surgical procedure involving the cervical spine, specifically an anterior cervical discectomy with additional steps like removal of herniated discs, osteophytes, and nerve root decompression, as well as creating an arthrodesis with spinal instrumentation. These types of surgeries generally address conditions like cervical spondylosis and spinal cord compression, which can have serious neurological implications if untreated. The stakes are high because the procedure involves operating near the spinal cord and nerve roots, which are critical structures, meaning surgical mishaps can lead to severe consequences such as paralysis or chronic pain. Therefore, the procedure demands significant precision and carries substantial risks associated with neurosurgery.


Medical Specialty: Consult - History and Phy.
Sample Name: Well-Child Check - 5

SUBJECTIVE:,  The patient presents with Mom for a first visit to our office for a well-child check with concern of some spitting up quite a bit.  Mom wants to make sure that this is normal.  The patient is nursing well every two to three hours.  She does have some spitting up on occasion.  It has happened two or three times with some curdled appearance x 1.  No projectile in nature, nonbilious.  Normal voiding and stooling pattern.  Growth and Development:  Denver II normal, passing all developmental milestones per age.  See Denver II form in the chart.,PAST MEDICAL HISTORY:,  Mom reports uncomplicated pregnancy with prenatal care provided by Dr. XYZ in Wichita, Kansas.  Delivery after induction secondary to postdate at St. Joseph Hospital.  Infant delivered by SVD with birth weight of 6 pounds 13 ounce.  Length of 19 inches.  Did well after delivery and dismissed to home with Mom.  Received hepatitis B #1 prior to dismissal.  No other hospitalizations.  No surgeries.  No known medical allergies.  No medications.  Mom has tried Mylicon drops on occasion.,FAMILY HISTORY: , Significant for cardiovascular disease, hypertension, diabetes mellitus and thyroid problems in maternal and paternal grandparents.  Healthy Mother, Father.  There is also history of breast, colon and ovarian cancer on the maternal side of the family, her grandmother who is present at visit today.  There is history of asthma in the patient's father.,SOCIAL HISTORY:,  The patient lives at home with 23-year-old mother, who is a homemaker and 24-year-old father, John, who is a supervisor at Excel.  The family lives in Bentley, Kansas.  No smoking in the home.  Family does have one pet cat.,REVIEW OF SYSTEMS:,  As per HPI, otherwise, negative.,OBJECTIVE:,  Weight:  7 pounds 12 ounces.  Height:  21 inches.  Head circumference:  35 cm.  Temperature:  97.2 degrees.,General:  Well-developed, well-nourished, cooperative, alert, interactive 2-week-old white female in no acute distress.,HEENT:  Atraumatic, normocephalic.  Anterior fontanel is soft and flat.  Pupils are equal, round and reactive.  Sclerae clear.  Red reflexes present bilaterally.  TMs are clear bilaterally.  Oropharynx:  Mucous membranes are moist and pink.,Neck:  Supple, no lymphadenopathy.,Chest:  Clear to auscultation bilaterally.  No wheeze or crackles.  Good air exchange.,Cardiovascular:  Regular rate and rhythm.  No murmur.  Good pulses bilaterally.,Abdomen:  Soft, nontender, nondistended.  Positive bowel sounds.  No mass nor organomegaly.,Genitourinary:  Tanner I female genitalia.  Femoral pulses are equal bilaterally.  No rash.,Extremities:  Full range of motion.  No cyanosis, clubbing or edema.  Negative Ortolani or Barlow maneuver.,Back:  Straight.  No scoliosis.,Integument:  Warm, dry and pink without lesions.,Neurologic:  Alert.  Good muscle tone and strength.,ASSESSMENT/PLAN:,1.  Well 2-week-old white female.,2.  Anticipatory guidelines for growth, diet, development, safety issues as well as immunizations and visitation schedule.  Gave 2-week well-child check handout and American Academy of Pediatrics book Birth to 5 years to Mom and family.,3.  Call the office or on-call physician if the patient has fever, feeding problems or breathing problems.  Otherwise plan to recheck at 1-month of age.
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DESCRIPTION: A well-child check with concern of some spitting up quite a bit.

consult - history and phy., well-child check, denver ii, child check, growth, development, denver, cardiovascular, maternal, mother, spitting, father, child, check, asthma, family, mom,

The situation involves a well-child check-up, which is a routine examination for a healthy infant. The only concern raised is occasional spitting up, which is common and normal in infants unless it is accompanied by more serious symptoms like projectile vomiting or failure to thrive. The child's overall health indicators, as noted in the findings, are normal. Therefore, this does not represent a high-stakes situation as there are no immediate risks to the child's health. The practitioners have provided guidance and set a schedule for follow-up, indicating that the current concerns are standard and manageable.


Medical Specialty: Discharge Summary
Sample Name: Multiple Medical Problems - Discharge Summary

ADMISSION DIAGNOSES:,1.  Seizure.,2.  Hypoglycemia.,3.  Anemia.,4.  Hypotension.,5.  Dyspnea.,6.  Edema.,DISCHARGE DIAGNOSES:,1.  Colon cancer, status post right hemicolectomy.,2.  Anemia.,3.  Hospital-acquired pneumonia.,4.  Hypertension.,5.  Congestive heart failure.,6.  Seizure disorder.,PROCEDURES PERFORMED:,1.  Colonoscopy.,2.  Right hemicolectomy.,HOSPITAL COURSE: , The patient is a 59-year-old female with multiple medical problems including diabetes mellitus requiring insulin for 26 years, previous MI and coronary artery disease, history of seizure disorder, GERD, bipolar disorder, and anemia.  She was admitted due to a seizure and myoclonic jerks as well as hypoglycemia and anemia.  Regarding the seizure disorder, Neurology was consulted.  Noncontrast CT of the head was negative.  Neurology felt that the only necessary intervention at that time would be to increase her Lamictal to 150 mg in the morning and 100 mg in the evening with gradual increase of the dosage until she was on 200 mg b.i.d.  Regarding the hypoglycemia, the patient has diabetic gastroparesis and was being fed on J-tube intermittent feedings throughout the night at the rate of 120 an hour.  Her insulin pump had a basal rate of roughly three at night during the feedings.  While in the hospital, the insulin pump rate was turned down to 1.5 and then subsequently decreased a few other times.  She seemed to tolerate the insulin pump rate well throughout her hospital course.  There were a few episodes of hypoglycemia as well as hyperglycemia, but the episode seem to be related to the patient's n.p.o. status and the changing rates of tube feedings throughout her hospital course.,At discharge, her endocrinologist was contacted.  It was decided to change her insulin pump rate to 3 units per hour from midnight till 6 a.m., from 0.8 units per hour from 6 a.m. until 8 a.m., and then at 0.2 units per hour from 8 a.m. until 6 p.m.  The insulin was to be NovoLog.  Regarding the anemia, the gastroenterologists were consulted regarding her positive Hemoccult stools.  A colonoscopy was performed, which found a mass at the right hepatic flexure.  General Surgery was then consulted and a right hemicolectomy was performed on the patient.  The patient tolerated the procedure well and tube feeds were slowly restarted following the procedure, and prior to discharge were back at her predischarge rates of 120 per hour.  Regarding the cancer itself, it was found that 1 out of 53 nodes were positive for cancer.  CT of the abdomen and pelvis revealed no metastasis, a CT of the chest revealed possible lung metastasis.  Later in hospital course, the patient developed a septic-like picture likely secondary to hospital-acquired pneumonia.  She was treated with Zosyn, Levaquin, and vancomycin, and tolerated the medications well.  Her symptoms decreased and serial chest x-rays were followed, which showed some resolution of the illness.  The patient was seen by the Infectious Disease specialist.  The Infectious Disease specialist recommended vancomycin to cover MRSA bacteria, which was found at the J-tube site.  At discharge, the patient was given three additional days of p.o. Levaquin 750 mg as well as three additional days of Bactrim DS every 12 hours.  The Bactrim was used to cover the MRSA at the J-tube site.  It was found that MRSA was sensitive to Bactrim.  Throughout her hospital course, the patient continued to receive Coreg 12.5 mg daily and Lasix 40 mg twice a day for her congestive heart failure, which remains stable.  She also received Lipitor for her high cholesterol.  Her seizure disorder remained stable and she was discharged on a dose of 100 mg in the morning and 150 mg at night.  The dosage increases can begin on an outpatient basis.,DISCHARGE INSTRUCTIONS/MEDICATIONS: , The patient was discharged to home.  She was told to shy away from strenuous activity.  Her discharge diet was to be her usual diet of isotonic fiber feeding through the J-tube at a rate of 120 per hour throughout the night.  The discharge medications were as follows:,1.  Coreg 12.5 mg p.o. b.i.d.,2.  Lipitor 10 mg p.o. at bedtime.,3.  Nitro-Dur patch 0.3 mg per hour one patch daily.,4.  Phenergan syrup 6.25 mg p.o. q.4h. p.r.n.,5.  Synthroid 0.175 mg p.o. daily.,6.  Zyrtec 10 mg p.o. daily.,7.  Lamictal 100 mg p.o. daily.,8.  Lamictal 150 mg p.o. at bedtime.,9.  Ferrous sulfate drops 325 mg, PEG tube b.i.d.,10.  Nexium 40 mg p.o. at breakfast.,11.  Neurontin 400 mg p.o. t.i.d.,12.  Lasix 40 mg p.o. b.i.d.,13.  Fentanyl 50 mcg patch transdermal q.72h.,14.  Calcium and vitamin D combination, calcium carbonate 500 mg/vitamin D 200 units one tab p.o. t.i.d.,15.  Bactrim DS 800mg/160 mg tablet one tablet q.12h. x3 days.,16.  Levaquin 750 mg one tablet p.o. x3 days.,The medications listed above, one listed as p.o. are to be administered via the J-tube.,FOLLOWUP:  ,The patient was instructed to see Dr. X in approximately five to seven days.  She was given a lab sheet to have a CBC with diff as well as a CMP to be drawn prior to her appointment with Dr. X.  She is instructed to follow up with Dr. Y if her condition changes regarding her colon cancer.  She was instructed to follow up with Dr. Z, her oncologist, regarding the positive lymph nodes.  We were unable to contact Dr. Z, but his telephone number was given to the patient and she was instructed to make a followup appointment.  She was also instructed to follow up with her endocrinologist, Dr. A, regarding any insulin pump adjustments, which were necessary and she was also instructed to follow up with Dr. B, her gastroenterologist, regarding any issues with her J-tube.,CONDITION ON DISCHARGE: , Stable.
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DESCRIPTION: Seizure, hypoglycemia, anemia, dyspnea, edema. colon cancer status post right hemicolectomy, hospital-acquired pneumonia,
and congestive heart failure.

This discharge summary involves a patient with a complex medical history and a variety of serious and chronic medical issues including colon cancer, seizure disorder, and congestive heart failure. Hospital-acquired pneumonia and a potential metastasis indicate high-risk health concerns that need close monitoring and follow-up. The need for a right hemicolectomy and cancer treatment adds urgency and gravity to the situation. The coordination among various specialists for ongoing care is crucial for the patient's prognosis. Given the combination of multiple serious conditions, recent surgical intervention, and the need for precise medication and dietary management, this situation presents as high-stakes for the patient's health outcomes.


Medical Specialty: General Medicine
Sample Name: Gen Med Consult - 7

CHIEF COMPLAINT:,  Right-sided facial droop and right-sided weakness.,HISTORY OF PRESENT ILLNESS: , The patient is an 83-year-old lady, a resident of a skilled nursing facility, with past medical history of a stroke and dementia with expressive aphasia, was found today with a right-sided facial droop, and was transferred to the emergency room for further evaluation.  While in the emergency room, she was found to having the right-sided upper extremity weakness and right-sided facial droop.  The CT scan of the head did not show any acute events with the impression of a new-onset cerebrovascular accident, will be admitted to monitor bed for observation and treatment and also she was recently diagnosed with urinary tract infection, which was resistant to all oral medications.,ALLERGIES: , SHE IS ALLERGIC TO PENICILLIN.,SOCIAL HISTORY: , She is a nondrinker and nonsmoker and currently lives at the skilled nursing facility.,FAMILY HISTORY: , Noncontributory.,PAST MEDICAL HISTORY:,1.  Cerebrovascular accident with expressive aphasia and lower extremity weakness.,2.  Abnormality of gait and wheelchair bound secondary to #1.,3.  Hypertension.,4.  Chronic obstructive pulmonary disease, on nasal oxygen.,5.  Anxiety disorder.,6.  Dementia.,PAST SURGICAL HISTORY: , Status post left mastectomy secondary to breast cancer and status post right knee replacement secondary to osteoarthritis.,REVIEW OF SYSTEMS: , Because of the patient's inability to communicate, is not obtainable, but apparently, she has urine incontinence and also stool incontinence, and is wheelchair bound.,PHYSICAL EXAMINATION:,GENERAL:  She is an 83-year-old patient, awake, and non-communicable lady, currently in bed, follows commands by closing and opening her eyes.,VITAL SIGNS:  Temperature is 99.6, pulse is 101, respirations 18, and blood pressure is in the 218/97.,HEENT:  Pupils are equal, round, and reactive to light.  External ocular muscles are intact.  Conjunctivae anicteric.  There is a slight right-sided facial droop.  Oropharynx is clear with the missing teeth on the upper and the lower part.  Tympanic membranes are clear.,NECK:  Supple.  There is no carotid bruit.  No cervical adenopathy.,CARDIAC:  Regular rate and rhythm with 2/6 systolic murmur, more at the apex.,LUNGS:  Clear to auscultation.,ABDOMEN:  Soft and no tenderness.  Bowel sound is present.,EXTREMITIES:  There is no pedal edema.  Both knees are passively extendable with about 10-15 degrees of fixed flexion deformity on both sides.,NEUROLOGIC:  There is right-sided slight facial droop.  She moves both upper extremities equally.  She has withdrawal of both lower extremities by touching her sole of the feet.,SKIN:  There is about 2 cm first turning to second-degree pressure ulcer on the right buttocks.,LABORATORY DATA: , The CT scan of the head shows brain atrophy with no acute events.  Sodium is 137, potassium 3.7, chloride 102, bicarbonate 24, BUN of 22, creatinine 0.5, and glucose of 92.  Total white blood cell count is 8.9000, hemoglobin 14.4, hematocrit 42.7, and the platelet count of 184,000.  The urinalysis was more than 100 white blood cells and 10-25 red blood cells.  Recent culture showed more than 100,000 colonies of E. coli, resistant to most of the tested medications except amikacin, nitrofurantoin, imipenem, and meropenem.,ASSESSMENT:,1.  Recent cerebrovascular accident with right-sided weakness.,2.  Hypertension.,3.  Dementia.,4.  Anxiety.,5.  Urinary tract infection.,6.  Abnormality of gait secondary to lower extremity weakness.,PLAN: , We will keep the patient NPO until a swallowing evaluation was done.  We will start her on IV Vasotec every 4 hours p.r.n. systolic blood pressure more than 170.  Neuro check every 4 hours for 24 hours.  We will start her on amikacin IV per pharmacy.  We will start her on Lovenox subcutaneously 40 mg every day and we will continue with the Ecotrin as swallowing evaluation was done.  Resume home medications, which basically include Aricept 10 mg p.o. daily, Diovan 160 mg p.o. daily, multivitamin, calcium with vitamin D, Ecotrin, and Tylenol p.r.n.  I will continue with the IV fluids at 75 mL an hour with a D5 normal saline at the range of 75 mL an hour and adding potassium 10 mEq per 1000 mL and I would follow the patient on daily basis.
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DESCRIPTION: Right-sided facial droop and right-sided weakness.  Recent cerebrovascular accident.  he CT scan of the head did not show any acute events with the impression of a new-onset cerebrovascular accident.

The patient's condition involves a suspected new cerebrovascular accident (stroke) with symptoms of right-sided facial droop and weakness, which can be life-threatening if not managed promptly. In addition, the patient has multiple comorbidities, such as dementia, chronic obstructive pulmonary disease, hypertension, and a resistant urinary tract infection. These complicate her medical situation further. The need for close monitoring, particularly with neuro checks and blood pressure management, highlights the urgency and potential seriousness of her condition. Based on these factors, this situation is high-stakes due to the immediate risk to the patient's health and the complexity of her care needs.


Medical Specialty: Consult - History and Phy.
Sample Name: Renal Insufficiency - Consult

REASON FOR CONSULT:, Renal insufficiency.,HISTORY OF PRESENT ILLNESS:, A 48-year-old African-American male with a history of coronary artery disease, COPD, congestive heart failure with EF of 20%-25%, hypertension, renal insufficiency, and recurrent episodes of hypertensive emergency, admitted secondary to shortness of breath and productive cough. The patient denies any chest pain, palpitations, syncope, or fever. Denied any urinary disturbances, difficulty, burning micturition, hematuria, or back pain. Nephrology is consulted regarding renal insufficiency.,REVIEW OF SYSTEMS:, Reviewed entirely and negative except for HPI.,PAST MEDICAL HISTORY:, Hypertension, congestive heart failure with ejection fraction of 20%-25% in December 2005, COPD, mild diffuse coronary artery disease, and renal insufficiency.,ALLERGIES:, NO KNOWN DRUG ALLERGIES.,MEDICATIONS:, Clonidine 0.3 p.o. q.8, aspirin 325 daily, hydralazine 100 q.8, Lipitor 20 at bedtime, Toprol XL 100 daily.,FAMILY HISTORY:, Noncontributory.,SOCIAL HISTORY:, The patient denies any alcohol, IV drug abuse, tobacco, or any recreational drugs.,PHYSICAL EXAMINATION:,VITAL SIGNS: Blood pressure 180/110. Temperature 98.1. Pulse rate 60. Respiratory rate 23. O2 sat 95% on room air.,GENERAL: A 48-year-old African-American male in no acute distress.,HEENT: Pupils equal, round, and reactive to light and accommodation. No pallor or icterus.,NECK: No JVD, bruit, or lymphadenopathy.,HEART: S1 and S2, regular rate and rhythm, no murmurs, rubs, or gallops.,LUNGS: Clear. No wheezes or crackles.,ABDOMEN: Soft, nontender, nondistended, no organomegaly, bowel sounds present.,EXTREMITIES: No cyanosis, clubbing, or edema.,CNS: Exam is nonfocal.,LABS:, WBC 7, H and H 13 and 40, platelets 330, PT 12, PTT 26, CO2 20, BUN 27, creatinine 3.1, cholesterol 174, BNP 973, troponin 0.18. Previous creatinine levels were 2.7 in December. Urine drug screen positive for cocaine.,ASSESSMENT:, A 48-year-old African-American male with a history of coronary artery disease, congestive heart failure, COPD, hypertension, and renal insufficiency with:,1. Hypertensive emergency.,2. Acute on chronic renal failure.,3. Urine drug screen positive.,4. Question CHF versus COPD exacerbation.,PLAN:,1. Most likely, renal insufficiency is a chronic problem. Hypertensive etiology worsened by the patient's chronic cocaine abuse.,2. Control blood pressure with medications as indicated. Hypertensive emergency most likely related to cocaine drug abuse.,Thank you for this consult. We will continue to follow the patient with you.
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DESCRIPTION: Patient with a history of coronary artery disease, congestive heart failure, COPD, hypertension, and renal insufficiency.

This case is high-stakes due to the combination of multiple chronic conditions, including coronary artery disease, congestive heart failure with a significantly reduced ejection fraction, COPD, and renal insufficiency, compounded by a hypertensive emergency and cocaine use. The patient's complex medical history and current issues, such as acute on chronic renal failure and potential exacerbations of heart or lung conditions, necessitate careful management to prevent further deterioration or life-threatening events.


Medical Specialty: Office Notes
Sample Name: Normal Newborn Infant Physical Exam

GENERAL: , A well-developed infant in no acute respiratory distress.,VITAL SIGNS:  ,Initial temperature was XX, pulse XX, respirations XX.  Weight XX grams, length XX cm, head circumference XX cm.,HEENT:  ,Head is normocephalic with anterior fontanelle open, soft, and non-bulging.  Eyes:  Red reflex elicited bilaterally.  TMs occluded with vernix and not well visualized.  Nose and throat are patent without palatal defect.,NECK: , Supple without clavicular fracture.,LUNGS:,  Clear to auscultation.,HEART:,  Regular rate without murmur, click, or gallop present.  Pulses are 2/4 for brachial and femoral.,ABDOMEN:,  Soft with bowel sounds present.  No masses or organomegaly.,GENITALIA: , Normal.,EXTREMITIES: , Without evidence of hip defects.,NEUROLOGIC:  ,The infant has good Moro, grasp, and suck reflexes.,SKIN: , Warm and dry without evidence of rash.
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DESCRIPTION: Normal newborn infant physical exam.  A well-developed infant in no acute respiratory distress.

office notes, fontanelle, normocephalic, newborn infant, physical exam, acute respiratory, newborn, respiratory, distress, head, infant,

The situation involves recording a normal physical exam of a newborn, indicating the infant is in good health without any medical emergencies or concerns. It's a routine check-up with no acute issues noted.


Medical Specialty: Surgery
Sample Name: Tympanomastoidectomy

PREOPERATIVE DIAGNOSIS: , Left canal cholesteatoma.,POSTOPERATIVE DIAGNOSIS: , Left canal cholesteatoma.,OPERATIVE PROCEDURE:,1.  Left canal wall down tympanomastoidectomy with ossicular chain reconstruction.,2.  Microdissection.,3.  NIM facial nerve monitoring for three hours.,COMPLICATIONS:  ,None.,FINDINGS:,  There is an extremely large canal cholesteatoma, which eroded most of the posterior and superior canal wall.  There was a significant amount of myringosclerosis and tympanosclerosis.  There is some mild erosion of the lenticular process of the incus.  The facial nerve was normal.  We removed the incus, removed the head of the malleus, and placed a titanium-PORP from the stapes capitulum to a cartilage graft.,PROCEDURE: , The patient was taken to the operating room, placed under general anesthetic and intubated without difficulty.  The NIM facial nerve monitoring electrodes were positioned and monitoring was performed throughout the procedure.  There was no abnormal activity during this case.  We inspected the ear canal, identified the huge defect, which was completely filled with cerumen.  Through the ear canal, we removed as much as we could and then infiltrated the canal and postauricular area with 1:100,000 of epinephrine.,We prepped and draped the ear in a sterile fashion.  We reopened the previously used postauricular incision and dissected down the mastoid cortex.  We reflected the soft tissues anteriorly to the level of the ear canal and identified where the ear canal skin entered the defect in the mastoid bone.  A #6 cutting bur was used to drill down the mastoid cortex and identified this cholesteatoma which was then carefully dissected out.  We went all the way to the mastoid antrum.  We finished a complete mastoidectomy with identification of the tegmen, sigmoid sinus.  We removed the lateral aspect of the mastoid tip.  We lowered the facial ridge.  The incudostapedial joint was already membranous in nature, we went ahead and used the joint knife and removed the incus.  We separated the incus from the stapes and then removed it.  We used a malleus head nipper to remove the head of the malleus and then we continued to saucerize the entire mastoid cavity.,There was no cholesteatoma within the middle ear space, but there was roughly 40% surface area perforation.  The remaining portion of the tympanic membrane was extremely calcified and myringosclerotic; this was removed.  There was also a large focus of tympanosclerosis between the stapes crura, which was impinging the ability of the stapes to move.  We carefully dissected this out.  This did seem to improve the mobility of the stapes somewhat.  At this point, there was a near total perforation.  There was only a minimal amount of anterior remnant of the drum left.  We tried to go ahead and harvest the temporalis fascia, but there was really only wisps of this fascia in place.  He had already had a previous tympanoplasty, but even outside the areas where the graft was taken, the temporalis muscle was quite atrophied and lumpy, and I suspect this was due to his chronic disease and long history of corticosteroid usage.  We harvested a few pieces as best as we could.  We went ahead and did a meatoplasty by making a canal incision in the 6 o'clock and 12 o'clock positions.  We excised cartilage posteriorly and inferiorly to enlarge the meatus.  This cartilage was thin and used for cartilage tympanoplasty.  We placed some Gelfoam in the middle ear space and placed the cartilage on the top of it.  We did cut a titanium-PORP of the proper side and placed on top of the stapes capitulum to interface with the cartilage cap.  A few other small pieces of temporalis fascia were used to bulge through the surrounding edges of the cartilage and make sure that it was medial to any remnant of ear canal and tympanic membrane remnants.  We placed a layer of Gelfoam lateral to the graft, closed the postauricular incision in layers and put 2 Merocel packs in the ear.  Glasscock dressing was applied.  The patient was awakened from anesthesia and taken to the recovery room in stable condition.  He will be given antibiotics and pain medicines and he will be given instructions to follow up with me in one week.
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DESCRIPTION: Left canal wall down tympanomastoidectomy with ossicular chain reconstruction, microdissection, NIM facial nerve monitoring for three hours.

surgery, cholesteatoma, gelfoam, glasscock dressing, microdissection, nim, canal, canal wall, cerumen, facial nerve, incus, myringosclerosis, ossicular chain reconstruction, titanium-porp, tympanomastoidectomy, tympanosclerosis, facial nerve monitoring, ear canal, cartilage, ear,

The medical procedure described, a tympanomastoidectomy with ossicular chain reconstruction, is a complex surgical procedure involving the ear, particularly necessary due to the presence of cholesteatoma. The potential risks involved, such as damage to the facial nerve, hearing loss, and infection, make it a high-stakes situation despite the absence of any immediate complications during the surgery. The procedure's complexity, the potential impact on the patient's hearing and facial nerve function, and the intensive preoperative and postoperative care required all contribute to the high-stakes nature of this situation.


Medical Specialty: Consult - History and Phy.
Sample Name: Rectal Bleeding - 1-year-old

HISTORY OF PRESENT ILLNESS:,  This is a 1-year-old male patient who was admitted on 12/23/2007 with a history of rectal bleeding.  He was doing well until about 2 days prior to admission and when he passes hard stools, there was bright red blood in the stool.  He had one more episode that day of stool; the stool was hard with blood in it.  Then, he had one episode of rectal bleeding yesterday and again one stool today, which was soft and consistent with dark red blood in it.  No history of fever, no diarrhea, no history of easy bruising.  Excessive bleeding from minor cut.  He has been slightly fussy.,PAST MEDICAL HISTORY:  ,Nothing significant.,PREGNANCY DELIVERY AND NURSERY COURSE: , He was born full term without complications.,PAST SURGICAL HISTORY: , None.,SIGNIFICANT ILLNESS AND REVIEW OF SYSTEMS: , Negative for heart disease, lung disease, history of cancer, blood pressure problems, or bleeding problems.,DIET:,  Regular table food, 24 ounces of regular milk.  He is n.p.o. now.,TRAVEL HISTORY: , Negative.,IMMUNIZATION: , Up-to-date.,ALLERGIES: , None.,MEDICATIONS: , None, but he is on IV Zantac now.,SOCIAL HISTORY: , He lives with parents and siblings.,FAMILY HISTORY:,  Nothing significant.,LABORATORY EVALUATION: , On 12/24/2007, WBC 8.4, hemoglobin 7.6, hematocrit 23.2 and platelets 314,000.  Sodium 135, potassium 4.7, chloride 110, CO2 20, BUN 6 and creatinine 0.3.  Albumin 3.3.  AST 56 and ALT 26.  CRP less than 0.3.  Stool rate is still negative.,DIAGNOSTIC DATA: , CT scan of the abdomen was read as normal.,PHYSICAL EXAMINATION:  ,VITAL SIGNS:  Temperature 99.5 degrees Fahrenheit, pulse 142 per minute and respirations 28 per minute.  Weight 9.6 kilogram.,GENERAL:  He is alert and active child in no apparent distress.,HEENT:  Atraumatic and normocephalic.  Pupils are equal, round and reactive to light.  Extraocular movements, conjunctivae and sclerae fair.  Nasal mucosa pink and moist.  Pharynx is clear.,NECK:  Supple without thyromegaly or masses.,LUNGS:  Good air entry bilaterally.  No rales or wheezing.,ABDOMEN:  Soft and nondistended.  Bowel sounds positive.  No mass palpable.,GENITALIA:  Normal male.,RECTAL:  Deferred, but there was no perianal lesion.,MUSCULOSKELETAL:  Full range of movement.  No edema.  No cyanosis.,CNS:  Alert, active and playful.,IMPRESSION: , A 1-year-old male patient with history of rectal bleeding.  Possibilities include Meckel's diverticulum, polyp, infection and vascular malformation.,PLAN:,  To proceed with Meckel scan today.  If Meckel scan is negative, we will consider upper endoscopy and colonoscopy.  We will start colon clean out if Meckel scan is negative.  We will send his stool for C. diff toxin, culture, blood for RAST test for cow milk, soy, wheat and egg.  Monitor hemoglobin.
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DESCRIPTION: Pediatric Gastroenterology - Rectal Bleeding Consult.

This situation involves a 1-year-old child with rectal bleeding, which is a potentially acute and serious medical issue. Rectal bleeding in young children can be indicative of significant underlying conditions such as Meckel's diverticulum, polyps, infections, or vascular malformations. The case includes abnormal vital signs (an elevated pulse) and concerning lab results (low hemoglobin and hematocrit), which suggest possible anemia due to blood loss. The plan includes diagnostic measures such as a Meckel scan and other potential invasive procedures like endoscopy or colonoscopy. Given that this involves a very young child with significant symptoms and potential for serious conditions, it is high-stakes.


Medical Specialty: Consult - History and Phy.
Sample Name: Nephrology Consultation - 2

HISTORY:,  The patient was in the intensive care unit setting; he was intubated and sedated.  The patient is a 55-year-old patient, who was admitted secondary to a diagnosis of pancreatitis, developed hypotension and possible sepsis and respiratory as well as renal failure and found to be intubated.  He has been significantly hypotensive during his stay in the intensive care unit and has had minimal urine output.  His creatinine has gone from 2.1 to 4.2 overnight and the patient also developed florid acidosis and hypokalemia.  Nephrology input has been requested for management of acute renal failure and acidosis.,PAST MEDICAL HISTORY:,1.  Pancreatitis.,2.  Poison ivy.  The patient has recently been on oral steroids.,3.  Hypertension.,MEDICATIONS: , Include Ambien, prednisone, and blood pressure medication, which is not documented in the record at the moment.,INPATIENT MEDICATIONS: , Include Protonix IV, half-normal saline at 125 mL an hour, D5W with 3 ounces of bicarbonate at 150 mL an hour.  The patient was initially on dopamine, which has now been discontinued.  The patient remains on Levophed and Invanz 1 g IV q.24 h.,PHYSICAL EXAMINATION:,  Vitals, emergency room presentation, the blood pressure was 82/45.  His blood pressure in the ICU had dipped down into the 60s systolic, most recent blood pressure is 108/67 and he has been maintained on 100% FiO2.  The patient has had minimal urine output since admission.  HEENT, the patient is intubated at the moment.  Neck examination, no overt lymph node enlargement.  No jugular venous distention.  Lungs examination is benign in terms of crackles.  The patient has some harsh breath sounds secondary to being intubated.  CVS, S1 and S2 are fairly regular at the moment.  There is no pericardial rub.  Abdominal examination, obese, but benign.  Extremity examination reveals no lower extremity edema.  CNS, the patient is intubated and sedated.,LABORATORY DATA: , Blood work, sodium 152, potassium 2.7, bicarbonate 13, BUN 36, and creatinine 4.2.  The patient's BUN and creatinine yesterday were 23 and 2.1 respectively.  H&H of 17.7 and 51.6, white cell count of 8.4 from earlier on this morning.  The patient's liver function tests are all out of whack and his alkaline phosphatase is 226, ALT is 539, CK 1103, INR 1.66, and ammonia level of 55.  Latest ABGs show a pH of 7.04, bicarbonate of 10.7, pCO2 of 40.3, and pO2 of 120.7.,ASSESSMENT:,1.  Acute renal failure, which in all probability is secondary to acute tubular necrosis and sepsis and significant hypotension, but the patient is at the moment on 100% FiO2.  He has been given intravenous fluid at a high rate to replete intravascular volume and to hopefully address his acidosis.  The patient also has significant acidosis and his creatinine has increased from 2.1 to 4.2 overnight.  Given the fact that he would need dialytic support for his electrolyte derangements and for volume control, I would suggest continuous venovenous hemodiafiltration as opposed to conventional hemodialysis as the patient will not be able to tolerate conventional hemodialysis given his hemodynamic instability.,2.  Hypotension, which is significant and is related to his sepsis.  Now the patient has been maintained on Levophed and high rate of intravenous fluid at the moment.,3.  Acidosis, which is again secondary to his renal failure.  The patient was administered intravenous bicarbonate as mentioned above.  Dialytic support in the form of continuous venovenous hemodiafiltration was highly recommended for possible correction of his electrolyte derangements.,4.  Pancreatitis, which has been managed by his gastroenterologist.,5.  Sepsis, the patient is on broad-spectrum antibiotic therapy.,6.  Hypercalcemia.  The patient has been given calcium chloride.  We will need to watch for rebound hypercalcemia.,7.  Hypoalbuminemia.,8.  Hypokalemia, which has been repleted.,RECOMMENDATIONS: , Again include continuation of IV fluid and bicarbonate infusion as well as transfer to the Piedmont Hospital for continuous venovenous hemodiafiltration.
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DESCRIPTION: Patient with a diagnosis of pancreatitis, developed hypotension and possible sepsis and respiratory, as well as renal failure.

consult - history and phy., intubated, consultation, hypercalcemia, hypoalbuminemia, iv fluid, nephrology, acidosis, creatinine, hemodiafiltration, hypokalemia, hypotension, intravenous, pancreatitis, renal failure, respiratory, urine output, continuous venovenous hemodiafiltration, electrolyte derangements, conventional hemodialysis, continuous venovenous, venovenous hemodiafiltration, blood pressure, venovenous, bicarbonate, sepsis,

The situation involves a critically ill patient in the ICU with multiple organ failures including acute renal failure, hypotension, sepsis, respiratory failure, and significant acidosis. The patient requires immediate nephrology consultation and intervention, specifically continuous venovenous hemodiafiltration, due to hemodynamic instability and electrolyte derangements. The patient's condition is life-threatening and requires urgent and precise medical management.


Medical Specialty: Consult - History and Phy.
Sample Name: Hip Fracture - ER Consult

REASON FOR CONSULTATION: , Left hip fracture.,HISTORY OF PRESENT ILLNESS: , The patient is a pleasant 53-year-old female with a known history of sciatica, apparently presented to the emergency room due to severe pain in the left lower extremity and unable to bear weight.  History was obtained from the patient.  As per the history, she reported that she has been having back pain with left leg pain since past 4 weeks.  She has been using a walker for ambulation due to disabling pain in her left thigh and lower back.  She was seen by her primary care physician and was scheduled to go for MRI yesterday.  However, she was walking and her right foot got caught on some type of rug leading to place excessive weight on her left lower extremity to prevent her fall.  Since then, she was unable to ambulate.  The patient called paramedics and was brought to the emergency room.  She denied any history of fall.  She reported that she stepped the wrong way causing the pain to become worse.  She is complaining of severe pain in her lower extremity and back pain.  Denies any tingling or numbness.  Denies any neurological symptoms.  Denies any bowel or bladder incontinence.,X-rays were obtained which were remarkable for left hip fracture.  Orthopedic consultation was called for further evaluation and management.  On further interview with the patient, it is noted that she has a history of malignant melanoma, which was diagnosed approximately 4 to 5 years ago.  She underwent surgery at that time and subsequently, she was noted to have a spread to the lymphatic system and lymph nodes for which she underwent surgery in 3/2008.,PAST MEDICAL HISTORY: , Sciatica and melanoma.,PAST SURGICAL HISTORY:  ,As discussed above, surgery for melanoma and hysterectomy.,ALLERGIES: , NONE.,SOCIAL HISTORY: , Denies any tobacco or alcohol use.  She is divorced with 2 children.  She lives with her son.,PHYSICAL EXAMINATION:,GENERAL:  The patient is well developed, well nourished in mild distress secondary to left lower extremity and back pain.,MUSCULOSKELETAL:  Examination of the left lower extremity, there is presence of apparent shortening and external rotation deformity.  Tenderness to palpation is present.  Leg rolling is positive for severe pain in the left proximal hip.  Further examination of the spine is incomplete secondary to severe leg pain.  She is unable to perform a straight leg raising.  EHL/EDL 5/5.  2+ pulses are present distally.  Calf is soft and nontender.  Homans sign is negative.  Sensation to light touch is intact.,IMAGING:,  AP view of the hip is reviewed.  Only 1 limited view is obtained.  This is a poor quality x-ray with a lot of soft tissue shadow.  This x-ray is significant for basicervical-type femoral neck fracture.  Lesser trochanter is intact.  This is a high intertrochanteric fracture/basicervical.  There is presence of lytic lesion around the femoral neck, which is not well delineated on this particular x-ray.  We need to order repeat x-rays including AP pelvis, femur, and knee.,LABS:,  Have been reviewed.,ASSESSMENT: , The patient is a 53-year-old female with probable pathological fracture of the left proximal femur.,DISCUSSION AND PLAN: , Nature and course of the diagnosis has been discussed with the patient.  Based on her presentation without any history of obvious fall or trauma and past history of malignant melanoma, this appears to be a pathological fracture of the left proximal hip.  At the present time, I would recommend obtaining a bone scan and repeat x-rays, which will include AP pelvis, femur, hip including knee.  She denies any pain elsewhere.  She does have a past history of back pain and sciatica, but at the present time, this appears to be a metastatic bone lesion with pathological fracture.  I have discussed the case with Dr. X and recommended oncology consultation.,With the above fracture and presentation, she needs a left hip hemiarthroplasty versus calcar hemiarthroplasty, cemented type.  Indication, risk, and benefits of left hip hemiarthroplasty has been discussed with the patient, which includes, but not limited to bleeding, infection, nerve injury, blood vessel injury, dislocation early and late, persistent pain, leg length discrepancy, myositis ossificans, intraoperative fracture, prosthetic fracture, need for conversion to total hip replacement surgery, revision surgery, DVT, pulmonary embolism, risk of anesthesia, need for blood transfusion, and cardiac arrest.  She understands above and is willing to undergo further procedure.  The goal and the functional outcome have been explained.  Further plan will be discussed with her once we obtain the bone scan and the radiographic studies.  We will also await for the oncology feedback and clearance.,Thank you very much for allowing me to participate in the care of this patient.  I will continue to follow up.
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DESCRIPTION: Left hip fracture.  The patient is a 53-year-old female with probable pathological fracture of the left proximal femur.

consult - history and phy., calcar, proximal femur, pathological fracture, hip, fracture, hemiarthroplasty, melanoma,

The situation involves a 53-year-old female with a probable pathological fracture of the left hip, potentially related to her history of malignant melanoma. This condition is high-stakes due to the potential implications of metastatic cancer, the immediate need for surgical intervention, and the associated risks and complications that can significantly impact the patient's health and quality of life. Additionally, the condition requires prompt action and interdisciplinary cooperation between orthopedics and oncology. Therefore, the situation has considerable medical urgency and complexity.


Medical Specialty: Surgery
Sample Name: Extensor Tendon Repair

PREOPERATIVE DIAGNOSIS:,  Left little finger extensor tendon laceration.,POSTOPERATIVE DIAGNOSIS: , Left little finger extensor tendon laceration.,PROCEDURE PERFORMED:  ,Repair of left little extensor tendon.,COMPLICATIONS:,  None.,BLOOD LOSS: , Minimal.,ANESTHESIA: , Bier block.,INDICATIONS: , The patient is a 14-year-old right-hand dominant male who cut the back of his left little finger and had a small cut to his extensor tendon.,DESCRIPTION OF PROCEDURE: , The patient was taken to the operative room, laid supine, administered intervenous sedation with Bier block and prepped and draped in a sterile fashion.  The old laceration was opened and the extensor tendon was identified and there was a small longitudinal laceration in the tendon, which is essentially in line with the tendon fibers.  This was just proximal to the PIP joint and on complete flexion of the PIP joint, I did separate just a little bit that was not thought to be significantly dynamically unstable.  It was sutured with a single 4-0 Prolene interrupted figure-of-eight suture and on dynamic motion it did not separate at all.  The wound was irrigated and closed with 5-0 nylon interrupted sutures.  The patient tolerated the procedure well and was taken to the PCU in good condition.
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DESCRIPTION: Left little finger extensor tendon laceration.  Repair of left little extensor tendon.

surgery, extensor tendon laceration, bier block, pip joint, extensor tendon, tendon, repair, finger, laceration, extensor,

The procedure described is a surgical repair of an extensor tendon in a finger. While surgery itself can always carry some risk, this situation is relatively low-stakes. The procedure is minor with minimal blood loss, no complications, and was done under a Bier block anesthesia which indicates it is localized and less invasive compared to a general anesthesia. Moreover, the patient is young and seems to have tolerated the procedure well. Therefore, the risks associated with this specific scenario are low.


Medical Specialty: Orthopedic
Sample Name: CT of Lumbar Spine w/o Contrast

EXAM: , Lumbar spine CT without contrast.,HISTORY: , Back pain after a fall.,TECHNIQUE:,  Noncontrast axial images were acquired through the lumbar spine. Coronal and sagittal reconstruction views were also obtained.,FINDINGS: , There is no evidence for acute fracture or subluxation.  There is no spondylolysis or spondylolisthesis.  The central canal and neuroforamen are grossly patent at all levels.  There are no abnormal paraspinal masses. There is no wedge/compression deformity.  There is intervertebral disk space narrowing to a mild degree at L2-3 and L4-5.,Soft tissue windows demonstrate atherosclerotic calcification of the abdominal aorta, which is not dilated.  There was incompletely visualized probable simple left renal cyst, exophytic at the lower pole.,IMPRESSION:,1.  No evidence for acute fracture or subluxation.,2.  Mild degenerative changes.,3.  Probable left simple renal cyst.,
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DESCRIPTION: CT of Lumbar Spine without Contrast.  Patient with history of back pain after a fall.

orthopedic, lumbar spine, back pain, ct, coronal, atherosclerotic, axial images, central canal, compression, deformity, degenerative, disk space, fracture, intervertebral, neuroforamen, sagittal, spondylolisthesis, spondylolysis, subluxation, wedge, without contrast, contrast, spine, lumbar, noncontrast,

The CT scan results for the lumbar spine indicate no acute fractures or critical issues. The findings note mild degenerative changes and a probable simple renal cyst, conditions that are generally not life-threatening. The lack of acute findings reduces the urgency of the situation, making it low-stakes in the context of immediate medical interventions. However, further clinical evaluation or monitoring could be necessary for the degenerative changes and renal cyst.


Medical Specialty: Consult - History and Phy.
Sample Name: Neuropsychological Evaluation - 2

REASON FOR REFERRAL:  ,The patient was referred for a neuropsychological evaluation by Dr. X.  A comprehensive evaluation was requested to assess neuropsychological factors, clarify areas of strength and weakness, and to assist in therapeutic program planning in light of episodes of syncope.,BRIEF SUMMARY & IMPRESSIONS:,RELEVANT HISTORY:,Historical information was obtained from a review of available medical records and an interview with ,the patient.,The patient presented to Dr. X on August 05, 2008 as she had been recently hospitalized for prolonged episodes of syncope.  She was referred to Dr. X for diagnostic differentiation for possible seizures or other causes of syncope.  The patient reports an extensive neurological history.  Her mother used alcohol during her pregnancy with the patient.  In spite of exposure to alcohol in utero, the patient reported that she achieved "honors in school" and "looked smart."  She reported that she began to experience migraines at 11 years of age.  At 15 years of age, she reported that she was thought to have hydrocephalus.  She reported that she will frequently "bang her head against the wall" to relieve the pain.  The patient gave birth to her daughter at 17 years of age.  At 18 years of age, she received a spinal tap as a procedure to determine the cause of her severe headaches.  She reported, in 1995 to 1996 she experienced a severe head injury, as she was struck by a car as a pedestrian and "thrown two and a half city blocks."  The patient reported that she could recall before being hit, but could not recall the activities of that same day or the following day.  She reported that she had difficulty walking following this head injury, but received rehabilitation for approximately one month.  Her migraines became more severe following the head injury.  In 1998, she reportedly was experiencing episodes of syncope where she would experience a headache with photophobia, phonophobia, and flashing lights.  Following the syncope episode, she would experience some confusion.  These episodes reportedly were related to her donating plasma.,The patient also reported that her ex-husband stated that she frequently jerked and would shake in her sleep.  She reported that upon awakening, she would feel off balanced and somewhat confused.  These episodes diminished from 2002 to June 2008.  When making dinner, she suddenly dropped and hit the back of her head on refrigerator.  She reported that she was unconscious for five to six minutes.  A second episode occurred on July 20th when she lost consciousness for may be a full day.  She was admitted to Sinai Hospital and assessed by a neurologist.  Her EEG and head CT were considered to be completely normal.  She did not report any typical episodes during the time of her 36-hour EEG.  She reported that her last episode of syncope occurred prior to her being hospitalized.  She stated that she had an aura of her ears ringing, vision being darker and "tunnel vision" (vision goes smaller to a pinpoint), and she was "spazzing out" on the floor.  During these episodes, she reports that she cannot talk and has difficulty understanding.,The patient also reports that she has experienced some insomnia since she was 6 years old.  She reported that she was a heavy drinker until about 1998 or 1999 and that she would drink a gallon daily of Jack Daniel.  She stopped the use of alcohol and that time she experienced a suicide attempt.  In 2002, she was diagnosed with bipolar disorder and was started on medication.  At the time of the neuropsychological evaluation, she had stopped taking her medicine as she felt that she was now in remission and could manage her symptoms herself.  The patient's medical history is also significant for postpartum depression.,The patient reported that she has been experiencing difficulty with cognitive abilities of attention/concentration, spelling, tangential and slow thinking, poor sequencing memory for events, and variable verbal memory.  She reported that she sometimes has difficulty understanding what people say, specifically she has difficulty understanding jokes.  She finds that she often has difficulty with expressing her thoughts, as she is very tangential.  She experiences episodes of not recalling what she was speaking of or remembering what activities she was trying to perform.  She reported that she had a photographic memory for directions.  She said that she experienced a great deal of emotional lability, but in general her personality has become more subdued.  At the present time, her daughter has now moved on to college.  The patient is living with her biological mother.  Although she is going through divorce, she reported that it was not really stressful.  She reported that she spends her day driving other people around and trying to be helpful to them.,At the time of the neuropsychological evaluation, the patient's medication included Ativan, Imitrex, Levoxyl, vitamin B12, albuterol metered dose inhaler as needed, and Zofran as needed.  (It should be noted that The patient by the time of the feedback on September 19, 2008 had resumed taking her Trileptal for bipolar disorder.).  The patient's familial medical history is significant for alcohol abuse, diabetes, hypertension, and high cholesterol.,TESTS ADMINISTERED:,Clinical Interview,Cognistat,Mattis Dementia Rating Scale,Wechsler Adult Intelligence Scale - III (WAIS-III),Wechsler Abbreviated Scale of Intelligence (WASI),Selected Subtests from the Delis Kaplan Executive Function System (DKEFS),  Trail Making Test,  Verbal Fluency (Letter Fluency & Category Fluency),  Design Fluency,  Color-Word Interference Test,  Tower,Wisconsin Card Sorting Test (WCST),Stroop Test,Color Trails,Trails A & B,Test of Variables of Attention,Multilingual Aphasia Examination II,  Token Test,  Sentence Repetition,  Visual Naming,  Controlled Oral Word Association,  Spelling Test,  Aural Comprehension,  Reading Comprehension,Boston Naming Test-2 (BNT-2),Animal Naming Test,The Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI),The Beery-Buktenica Developmental Test of Motor Coordination,The Beery-Buktenica Developmental Test of Visual Perception,Judgment Line Orientation,Grooved Pegboard,Purdue Pegboard,Finger Tapping Test,Rey Complex Figure,Wechsler Memory Scale -III (WMS-III),California Verbal Learning Test
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DESCRIPTION: A neuropsychological evaluation to assess neuropsychological factors, clarify areas of strength and weakness, and to assist in therapeutic program planning in light of episodes of syncope.

The case involves a patient with a complex medical history including episodes of syncope, potentially serious neurological issues, and a history of head trauma, substance abuse, and mental health disorders. This patient is undergoing a comprehensive neuropsychological evaluation which may influence future treatment plans and has significant implications for her quality of life. The potential for underlying seizure disorders or other serious neurological conditions increases the stakes of this evaluation. Therefore, any misdiagnosis or oversight could have serious consequences on the patient's health or treatment plan.


Medical Specialty: Cardiovascular / Pulmonary
Sample Name: Heart Catheterization, Ventriculography, & Angiography - 1

PROCEDURE:,  Left heart catheterization, left ventriculography, coronary angiography, and successful stenting of tight lesion in the distal circumflex and moderately tight lesion in the mid right coronary artery.  This gentleman has had a non-Q-wave, troponin-positive myocardial infarction, complicated by ventricular fibrillation.,PROCEDURE DETAILS:,  The patient was brought to the catheterization lab, the chart was reviewed, and informed consent was obtained.  Right groin was prepped and draped sterilely and infiltrated 2% Xylocaine.  Using the Seldinger technique, a #6-French sheath was placed in the right femoral artery.  ACT was checked and was low.  Additional heparin was given.  A #6-French pigtail catheter was passed.  Left ventriculography was performed.  The catheter was exchanged for a #6-French JL4 catheter.  Nitroglycerin was given in the left main.  Left coronary angiography was performed.  The catheter was exchanged for a #6-French __________ coronary catheter.  Nitroglycerin was given in the right main, and right coronary angiography was performed.  Films were closely reviewed, and it was felt that he had a significant lesion in the RCA and the distal left circumflex is basically an OM.  Considering his age and his course, it was elected to stent both these lesions.  ReoPro was started, and the catheter was exchanged for a #6-French JR4 guide.  ReoPro was given in the RCA to prevent no reflow.  A 0.014 Universal wire was passed.  The lesion was measured.  A 4.5 x 18-mm stent was passed and deployed to moderate pressures with an excellent result.  The catheter was removed and exchanged for a #6-French JL4 guide.  The same wire was passed down the circumflex and the lesion measured.  A 2.75 x 15-mm stent was deployed to a moderate pressure with an excellent result.  Plavix was given.  The catheter was removed and sheath was in place.  The results were explained to the patient and his wife.,FINDINGS,1.  Hemodynamics.  Please  see attached sheet for details.  ED was 20.  There is no gradient across the aortic valve.,2.  Left ventriculography revealed septum upper limits of normal size with borderline normal LV systolic function with borderline normal wall motion, in which there is a question of  diffuse, very minimal global hypokinesis.  There is mild MR noted.,3.  Coronary angiography.,a.  Left main normal.,b.  LAD.  Some very minimal luminal irregularities.  There is a 1st diagonal which has a branch that is 1.5 mm with a proximal 50% narrowing.,c.  Left circumflex is basically a marginal branch, in which distally there was a long 98% lesion.,d.  The RCA is large dominant and has a mid somewhat long 70% lesion.,4.  Stenting.,a.  The RCA revealed a lesion that went from 70% to a -5%.,B.  The circumflex went from 95% to -5%.,CONCLUSION,1.  Decreased left ventricular compliance.,2.  Borderline normal overall ejection fraction with mild mitral regurgitation.,3.  Triple-vessel coronary artery disease with a borderline lesion in a very small branch of the 1st diagonal and significant lesions in the mid dominant right coronary artery and the distal circumflex, which is basically old.,4.  Successful stenting of the right coronary artery and the circumflex.,RECOMMENDATION: , ReoPro/stent protocol, Plavix for at least 9 months, aggressive control of risk factors.  I have ordered Zocor and a fasting lipid panel.,AICD will be considered, realizing when this gentleman becomes ischemic he is at high risk for fibrillating.
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DESCRIPTION: Left heart catheterization, left ventriculography, coronary angiography, and successful stenting of tight lesion in the distal circumflex and moderately tight lesion in the mid right coronary artery.

cardiovascular / pulmonary, heart catheterization, ventriculography, coronary angiography, stenting, distal circumflex, coronary artery, coronary, lesion, catheterization, cardiac, angiography, heart, rca, artery, circumflex,

The situation involves a detailed cardiovascular procedure that includes heart catheterization, ventriculography, angiography, and stenting, following a myocardial infarction complicated by ventricular fibrillation. This highlights a critical and potentially life-threatening condition, requiring careful management and follow-up. Successful stenting was achieved, which suggests that the immediate threat has been mitigated, but the recommendations also indicate ongoing risk due to the patient's coronary artery disease. Therefore, the stakes are high since the outcome directly impacts the patient's health and survival.


You are an LLM as part of a medical assistant system, interacting with medical practitioners to improve efficiency.

Medical Specialty: Urology
Sample Name: Ultrasound Scrotum

EXAM: , Ultrasound examination of the scrotum.,REASON FOR EXAM: , Scrotal pain.,FINDINGS:  ,Duplex and color flow imaging as well as real time gray-scale imaging of the scrotum and testicles was performed.  The left testicle measures 5.1 x 2.8 x 3.0 cm.  There is no evidence of intratesticular masses.  There is normal Doppler blood flow.  The left epididymis has an unremarkable appearance.  There is a trace hydrocele.,The right testicle measures 5.3 x 2.4 x 3.2 cm.  The epididymis has normal appearance.  There is a trace hydrocele.  No intratesticular masses or torsion is identified.  There is no significant scrotal wall thickening.,IMPRESSION:  ,Trace bilateral hydroceles, which are nonspecific, otherwise unremarkable examination.
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DESCRIPTION: Ultrasound examination of the scrotum due to scrotal pain.  Duplex and color flow imaging as well as real time gray-scale imaging of the scrotum and testicles was performed.

urology, scrotal pain, epididymis, torsion, ultrasound examination, intratesticular masses, ultrasound, scrotal, testicles, scrotum,

The situation involves a medical examination for scrotal pain using an ultrasound. The findings indicate trace bilateral hydroceles but no significant issues such as intratesticular masses or torsion, which can be more serious conditions. Hydroceles are often non-specific and may not require urgent treatment unless symptomatic or problematic. Given the findings, this situation is not high-stakes in a medical context.


Medical Specialty: Radiology
Sample Name: Chest PA & Lateral

EXAM: , Chest PA & Lateral.,REASON FOR EXAM: , Shortness of breath, evaluate for pneumothorax versus left-sided effusion.,INTERPRETATION:  ,There has been interval development of a moderate left-sided pneumothorax with near complete collapse of the left upper lobe.  The lower lobe appears aerated.  There is stable, diffuse, bilateral interstitial thickening with no definite acute air space consolidation.  The heart and pulmonary vascularity are within normal limits.  Left-sided port is seen with Groshong tip at the SVC/RA junction.  No evidence for acute fracture, malalignment, or dislocation.,IMPRESSION:,1.  Interval development of moderate left-sided pneumothorax with corresponding left lung atelectasis.,2.  Rest of visualized exam nonacute/stable.,3.  Left central line appropriately situated and stable.,4.  Preliminary report was issued at time of dictation.  Dr. X was called for results.
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DESCRIPTION: Chest PA & Lateral to evaluate shortness of breath and pneumothorax versus left-sided effusion.

radiology, effusion, interstitial thickening, chest pa & lateral, shortness of breath, chest, pneumothorax,

The exam reveals a moderate left-sided pneumothorax with near complete collapse of the left upper lobe, which constitutes a serious and potentially life-threatening condition requiring prompt medical intervention, typically involving procedures to re-expand the lung. Combined with the initial symptoms of shortness of breath, this suggests a high-stakes scenario due to the immediate risk to the patient's breathing and overall health.