text
stringlengths 164
21.9k
|
|---|
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2063-01-17
GIPSON, ALEXANDER
32707420
01/17/2063
Ulysses Peralta, M.D.
82 March Street
Coalinga, FL 84635
Dear Dr. Peralta:
I saw your patient, Dr. Gipson, in the Cardiology Office today on a somewhat urgent basis. He was recently in Italy last week with very difficult events concerning his father's ill health. His father ultimately died and was a very traumatic series of days for Dr. Gipson and his family. He developed left chest discomfort, which persisted for a number of days. He was afraid to take nitroglycerin despite knowing that he should, and therefore remained with chest discomfort for about six days. He was able to be reasonably active and had no exacerbation of his chest discomfort. He had no nausea, vomiting, diaphoresis, or palpitations. He then returned to the United States and his symptoms have resolved. Because of these discomforts, he wanted to undergo an additional evaluation.
We performed an exercise treadmill test with perfusion imaging two days ago for better understanding of his symptoms. He exercised for 7 minutes and 30 seconds on the standard Bruce protocol to a peak heart rate of 122 beats per minute (84% of maximum predicted for age) and peak blood pressure of 162/80. He stopped because of dyspnea and had some discomfort. The discomfort resolved into recovery. He had no ST segment changes. His perfusion scan demonstrated normal LV size and normal tracer uptake in the lungs. There was normal RV size as well. There was a small-to-medium medium-sized defect of moderate intensity in the mid and basal inferior wall that was reversible. These were no different than the prior study he had in July 2061.
As you may remember, in January 2061, he underwent cardiac catheterization that demonstrated the presence of non-major flow-limiting obstructions and so no intervention was performed.
His current medical regimen includes ramipril 5 mg b.i.d., aspirin 162 mg daily, Cozaar 50 mg b.i.d., Crestor 10 mg daily, fish oil 500 mg b.i.d., metformin 500 mg b.i.d., multivitamins, niacin 500 mg daily, Plavix 75 mg daily, Toprol-XL 100 mg b.i.d., HCTZ 12.5 mg daily, and Nexium.
On exam today, he is comfortable with a blood pressure of 135/75, a heart rate of 60 and regular, and weight of 189 pounds. Head and neck are unremarkable. Chest is clear. Cardiac exam shows no jugular venous distention at 30 degrees. PMI is normal. S1 and S2 are normal with a physiologic split. There is an S4 and 1/6 systolic ejection murmur at the left sternal border. Abdominal exam is unremarkable without organomegaly. Bowel sounds are normal. The extremities show no edema or cyanosis. Carotid upstrokes are normal in contour and volume without bruit. Distal pulses are normal.
His resting 12-lead electrocardiogram demonstrates normal sinus rhythm and normal morphology.
I think Dr. Gipson is basically doing very well. I think his chest discomforts for six days while in Italy may be related to anxiety and perhaps the known gastroesophageal reflux disease that he has. I think there is no evidence that the discomfort was cardiac in origin. His exercise capacity is quite good and his perfusion is actually somewhat even improved from his prior evaluation two years ago. I think we can maintain our current approach. I suggest that I see him in a number of months for future evaluation.
If any problems develop in the interim, please do not hesitate to contact me. Thank you for allowing me to help with his care.
Kindest regards.
Sincerely yours,
______________________________
Vernon A Lozano, MD
eScription document:9-1764070 IFFocus
DD: 01/17/63
DT: 01/18/63
DV: 01/17/63
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["2063-01-17", "01/17/2063", "July 2061", "January 2061", "01/17/63", "01/18/63", "01/17/63"], "ID": ["32707420", "9-1764070"], "LOCATION": ["82 March Street", "Coalinga", "FL", "84635", "Italy", "United States", "Italy"], "NAME": ["GIPSON, ALEXANDER", "Ulysses Peralta", "Peralta", "Gipson", "Gipson", "Gipson", "Vernon A Lozano"], "PROFESSION": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
We report three cases of severe hepatotoxicity related to benzarone , a benzofuran derivative .
<|output|>{"drugs": [{"name": "benzarone", "reaction": ["severe hepatotoxicity"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
He denies CP , abdominal pain , HA , N/V/D , joint pain , skin rashes , dysuria .
His son had a " head cold prior to the onset of his symptoms .
No other sick contacts .
He was admitted for further workup .
He is up tp date received influenza & ;
pneumococcal vaccines .
ROS : as above , otherwise negative
PMH :
1 .
Lymphoma , non-Hodgkin's , large B-cell lymphoma status post CHOP in 2066 and radiation therapy for a T9 to T12 mass , in remission .
2 .
Secondary MDS , newly diagnosed 06/73 s/p unrelated donor nonmyeloablative stem cell transplant 12/73
Pt : RPR neg , CMV neg , HSV pos , TOXO pos , EBV pos , VZV pos , Hep Panel neg , HTLV neg and HIV neg , PPD neg 9/20/73 and 8/7/73
Donor : RPR neg , CMV neg , Hep Panel neg , HIV neg , HTLV neg , PPD neg ( traveled to Saudi Arabia , Cartersville , Newport )
3 .
Diabetes mellitus type
2 . He is on insulin at home and his last hemoglobin A1C was around 8 .
4 .
Hyperlipidemia on Zetia .
5 .
B12 deficiency .
7 .
History of basal cell cancer status post resection .
8 .
Tonsillectomy .
9 .
Orbital Cellulitis ( 7/73 tx with ceftriaxone/nafcillin/flagyl )
Home Medications :
Actigall ( URSODIOL ) 300 MG ( 300MG CAPSULE Take 1 ) PO TID #90 Capsule
( s )
Aspirin ( ACETYLSALICYLIC Acid ) 81 MG ( 81MG TABLET Take 1 ) PO QD
Folic Acid 1MG TABLET Take 1 Tablet
( s ) PO QD , please ship to patients home #NAME? they are out of medication #30 Tablet
( s )
Lantus ( INSULIN Glargine ) 18 UNITS SC QHS
Novolog ( INSULIN Aspart ) 6-8 UNITS SC tid
Vitamin D 1000 U PO QD
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["8/7/73", "2066", "9/20/73", "12/73", "06/73", "7/73"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["Saudi Arabia", "Cartersville", "Newport"], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
HPI :
65 y/o F with colon cancer ( known , surgery/GI refuse to proceduralize ), ESRD on HD ( M / W / F ), CVA c/b severe residual speech/cognitive deficits , HTN , recurrent GIB who presents with hypotension .
She was en route to her normal dialysis session , and EMT took BP that was 80s/40s , brought to LCH ED for evaluation .
Notably recently admitted to Santa Rosa on 9/10/2098 for hematemesis/hematochezia , but no intervention done .
No report of recent GI bleeding .
In ED , initial BP in 80s/30s , got 1.5 liters of IV fluid , came up to 90s/50s .
Also was on 4-5 liters of oxygen with sat 95% .
Blood and urine cultures sent , Vancomycin and Cefepime given .
Daughter was contacted , who states patient is definitely DNR/DNI and no invasive interventions are to be done ( including central lines , surgery , etc .) Bedside ultrasounds revealed known pleural effusions , pericardial effusion without signs of tamponade , and hypoechoic material in bladder suspicious for abscess/infection .
CT abdomen done , was notable for bladder wall thickening potentially c/w cystitis , a new moderate sized pericardial effusion , and rectal wall thickening c/w proctitis .
After CT , Foley placed with reported return of 400-500 cc of frank pus .
Labs notable for K 5 , BUN/Cr 39/4.02 , WBC count 7.7 .
Patient seen in ED – ;
BP 80s/40s , but arousable and able to answer simple questions .
Denies any complaints , including pain , dyspnea , nausea , with one-word answers .
When daughter subsequently arrives , she confirms desire for no invasive procedures , lines , surgeries , or ICU level care .
She does add that patient was at Levi Hospital two weeks ago , treated for “ ;
lung infection .
” ;
Uncertain of specifics .
ROS
15-point ROS as above ;
limited by mental status .
MEDICAL HISTORY
1 – ;
Recurrent GIB – ;
s/p EGD/colo showing multiple duodenal/colonic polyps ( 12/2097 )
, here with GI bleed in September , no workup pursued as thought to be major cardiac risk .
2 – ;
Colon Ca - Pt seen by surgery and is not a surgical candidate 2/2 multiple medical comorbidities .
3 – ;
ESRD since 2096 ( HD : M / W / F )
- Access L brachiocephalic AVF
- Presumed 2/2 longstanding DM
4 – ;
DM2 – ;
On SSI 2/2 frequent hypoglycemia episodes on long acting insulin
<|output|>{"AGE": ["65"], "CONTACT": [], "DATE": ["2096", "W", "M", "September", "12/2097", "F", "9/10/2098"], "DEVICE": [], "DLN": [], "HOSPITAL": ["LCH", "Santa Rosa", "Levi Hospital"], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
( 3 ) Hyperlipidemia Reviewed lipids from last visit .
To try further to reduce chol .
per diet .
control .
( 4 ) Nausea Does not seem cardiac .
Sounds c/w GERD .
Discussed prevention and management .
HCT in the fall was normal .
( 5 ) H/e elevated serum glucose No sx's .
Has been normal lately .
( 6 ) General Full PE done .
As above .
Skin eval.done .
Refuses pelvic/PAP .
TO do stool guaiac , tho ' ? if would do anything to w/u abn .
Result .
Basic neuro exam ok .
( 7 ) NO further wt .
loss of significance .
CBC was ok last visit .
.
The patient will follow up in a few months .
Hayden Richard , M.D .
Record date : 2134-12-14
Internal Medicine INTERN ADMISSION NOTE
Name : Vastie Uecker
MR # : 7045247
Date of admission : 12/13/34
Resident : William Uecker
Attending : Reynolds
ID/CC : 61 yo female w/ Hx of bronchiectasis presents with chronic productive cough .
HPI : Pt is directly admitted to the Georgian Clinic with long standing pulmonary complaints with recent exacerbation of SOB , DOE , and cough productive of green sputum .
She has had multiple episodes similar to this throughout her life with her first pneumonia apparently occurring when she was 3 years old .
Her most recent episode peaked 3 weeks ago with a violent cough , sore throat , and ear pain .
She was sputum culture positive for moraxella and started on a 19 day course of Ketek ( Telithromycin ) with some resolution of symptoms over the first 8 days .
She reports worsening of symptoms over the last 4 days PTA to include increasing SOB , malaise , intermittent muscular back pain and worsening cough .
<|output|>{"AGE": ["3", "61"], "CONTACT": [], "DATE": ["12/13/34", "2134-12-14"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Georgian Clinic"], "ID": ["7045247"], "LOCATION": [], "NAME": ["Hayden Richard", "Reynolds", "William Uecker", "Vastie Uecker"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Clozapine is speculated to cause rhabdomyolysis in patients with defective calcium-activated K+ channels .
<|output|>{"drugs": [{"name": "Clozapine", "reaction": ["rhabdomyolysis"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
PHYSICAL EXAM : Small lacunar infarcts .
Most likely related to hypertension rather
than embolic disease .
Her blood pressure has been very well controlled .
In fact , today
on exam , her blood pressure was 100/60 .
She brought her medications with her and
has been taking atenolol 50 mg p.o . q.d ., Cozaar 50 mg 1 tab twice a day and
hydrochlorothiazide 12.5 mg p.o . q.d .
She had not taken her medications today and
her blood pressure here when I repeated it was 110/70 in the right arm and 120/70 in
the left .
Her neck is supple without JVD or bruits .
Her lungs are clear without
wheezes , rales or rhonchi .
Her cardiac exam shows a regular rate and rhythm , normal
S1 , S2 .
ASSESSMENT AND PLAN : History of hypertension .
Now with lower blood
pressure and some lightheadedness .
We will d/c her atenolol .
I would like her to get a
repeat blood pressure in one week .
I discussed her MRI/MRA findings with her .
Long term we will need to continue to try and optimize her cholesterol levels and her
diabetes .
She will follow up in one week for a repeat blood pressure .
Julie Fraser , M.D .
JF crane powell
Record date : 2098-01-26
Reason for Visit
Date/Time of Visit :
Mr . Ogrady was transferred to GSH on 1/26 from Muncy Valley Hospital , where he had presented with shortness of breath and chest pain .
Wife reports that nodules were noted on CT in lung and liver .
Source/Reason for Referral :
High risk screening evaluation for patient with hx of esophageal cancer .
Social History
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["2098-01-26", "1/26"], "DEVICE": [], "DLN": [], "HOSPITAL": ["GSH", "Muncy Valley Hospital"], "ID": [], "LOCATION": [], "NAME": ["JF crane powell", "Julie Fraser", "Ogrady"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Quinine and its isomer quinidine are well-known causes of iatrogenic hypoglycaemia , due to excessive insulin secretion .
<|output|>{"drugs": [{"name": "Quinine", "reaction": ["iatrogenic hypoglycaemia"]}]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2061-01-15
ST LUCIA EMERGENCY DEPT VISIT
VUONG,XOCHILT R 515-31-23-5 VISIT DATE: 01/15/61
PRESENTING COMPLAINT: Bleeding.
HISTORY OF PRESENTING COMPLAINT: This 71 year old female status
post cardiac cath stent placement and then later EP study states
that she was doing well until last night when she started to ooze
from the groin site. She did not apply any pressure. She states
that she was bleeding through the night, did not want to bother her
brother, called Dr. Aponte today who told her to come in. She
states that she did not know where the site was. She could not see
it and she did not apply pressure. She has no chest pain, no
shortness of breath. She is not dizzy. She is on Lovenox and
Coumadin both. She has not had her PT checked. The rest of the
systems were reviewed and are negative.
PAST MEDICAL HISTORY: Depression, cardiac cath, hypothyroidism.
MEDICATIONS: Taken from the chart.
ALLERGIES: Taken from the chart.
SOCIAL HISTORY: She lives with her brother.
PHYSICAL EXAMINATION: Her heart rate was 81, her temperature is
96.5 degrees, blood pressure is 123/64. This is a well-developed
female, alert, oriented. HEENT exam is atraumatic, normocephalic.
Neck is soft and supple. Mouth and throat are normal.
Well-hydrated moist mucosa. Conjunctiva are clear. Sclerae are
non-icteric. There is no jugular venous distention. Heart had a
regular rate and rhythm. The lungs were clear to auscultation
bilaterally. The abdomen was soft, nontender. No guarding. No
hepatosplenomegaly. There is a hematoma at the right groin. The
cath site was about 1 cm and closed but there was some small oozing
from the site. It stopped with pressure. The patient was covered
in blood and blood clots. The old dressing was removed. All the
dried blood and blood clots were removed. The patient was cleaned
up by myself. Then, the nurses put her in the hospital gown.
LABORATORY EVALUATION: PT, PTT, CBC were obtained.
THERAPY RENDERED/COURSE IN ED: After speaking with the patient at
length, it seems that she lives with her older brother. She is
caring for him and is a bit overwhelmed with this. Obviously, her
medical knowledge base is not adequately prepared to deal with this
problem. She will be admitted to the Observation Area through the
day for nurse training. Social Services will be consulted to
arrange for a home visiting nurse. Dr. Aponte was called.
CONSULTATIONS (including PCP): Social Services and Dr. Aponte.
FINAL DIAGNOSIS: Bleeding from cath site and knowledge deficit.
DISPOSITION (including condition upon discharge): See the chart
for disposition.
___________________________________ OO412/09605
NATHAN PLATT, M.D. NP27 D:01/15/61
T:01/15/61
Dictated by: NATHAN PLATT, M.D. NP27
cc: OWEN R. APONTE, M.D. OA0
******** Not reviewed by Attending Physician ********
<|output|>{"AGE": ["71"], "CONTACT": [], "DATE": ["2061-01-15", "01/15/61", "01/15/61", "01/15/61"], "ID": ["515-31-23-5", "OO412/09605"], "LOCATION": ["ST LUCIA"], "NAME": ["VUONG,XOCHILT R", "Aponte", "Aponte", "Aponte", "NATHAN PLATT", "NP27", "NATHAN PLATT", "NP27", "OWEN R. APONTE", "OA0"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
please take AFTER meals
23 .
Prednisone 10 MG PO QD
24 .
Pregabalin ( Lyrica ) 50 MG PO TID
25 .
Sennosides ( Senna Tablets ) 2 TAB PO BID prn Constipation
26 .
Simvastatin 10 MG PO QPM
take one po daily
27 .
Tiotropium 18 MCG INH QD
28 .
Trazodone 25 MG PO QHS prn Insomnia
PHYSICAL EXAM
VITALS : T : 99.2 P : 91
BP : 98/63 RR : 22
SpO2 : 98% 2.5L NC
GEN’ ;
L : Obese , tearful woman reclining flat in bed
HEENT : EOMI , PERRL .
NECK : Supple .
Could not appreciate IJ .
No lymphadenopathy .
Heart : RRR .
No m/r/g .
LUNG : Exam limited by obesity ( could not sit up for full posterior exam ), but I could not appreciate any wheezes or crackles .
ABD :
Obese , soft , non-tender .
Bowel sounds present .
EXT :
Changes c/w venous stasis ;
trace bilateral ankle edema .
LABS :
Plasma Sodium 138 ( 135-145 ) mmol/L
Plasma Potassium 3.6 ( 3.4-4.8 ) mmol/L
Plasma Chloride 89 L ( 100-108 ) mmol/L
<|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
The authors describe a case of the catatonia syndrome associated with disulfiram therapy .
<|output|>{"drugs": [{"name": "disulfiram", "reaction": ["catatonia syndrome"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
We report on a 56-year-old female who exhibited drug refractory paroxysmal atrial fibrillation , in which marked prolongation of the QT interval and T wave inversion on electrocardiogram was demonstrated reproducibly shortly after the administration of oral pirmenol therapy .
<|output|>{"drugs": [{"name": "pirmenol", "reaction": ["prolongation of the QT interval"]}]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2062-09-25
INTERNAL MEDICINE ASSOCIATES
CAPE CORAL HOSPITAL
Personal data and overall health The patient is a 53-year-old white male, who presents for followup of multiple medical problems.
Major Problems
Diabetes mellitus
Very noncompliant for many years. Previously had blood sugars as high as 400 to 600 and would not take any medications. Diabetes complicated by peripheral neuropathy, which is severe; gastroparesis, which has been severe; recurrent skin abscesses; and probable coronary artery disease.
Hypertension
This has been also severe for many years and noncompliance is a significant issue. Now complicated also by significant orthostatic hypotension presumably on the basis of autonomic insufficiency.
Coronary artery disease
He is status post recent non Q wave MI with elevated troponins presenting with congestive heart failure and chest pain in the setting of an elevated creatinine.
Chronic renal insufficiency
Creatinine approximately 3.
Pyelonephritis HISTORY OF
Anemia
Chronic. Extensive workup negative.
Sinus tachycardia
Chronic. This has been present for many years. Etiology unclear. Recent stress test does not show evidence of more complicated arrhythmia. Cardiac ultrasound was done on his recent admission, and he has an ejection fraction of 63% with no significant valvular disease. He has symmetric left ventricular hypertrophy.
Migraine headache HISTORY OF
Hepatitis C
Chronic.
Allergies
No known allergies
Change in therapies and Renewals
senna 2 teaspoons BID
aspirin 325 mg qd
hydralazine 25 mg TID
Imdur 30 mg QD
Lasix 20 mg qd
Nexium 20 mg qd
Norvasc 5 mg BID
Neurontin 100 mg TID
labetalol HCl 100 mg BID
losartan 25 mg qd
erythromycin 250 mg TID
Epogen 3000 units sq qwk
Colace 100 mg BID
Family history Notable for diabetes, hypertension, and hyperlipidemia.
Social history He was previously the head statistical programmer for electronic data systems for many years and now disabled. He is married and has a daughter. Cigarettes, none times years. Alcohol, previously heavy. There was a history of previous illicit drug use.
Review of systems Since he has been home, he has done reasonably well though he has noted increasing leg edema bilaterally with a significant weight gain. He denies chest pain or palpitations. He denies shortness of breath. He has not been vomiting, and he actually self-discontinued both OxyContin and methadone because he felt that they did not make him feel well.
Physical examination
Pulse 86 per minute
Blood pressure 150/90 Today, 150/90 then 144/86
Weight 185 pounds
Heent Eyes, ears, nose, and pharynx are normal, but dentition is poor
Neck No bruits
Nodes None palpable
Chest Lungs, clear
Cor Regular rate and rhythm without murmur
Abdomen Benign
Extrem With 3+ massive edema
Neuro Abnormal gait due to peripheral neuropathy
Assessment and plan Leg edema is uncertainly due to his vasodilators. We will discontinue hydralazine and Norvasc. He has already stopped his OxyContin and methadone. We will see him back in approximately two weeks to follow up on his blood pressure. He will have routine laboratory studies done today.
Note transcribed by outside service Transcription errors may be present.
Signed electronically by Patrick I Yeates MD on Oct 1, 2062
<|output|>{"AGE": ["53"], "CONTACT": [], "DATE": ["2062-09-25", "Oct 1, 2062"], "ID": [], "LOCATION": ["CAPE CORAL HOSPITAL", "electronic data systems"], "NAME": ["Patrick I Yeates"], "PROFESSION": ["head statistical programmer"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
multivitamins 1 tab po qd QTY:90 Refills:3 Start : 5/19/2121
atenolol 25mg po qd QTY:90 Refills:6 Start : 5/19/2121
Past medical history
1 . Paraplegia #NAME? On 10/06 the patient had a lumbar laminectomy for sciatica .
His sciatical pain improved until 5/07 when he developed proximal leg weakness .
By 7/07 the patient was bound to a wheelchair .
Orginally an extensive workup suggested that the patient had an extramedullary tumor from T8-T12 .
However all biopsies were inconclusive .
The patient subsequently received a T10 laminectomy on 9/09 that revealed Spinal Vascular Malformation but no tumor .
The patient received serial MRI's until 12/14 that were able to demonstrate no " recurrent tumors .
2 .
DMII-first diagnosed in 2113
3 .
HTN
4 .
Recurrent UTI's
5 .
PSA of 6.6
6 .
Flap 3 Closure Surgery-patient says that he received this surgery to correct damage to his skin caused by his multiple back surgeries
2070's received surgery for shrapnel removal
7 .
Sacral decubitus ulcers
Family history
Father #NAME? was an alcoholic who died in an accident
Mom #NAME? died at the age of 76 with peripheral vascular disease
Brother #NAME? died in 50's of CAD , was an alcoholic
Social history
The patient lives alone .
He never married and has no children .
He is a retired Heavy-Duty Equipment Mechanic ( 15yrs ) and Concrete Finisher ( 25yrs ).
He is a veteran .
The patient quit smoking 20 years ago but had smoked 1.5ppd*20yrs ( 30 pack year ).
Very rarely drinks .
Physical examination
Blood pressure 135/70
Pulse 82
<|output|>{"AGE": ["76", "50's"], "CONTACT": [], "DATE": ["9/09", "5/07", "10/06", "12/14", "2070's", "5/19/2121", "2113", "7/07"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Concrete Finisher", "Heavy-Duty Equipment Mechanic", "veteran"], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
This report presents a potential case of risperidone -induced tardive dyskinesia .
<|output|>{"drugs": [{"name": "risperidone", "reaction": ["tardive dyskinesia"]}]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2079-03-23
March 23, 2079
Gage Yingling, M.D.
Protestant Home Hospital
57 Chinook Drive
Whiteville, AL 73844
RE: Adler, Imogene
MRN: 618-13-82-6
Dear Dr. Yingling:
Thank you for referring your patient, Imogene Adler,
for her problem of coronary ischemia. As you know, Ms.
Adler is a 49 year old woman with four years of
essential hypertension and mild dyslipidemia who is
postmenopausal and has noticed increasing symptoms of chest
tightness associated with exertion. A stress MIBI SPECT
study ordered by you demonstrated inferolateral mid and
basal inferior ischemia consistent with a left circumflex
distribution. The details of the study include an exercise
protocol for which the patient exercised for 7 minutes and
15 seconds for 8.9 mets, with an increase in heart rate from
74 to 159 (which is 94% of predicted peak heart rate), and
increase in blood pressure from 134/80 to 210/80 (with a
rate pressure product of 33,390). The test was stopped due
to fatigue and moderately severe chest pain. EKG
demonstrated 1.5mm of upsloping depression in II, III, F and
V4-V5, and there were no noted arrhythmias.
Her past medical history is otherwise unremarkable and her
current medications include estrogen, Premarin, Provera, and
verapamil 240mg q.d. A recent lipid panel demonstrated a
total cholesterol of 203, LDL of 142, and an HDL of 39.
On physical examination, she is comfortable, well appearing
woman with a weight of 186 pounds, pulse 68 beats per minute
and regular, blood pressure 140/82 in the left arm. Jugular
venous pressure was approximately 6-8cm of water. Carotids
demonstrates normal upstroke with no bruits. Chest
examination was clear to auscultation. Heart examination
demonstrated a normal S1, positive S4, physiologically split
S2, no murmurs or rubs. Abdominal examination was
RE: Adler, Imogene
MRN: 618-13-82-6
Page 2
March 23, 2079
unremarkable. Peripheral examination demonstrated no
peripheral examination and 2+ bilateral peripheral pulses.
EKG demonstrated normal sinus rhythm and otherwise normal
EKG.
I reviewed the findings suggestive of an obstructive
coronary lesion in the left circumflex distribution and the
probability of her having single vessel coronary artery
disease as the culprit for her chest pain. We reviewed the
options which include medical therapy and/or coronary
angiography and possible angioplasty. I made no solid
recommendations for her, but suggested that the angioplasty
approach was a relatively low risk approach which may lead
to curing the obstructive lesion as opposed to medical
therapy, which would also be a well supported decision, and
I reviewed the evidence to suggest medical treatment of
single vessel disease does not shorten one's life span and
only affects the quality of life depending on the symptom
tolerance. She and her husband are going to reflect on
these recommendations and get back to me by the end of the
week. If she does decide to undergo coronary angiography
and possible angioplasty, we will schedule her immediately
in Cardiology.
I have scheduled follow-up in one month regardless to see
her in the office. Please do not hesitate to contact me if
I can be of any further assistance.
With warm regards,
William Gomes, M.D.
WG/anderson
******** Not reviewed by Attending Physician ********
<|output|>{"AGE": ["49"], "CONTACT": [], "DATE": ["2079-03-23", "March 23, 2079", "March 23, 2079"], "ID": ["618-13-82-6", "618-13-82-6"], "LOCATION": ["Protestant Home Hospital", "57 Chinook Drive", "Whiteville", "AL", "73844"], "NAME": ["Gage Yingling", "Adler, Imogene", "Yingling", "Imogene Adler", "Adler", "Adler, Imogene", "William Gomes", "WG", "anderson"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
D : 12/07/65
T : 12/07/65
Dictated by : Marillin Whetstone Daron , M.D .
Record date : 2095-12-09
Alease Amend 411-05-15-1 VISIT DATE : 12/09/95
HISTORY OF PRESENTING COMPLAINT : The patient is an unfortunate 63
___________________________________ OT111/6637
T : 12/09/95
Dictated by : Loral Dragon Fernald , M.D .
Record date : 2077-04-16
Patient : Georgi Kinsman PEACHFORD HOSPITAL MRN : 8850277
CC/ID : Asked to see this 29 y/o M admitted with Fourier's gangrene , s/p multiple surgical procedures , for DM management
HPI/ROS : Pt is a 29 y/o with DM-2 who was in his USH until about 2 weeks PTA , when he developed buttock pain .
He was seen in IONIA COUNTY MEMORIAL HOSPITAL Urgent Care on 3/9/77 at which time a small erythematous and tender cyst was noted between his buttocks .
He was seen again in IONIA COUNTY MEMORIAL HOSPITAL on 3/17/77 at which time he reported resolution of his buttock pain .
On the morning of 18/2/77 he developed worsening of his shortness of breath , followed by the development of left jaw pain , and cold sweats , so he presented to the PEACHFORD HOSPITAL ED .
His WBC was 41287 with 91% PMNs .
He was admitted to the SICU and has since undergone multiple debridements , last on 4/8/77 .
In terms of his DM , he has type 2 diagnosed in December 2075 .
At the time he was feeling " lousy ",""" tired , nauseated , and increased urinary frequency : went to WILKES-BARRE VETERANS AFFAIRS MEDICAL CENTER and FS was 376 .
He was being followed by Dr .
SH : Works as a Interior and spatial designer .
FH : Father had an MI in his 55's .
04/16/2077 NA 143 , K 4 , CL 110 ( H ), CO2 23 , BUN 28 ( H ), CRE 0.8 , GLU 101
04/16/2077 CA 9.3 , PHOS 3.3 , MG 1.6
04/15/2077 IC 1.21
04/16/2077 WBC 10.5 , RBC 3.11 ( L ), HGB 8.8 ( L ), HCT 26.1 ( L ), MCV 84 , MCH 28.4 , MCHC 33.8 , PLT 351 ( H ), RDW 17.6 ( H )
04/14/2077 ALT/SGPT 26 , AST/SGOT 20 , ALKP 75 , TBILI 0.3 , DBILI 0.1
04/01/2077 CHOL 124 , TRIG 346 ( H )
18/08/2077 CHOL 106 , TRIG 226 ( H )
19/05/2077 CHOL 141 , TRIG 478 ( H ), HDL 13 ( L ), LDL --, CHOL/HDL 10.8
18/11/2077 CORT 30.4
18/11/2077 CORT 13.6
02/05/2077 MALB 286 (*), MALB/CRE 4132.9 (*)
02/05/2077 HGBA1C 11.3 (*)
10/16/2076 HGBA1C 10 (*)
<|output|>{"AGE": ["29", "55's", "63"], "CONTACT": [], "DATE": ["2077-04-16", "04/01/2077", "18/08/2077", "04/14/2077", "18/2/77", "4/8/77", "04/16/2077", "19/05/2077", "02/05/2077", "04/15/2077", "18/11/2077", "10/16/2076", "3/9/77", "December 2075", "2095-12-09", "12/07/65", "12/09/95", "3/17/77"], "DEVICE": [], "DLN": [], "HOSPITAL": ["PEACHFORD HOSPITAL", "WILKES-BARRE VETERANS AFFAIRS MEDICAL CENTER", "IONIA COUNTY MEMORIAL HOSPITAL"], "ID": ["8850277"], "LOCATION": [], "NAME": ["Georgi Kinsman", "Alease Amend", "Loral Dragon Fernald", "Marillin Whetstone Daron"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Interior and spatial designer"], "ZIP": ["41287"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
No spasticity of the lower extremities .
Sensory examination : Significant for absent pin prick sensation in both feet up to the level of the knees .
Pin prick sensation is diminished in the dorsal aspect of all fingers and the palmar aspect of both hands .
Vibratory sensation absent in the toes , intact at the ankles and knees bilaterally .
Intact vibratory sensation in the upper extremities .
Romberg test significant for body swaying , but the patient did not fall .
Tandem gait was poor , but improved when holding the examiner .
No limb ataxia .
LABORATORY DATA : Review of previous laboratory tests of May , 2145 , BUN 36 , creatinine 1.7 , glucose 310 .
December , 2144 , TSH normal .
October , 2143 , B12 normal .
Negative RPR .
The patient said he was tested negative for HIV in 2142 , and 2143 .
MRI of the brain in 2142 and 2143 revealed bilateral white matter changes in the cerebral hemisphere without any intracranial mass lesion .
ASSESSMENT AND PLAN : In summary , we have a 63-year-old diabetic man who appears to have significant sensorimotor polyneuropathy with autonomic involvement .
He does have constipation and impotence as well as orthostatic hypotension .
As we discussed on the phone , his antihypertensive medications need to be adjusted and the patient will be following up with you regarding this .
He may benefit from Jobst stockings to reduce his symptoms of orthostatic hypotension .
I will be ordering an EMG to assess his polyneuropathy and look for any evidence of superimposed ulnar neuropathy or cervical radiculopathy on the left .
The EMG should also include RR interval variations and sympathetic skin responses .
MRI of the cervical spine was also ordered to rule out any cord compression which may also contribute to loss of sensation in the legs .
The patient does have a history of traumatic cervical herniated disk in 2125 .
He may also have had a left elbow injury at this time which can make him prone to develop tardy ulnar palsy .
The patient will return for a follow-up visit after the above tests .
Thank you again for referring Mr . Sandy Tuttle to our Neurology Department .
Sincerely ,
Stanly Lang , M.D .
cc : Dr . T . Villagomez,Internal Medicine 502F , Bellflower Doctors Hospital
DD : 08/13/45
DT : 08/17/45
QY:40282 : 214
Record date : 2114-03-16
March 16 , 2114
Brice Short , M.D .
671 Foundation Street
Lambertville , OK 66399
<|output|>{"AGE": ["63-year-old"], "CONTACT": [], "DATE": ["2142", "March 16 , 2114", "2114-03-16", "2125", "08/13/45", "08/17/45", "2143", "May , 2145", "December , 2144", "October , 2143"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Bellflower Doctors Hospital"], "ID": ["QY:40282 : 214"], "LOCATION": ["OK", "Lambertville", "671 Foundation Street"], "NAME": ["Sandy Tuttle", "T .", "Stanly Lang", "Brice Short"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["66399"]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2096-04-10
GLENN HELEN EMERGENCY DEPT VISIT
VINCENT,ROBERTA J. 380-18-32-2
HISTORY OF PRESENTING COMPLAINT: The patient is a 59-year-old
female who is status post renal transplant with history of
hypertension and diabetes who presents complaining of recurrent
shortness of breath. She had a renal transplant in 2093 with
history of chronic renal insufficiency. She was last admitted here
on February 23 for shortness of breath. The patient has had sore
throat and URI symptoms now for a few days. No nausea and
vomiting. No sweating. No chest pain or dizziness.
PAST MEDICAL HISTORY: Complicated by hypertension, diabetes, pedal
neuropathy, hernia, and hysterectomy.
MEDICATIONS: Premarin, insulin, Prilosec, prednisone, and sodium
bicarbonate. She is also on Lasix, hydralazine, and Talwin.
PHYSICAL EXAMINATION: She is afebrile. Vital signs are normal.
Oxygen saturation 97%. Initial blood pressure is 214/118. The
second blood pressure is 188/100. HEENT: Normal. Cardiac: No
murmurs or rubs. Lungs: Crackles bilaterally, but no wheezing.
Abdomen: Soft and nontender with good bowel sounds. Extremities:
Trace pedal edema 1+ throughout. Neuro: Intact.
LABORATORY EVALUATION: Electrolytes here are normal. Creatinine
is pretty good. She was 4.4 on February 26. She is 3.3 now, so
she has improved in creatinine. White count is 12.9 and hematocrit
of 36. EKG showed sinus rhythm at 97, old left ventricular
hypertrophy, and no acute changes. Chest x-ray shows increased
chronic pulmonary edema and old small right pleural fluid seen.
CONSULTATIONS (including PCP): The Renal fellow is here. The case
has been discussed with the Renal fellow.
ADMITTING DIAGNOSIS: Congestive heart failure and hypertension.
DISPOSITION (including condition upon discharge): The patient is
going to be admitted to the Renal Service, admitted to Dr. Elias
Mercado. Admitted in stable condition.
___________________________________ VC341/8846
DEXTER N. JOHNSON, M.D. DJ50 D:04/10/96
T:04/10/96
Dictated by: DEXTER N. JOHNSON, M.D. DJ50
******** Not reviewed by Attending Physician ********
<|output|>{"AGE": ["59"], "CONTACT": [], "DATE": ["2096-04-10", "2093", "February 23", "February 26", "04/10/96", "04/10/96"], "ID": ["380-18-32-2", "VC341/8846"], "LOCATION": ["GLENN HELEN"], "NAME": ["VINCENT,ROBERTA J.", "DEXTER N. JOHNSON", "DJ50", "DEXTER N. JOHNSON", "DJ50"], "PROFESSION": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
This is the first description , to our knowledge , of ductopenia apparently caused by clindamycin .
<|output|>{"drugs": [{"name": "clindamycin", "reaction": ["ductopenia"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
I am concerned that patient feels as though his depression was " just a phase " and that his d/c'ing of medications will lead to symptom recurrence .
Will reinforce this .
Will call him in 1-2 wks for f/u .
2 .
Psychosis : no longer feels guilty , does not think he is in hell .
Again , have encouraged pt not to stop Zyprexa completely .
He will try to get outpt f/u at the FHV as well
3 .
Insomnia : Improved vs b/l on Remeron .
Goes to bed late ~3-4am and wakes at 12noon .
Watches a lot of TV .
This schedule not new .
Encouraged going to bed earlier .
4 .
Syncope : no further episodes .
No pre-syncopal episodes either .
Saw cardiologist yesterday , Dr . Benjamin .
Event recorder just with one episode of sinus brady at 40 during sleep .
Cards to continue following
5 .
Constipation : much improved on bowel regimen with increased fiber intake
6 .
Hernia : To see Dr . Small for repair of inguinal hernia
7 .
CAD : continue ASA , BB , ACEI .
CP free .
NTD for now
8 .
Hyperlipidemia : fasting lipid panel today
9 .
DM : Will get A1c today .
Urine microalbumin and creatinine .
Patient rarely checks blood sugars .
No known retinal disease or nephropathy at this time .
10 .
HTN : BP today 120/60 .
No changes in medication today
<|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": ["FHV"], "ID": [], "LOCATION": [], "NAME": ["Small", "Benjamin"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Yours truly ,
Norman C . Ivers , M.D .
Norman C . Ivers , MD
Transcribed by : Nina Uresti
Signed electronically by Norman C . Ivers , MD
Document Status : Final
Record date : 2099-06-29
Mr .
Fredrick returns to clinic three years following right middle lobectomy for T1N0 carcinoid .
He is a 50 -year-old man without symptomatic complaints .
He denies any stridor , wheezing , productive cough , shortness of breath , hemoptysis or fever .
He had a recent chest CT scan which was of concern to him .
On physical exam today , the patient appears quite well .
HEENT examination shows no JVD or thyromegaly .
No supraclavicular , cervical or axillary adenopathy is noted .
His blood pressure today is 132/92 , with a regular heart rate and rhythm of
86 . S1 and S2 are within normal limits ;
there is no murmur , rub or gallop .
His resting O2 saturation is 98% on room air , with a respiratory rate of 16 per minute .
His temperature is 98.6 , and his weight is 228 pounds .
Chest examination reveals clear breath sounds bilaterally to percussion and auscultatory examination .
He has good chest wall excursion and no evidence of wheezing .
He does not have any egophony .
His abdomen is soft , nondistended and nontender , without hepatosplenomegaly ;
and his extremities show no evidence of edema , cyanosis or clubbing .
The surgical wound is well-healed .
There is no evidence of local recurrence .
The chest CT scan shows two small nodules that do not appear to have significantly changed given the correction for volume averaging .
The area of his previous resection shows no suggestion of recurrence .
In summary , Mr . Fredrick has two small pulmonary abnormalities that are not particularly suggestive of recurrent disease .
I agree with Dr . Ordonez 's plan to repeat the CT scan in four months .
Larry T . Jansen , M.D .
Record date : 2084-12-12
Internal Medicine
30 Nashua Mall Street FAIR , BILL
Plymouth , IN 46368 22041864
<|output|>{"AGE": ["50"], "CONTACT": [], "DATE": ["2084-12-12", "2099-06-29"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["22041864"], "LOCATION": ["IN", "Plymouth", "30 Nashua Mall Street"], "NAME": ["FAIR , BILL", "Fredrick", "Ordonez", "Norman C . Ivers", "Larry T . Jansen", "Nina Uresti"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["46368"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Lungs ;
clear .
Abdomen ;
soft , nontender no HSM .
Extr ;
no edema .
A/P : 74 yr old woman with multiple medical problems , s/p 5 month hospitalization .
1 ) Diabetes .
Throughout her hospitalization she lost a lot of weight down from 160's to 170's last spring to current level of 135 lbs .
Insulin was stopped and just recently Glipizide 2.5 mg added on .
Recent Hg A1C obtained after this visit on 12/04/02 was 6 .
Bun /Cr was 11/0.9 .
glucose 196 .
Cholesterol 225/68/135 .
LFT's were not done and need to be done , will be ordered next lab draw .
If normalized then will add back Lipitor .
History of gastroparesis , on new med has replaced Reglan , doing better .
2 ) Hypertension .
Doing well on Norvasc 10 , Labetolol 200 bid and Isordil 20 tid .
3 ) S/p recent upper extremity DVT , on coumadin .
Per Dr . Herbert Paris's note of 12/02 , she needs 3 months of anticoag , and then 1mg/day until the portacath discontinued .
With history 2 prior DVT's will need to discuss whether she should be on long term therapy .
She is now getting FS INR's thru the VNA , but will be transitioned to Internal Medicine , with access thru the portacath , or continued FS's .
INR has been in good range with 7.5 mg coumadin .
4 ) S/P compression fracture of T4 , s/p vertebroplasty with successful resolution of the pain .
Has other compression fractures but not interested in further procedures at this time .
5 ) History of hypothyroidism .
Had recent labs at SRH on 12/04/02 with TSH of 1.3 and Free T4 of 0.9 .
6 ) History of anemia , requiring Procrit and ? transfusions during her hospitalizations , with normal hct of 41.1 on 12/04/02 .
7 ) Neuro ;
History of partial seizures , TIA's .
Followed by Dr . Gary Keyes .
History of silent cerebellar brain infarction on MRI .
History of moderate intracranial carotid stenosis , with recent ? TIA left hemisphere , ? repeat carotid noninvasives per Dr . Keyes vs CT angiogram .
On Plavix and coumadin .
Per Dr . Keyes coumadin alone would be enough for stroke prophylaxis , and he would defer to Dr . Barry as to whether to continue Plavix .
8 ) History of elevated LFT's .
<|output|>{"AGE": ["74"], "CONTACT": [], "DATE": ["12/04/02", "12/02", "spring"], "DEVICE": [], "DLN": [], "HOSPITAL": ["SRH"], "ID": [], "LOCATION": [], "NAME": ["Keyes", "Barry", "Herbert Paris's", "Gary Keyes"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2078-10-25
October 25, 2078
Office Visit
Re: Larry Lockwood
MPC# 590-33-20-3
This is a 56 year old morbidly obese male who was discharged recently from
the
Marshalltown Pond Clinic who is here for follow up of his newly diagnosed
diabetes mellitus. He was seen in the emergency room on 10/21 with the
complaint of urinary frequency, hesitancy, and generally not feeling well.
Prior to that, he had been treated with antibiotics by his primary care
physician for a urinary tract infection with Bactrim and then ampicillin but
he did not get better. He went to the emergency room and was admitted to the
hospital because his blood sugar was in the 400s and he was diagnosed with
diabetes at that time. He was discharged on 10/22/78 on insulin NPH 30 units
in
the morning and 15 units in the PM and was advised to follow up in the
outpatient clinic today. Since discharge, his blood sugars have been in the
200s. This afternoon, it is 242 2 hours after his last meal.
Past Medical History: He has a history of benign prostatic hypertrophy. He
sees a urologist and they are discussing a new procedure for the same. He
cannot have ______ because of his morbid obesity, he cannot be positioned on
the table for the same. He also gives a history of sleep apnea. No
hypertension. He does have a history of gastric reflux and obesity.
Past Surgical History: He has had bilateral hip surgery for slipped ______ as
an adolescent.
Review of Systems: No chest pain. Positive review of systems for UTI symptoms
with increased frequency and hesitancy. Other review of systems-he has
arthritis generalized with more pain in the hip. Also has acid reflux.
Family History: Family history of obesity and hypertension but no diabetes or
coronary artery disease.
Social History: He is a smoker but is trying to quit. He smokes less than one
pack a day. He is a manager and is on disability. He has 2 children and is
separated.
Physical Examination: He is morbidly obese and weighs about 405 pounds. Blood
pressure 110/88. Pulse 84. Skin exam-there is evidence of acanthosis
nigricans. He has gynecomastia. Head and neck exam-atraumatic, normocephalic.
Extraocular movements are intact. Pupils equal, round and reactive to light.
Cardiovascular system exam-S1, S2 heard. No S3, S4. Respiratory system-clear
to auscultation and percussion. No added sounds. Abdomen-obese, very
difficult
to examine for masses or hepatosplenomegaly. On limited exam, there are no
masses palpable. CNS-cranial nerves II-XII intact. Examination of feet with
monofilament is negative as he is not able to feel the monofilament in both
feet. This impairment is greater on the right foot than left.
Labs done so far: hemoglobin A1c of 14, glucose on 10/21 422, creatinine 1.7,
BUN 22, sodium 132, potassium 4.5, chloride 97, liver function tests with ALT
10, AST 10, alkaline phosphatase 126, bilirubin 0.4, total protein 8.1,
albumin 3.6, globulin 4.5, calcium 9.5, hemoglobin 15.
Assessment and Plan: 1. New onset diabetes mellitus. The patient is morbidly
obese, has features of insulin resistance. His blood sugars today are better
since admission. He is on insulin twice a day. He checks his blood sugars 3
times a day and since discharge, they have been around 240 to 300. The
patient
is not a good candidate for metformin with his last creatinine of 1.7. He may
be a candidate for Avandia. At the present time, his alkaline phosphatase is
mildly elevated but his ALT and AST are normal. He has difficulty coming to
the clinic and would prefer to have his visiting nurse and nutritionist
communicate with the clinic physicians to adjust the dose of his insulin and
also have his blood tests done locally rather than here in the clinic. We
will
increase his NPH to 40 units in the morning and 26 units in the PM. We will
work with the visiting nurse and nutritionist to adjust the insulin dose and
also order lab tests. We will repeat his hemoglobin A1c in a month and also
repeat his creatinine and liver function tests at that time to see if he may
be a candidate for Avandia. I advised the patient to return to the clinic in
6
months and also for him to send the blood sugar results every week until his
blood sugars are under better control.
____________________________
Dr. Xan Dunn
XD:ullmann
DD: 10.25.78/Rec=d 11.04.78
DT: 12.03.78
DV: 10.25.78
******** Not reviewed by Attending Physician ********
<|output|>{"AGE": ["56"], "CONTACT": [], "DATE": ["2078-10-25", "October 25, 2078", "10/21", "10/22/78", "10/21", "10.25.78", "11.04.78", "12.03.78", "10.25.78"], "ID": ["590-33-20-3"], "LOCATION": ["MPC", "Marshalltown Pond Clinic"], "NAME": ["Larry Lockwood", "Xan Dunn", "XD", "ullmann"], "PROFESSION": ["manager"]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2070-05-15
78 y o female pt dr olivas at home. special visit to prepare meds for the week end. unfortunately pt does not know why she does not yet have new meds. expects family to deliver them to her later today. Has not taken meds today and does not have lasix, neurontin, protonix. very anxious, worried about having to be placed in nursing home because cannot do own med preparation, test fingersticks. says she is having some sob at rest but no doe, orthop, pnd, cp. ankle swelling is also a little more.
Allergies
* Haldol - Unknown
Medications
Asa (CHILDRENS) (ACETYLSALICYLIC Acid (C... 81MG, 1 Tablet(s) PO QD
Mvi (MULTIVITAMINS) 1 CAPSULE PO QD
Pericolace (DOCUSATE W/casanthranol) 1 CAPSULE PO QD
AMIODARONE 200MG, 1 Tablet(s) PO QD
Lasix (FUROSEMIDE) 40MG, 1 Tablet(s) PO BID
Premarin (CONJUGATED Estrogens) 0.625MG, 1 Tablet(s) PO QD
Provera (MEDROXYPROGESTERONE) 2.5MG, 1 Tablet(s) PO QD
Celexa (CITALOPRAM) 40MG, 1 Tablet(s) PO QD
ATENOLOL 25MG, 1 Tablet(s) PO QD
Tylenol (ACETAMINOPHEN) 500MG, 2 Tablet(s) PO TID PRN arthritis pain
Advil (IBUPROFEN) 200MG, 1 Tablet(s) PO BID PRN pain not relieved by tylenol
Protonix (PANTOPRAZOLE) 40MG, 1 Tablet(s) PO QD PRN .
Glucophage (METFORMIN) 500MG, 2 Tablet(s) PO BID
Neurontin (GABAPENTIN) 100MG, 2 Capsule(s) PO TID
Problems
Hypertension
Osteoarthritis
Dizziness
amputation : 3rd left toe
Depression : with psychotic features
Lumbar disc disease : s/p discectomy
Cholecystectomy : s/p open procedure
H/O Atrial fibrillation : vs. atrial tachycardia -- s/p cardioversion 2/68
Diabetes mellitus : type 2
Pulmonary embolism : bilateral; tx'd at Buzan Chiropractic Clinic
Myocardial infarction : NQWMI with inferolateral/apical depressions 5/31/69 - 6/04/69 at Buzan County Clinic; no cath or f/u ETT done there as pt requested conservative management
O: bp 144/82 r sitting. hr 68 reg rr 20. chest clear, cor no MRG, ext 1-2+ edema, callus on heal improved, no open areas, infection.
A/P: call to castro, message left with daughter re need to get lasix and add to med boxes asap, no message machine working and no answer with alaniz's number. will return 4 days to check on situation with meds. castro will check on patient daily over that time.
_____________________________________________
Kay K. Edge,RNC,ANP
<|output|>{"AGE": ["78"], "CONTACT": [], "DATE": ["2070-05-15", "2/68", "5/31/69", "6/04/69"], "ID": [], "LOCATION": ["Buzan Chiropractic Clinic", "Buzan County Clinic"], "NAME": ["olivas", "castro", "alaniz", "castro", "Kay K. Edge"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
#NAME?
Record date : 2081-04-21
58 yo male here for f/u of his various medical issues :
1)CV : admitted 2/81 w/atypical CP ( similar admission in recent past ).
Ruled out .
MIBI w/small fixed defect ant/lat wall .
EF 61% w/out WMA .
Statin changed to Zetia for elevated CK ( 2412 ).
Last lipid panel 3/17 chol 184 , trig 281 , HDL 31 , LDL 97 , VLDL
56 . Also continues on Plavix and ASA ( for prior stroke "), lisinopril .
Will recheck CK and lipid panel .
2 ) Neuro : CT 2080 old infarct R caudate region .
MRI confirmed R caudate lesion , other small vessel dz ( small foci infarcts basal ganglia , few foci increased signal intestity subcortical white matter .) Neuro testing recently showed mild deficits in attention , processing ;
intellectual capacity superior range .
Per Dr . Sims ( stroke clinic "), lesions on imaging could explain memory problems and slurred speech .
Pt continuing on ASA and Plavix .
Also Zetia as above .
3 ) Depresion : Pt continues on 100 Zoloft ( had incr to 200 per pt request but made him " feel funny ).
Pt referred to psych , upcoming appt .
Ambien QHS .
3 ) LFT's : Isoloated Elevated AST ( 3/18 193 , 3/17 62 ).
Will check hep C . and recheck LFT's .
4 ) Pilonidal cyst : see separate note dated today .
5 ) Health maintenance : Lipids : see above .
Sigmoidoscopy 1/20 normal
6 ) HTN : stable .
Continue lisinopril
_____________________________________________
Quiana Lou Qu , M.D .
#NAME?
Record date : 2078-07-01
CARDIOLOGY
OAKLAND ASSOCIATES CENTER
Interval History :
This 63 y/o male patient with a h/o HTN , HLP , non-revascularized 4-vessel CAD , preserved LV systolic function , PAD with past PTA and stenting to the R EIA and distal L SFA , tobacco abuse , type 2 DM , peripheral neuropathy , L ulnar nerve compression , ulcerative colitis , GERD , depressive disorder , anxiety disorder , and gouty arthritis presents to the OAC Cath Lab this morning for a scheduled elective peripheral arterial catheterization procedure .
The patient was last seen in outpatient vascular medicine follow-up by Dr . Levi Barton at the OAC 04/09/2078 , at which time he reported recurrent and persistent BLE claudication symptoms , RLE > LLE , with pain in his buttocks , thighs , and calves with ambulation .
He reports that these symptoms , coupled with his peripheral neuropathy symptoms , have become quite debilitating and lifestyle-limiting .
<|output|>{"AGE": ["58", "63"], "CONTACT": [], "DATE": ["3/18", "2080", "1/20", "2081-04-21", "3/17", "2078-07-01", "04/09/2078", "2/81"], "DEVICE": [], "DLN": [], "HOSPITAL": ["OAC", "OAKLAND ASSOCIATES CENTER"], "ID": [], "LOCATION": [], "NAME": ["Levi Barton", "Quiana Lou Qu", "Sims"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
A child in whom a phenobarbital hypersensitivity drug reaction developed which consisted of fever , a pruritic desquamating erythrodermic rash , alopecia , icterus , protein-losing enteropathy , myositis , and nephritis , is described .
<|output|>{"drugs": [{"name": "phenobarbital", "reaction": ["hypersensitivity"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Ativan ( LORAZEPAM ) 1MG TABLET take 1 Tablet
( s ) PO x1 , take 1 hour prior to procedure
Acucheck ADVANTAGE STRIPS 1 STRIP Topical As directed
Calcium CARBONATE + VIT D 250 MG PO TID
Multivitamin ( THERAPEUTIC MULTIVITAMINS ) 1 TAB PO QD
Nph HUMULIN INSULIN ( INSULIN NPH HUMAN ) 15 SC QAM
Ecasa ( ASPIRIN ENTERIC COATED ) 325MG TABLET EC take 1 Tablet
( s ) PO QD
Zestril ( LISINOPRIL ) 10MG TABLET take 1 Tablet
( s ) PO QD
Amlodipine 5 MG ( 5MG TABLET take 1 ) PO QD , overdue for physical ;
please schedule visit with Dr . Sampson
Hydrochlorothiazide 25 MG PO QD , Please schedule visit with Dr . Sampson for follow-up ( taking Dr . Yao's place )
Accu CHECK STRIPS 1 STRIPT SC As directed
Crestor ( ROSUVASTATIN ) 5 MG ( 5MG TABLET take 1 ) PO QHS
Allergies
NKA
Vital Signs
BP 120/78 , P 80 , Temp 97.8 F , Wt 177 lb
no adenopathy
no carotid bruit
heart sounds normal , no murmur , regular
few crackles , clear with coughing
abdomen soft
good DP pulses
skin on feet intact
CN intact
Health Maintenance
Influenza Vaccine 11/07/87 refused
Breast Exam 11/07/87 diffusely fibronodular breasts
Cholesterol 08/09/2092 207 DESIRABLE : <200
Rectal Exam 05/28/2088 guaiac neg , no masses
Mammogram 07/22/2089 see report in Results
Pap Smear 08/02/86 never
Stool Guaiac Test 05/28/2088 negative
Pneumovax 11/07/87 refused
EKG 12/13/86 normal sinus , normal axis , no chamber enlargement , no ischemia , ? q in III
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["12/13/86", "08/09/2092", "07/22/2089", "08/02/86", "05/28/2088", "11/07/87"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Yao's", "Sampson"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2095-01-31
EDVISIT^65219816^HALL, NICK^01/31/95^PENN, GINO
The patient was seen and examined in the Emergency Department on
01/31/2095. The patient was seen by Dr. Ibarra. I have discussed
the management with her. I have also seen the patient personally
and reviewed the ED record. This is an addendum to the record.
I have also reviewed the old medical record and discussed the
management with Dr. Gil, who will be speaking with Dr. Gomez
about accepting this patient to the Cardiology Service.
HISTORY OF PRESENT ILLNESS: This is a 54-year-old gentleman who
has a history of stent placements as he had a cardiac arrest
status post lobectomy for squamous cell carcinoma. This occurred
in 02/2094, where the patient was taken to the Cath Lab after His
postoperative rest. Stents were placed and the patient says he
has been doing well. In the meantime, he has had no chest pain
or shortness of breath until one week prior, he was on a
treadmill and felt unwell with shortness of breath and chest
discomfort. He stopped and felt better. Last night, he was in
bed watching TV, he felt some chest discomfort and took
nitroglycerin with relief of pain, and this morning he was
walking and walked about 100 yards, felt short of breath and
chest pain at rest and took nitroglycerin with relieve and now
has no chest pain or shortness of breath at this time. His chest
pain he describes it as pressure with exertion and he feels well
now. No fevers, chills, or cough.
REVIEW OF SYSTEMS: As indicated and otherwise negative.
PAST MEDICAL HISTORY: As indicated and also includes
hypertension and increased cholesterol.
SOCIAL HISTORY: He is a nonsmoker.
PHYSICAL EXAMINATION: The patient is pleasant, well appearing,
and in no acute distress. Normocephalic and atraumatic. Chest
is clear. Heart is regular. Abdomen is soft and nontender.
Extremities are nontender. Rectal exam is heme-negative.
ASSESSMENT AND PLAN: This is a gentleman with a history of
coronary artery disease and cardiac arrest, who has a very
typical symptoms concerning for coronary artery disease and
angina including components at rest. We have started heparin on
the patient medicated with cardiologist for the possibility of
early catheterization. Laboratory was pending at the time of
this dictation.
DISPOSITION: The patient will be admitted to Cardiology in fair
condition.
______________________________
PENN, GINO M.D.
D: 01/31/95
T: 01/31/95
Dictated By: PENN, GINO
eScription document:2-5902888 BFFocus
******** Not reviewed by Attending Physician ********
<|output|>{"AGE": ["54"], "CONTACT": [], "DATE": ["2095-01-31", "01/31/95", "01/31/2095", "02/2094", "01/31/95", "01/31/95"], "ID": ["65219816", "2-5902888"], "LOCATION": [], "NAME": ["HALL, NICK", "PENN, GINO", "Ibarra", "Gil", "Gomez", "PENN, GINO", "PENN, GINO"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
HPI : Ms Uher was doing well until 8/70 when she she was noted to have several " staring spells . At the same time she had increased gait instability leading to admission to SLMC .
A head MRI was reportedly normal .
She improved and was discharged without treatment or diagnosis .
At that time she also noticed subtle decline in visual acuity and eye exam confirmed this .
She was told that this was caused by her diabetes .
Her vision continued to worsen and she was treated with laser OS .
Over the past month her balance has worsened nad her vision has continued to deteriorate .
She reports severe HA in 8/70 but none recently .
She was seen by ophtalmology at SGAH and noted to have optic disc swelling , cotton wool spots and hemorrhages .
She was sent to CCH EW for evaluation .
ROS:She c/o painful dysesthesia and weakness BLE
( lonstanding ).
She denies HA , tinnitus , vertigo , numbness , fever , chills , cough , nausea , vomiting , chest pain , palpitations , shortness of breath , heartburn , constipation , diarrhea , dysuria , incontinence , or rash .
PMH :
ear infection spring 2069 requiring IV abx (? mastoiditis )
type 1 DM x 38 year {retinopathy , nephropathy , neuropathy
arthritis , tendonitis , capsulitis
hypothyroidism
hypercholesterolemia
MED :
Insulin NPH 12U qam and 9U qpm
Insulin Reg SS
levothyroxine 200 mcg qd
Epogen 3x/wk
ALL : NKDA
SH : Retired , lives alone in Cape Cod , denies tobacco and alcohol
FH : type 1 DM
VS : T 98.8 HR 86 BP 157/94 RR 16
PE : Genl WD WN WF mildly agitated NAD
HEENT AT/NC , MMM no lesions
Neck Supple , no thyromegaly , no LAN , no bruits
Chest CTA B
CVS RRR no MGR
ABD ND , #NAME? , NT , no masses , no hepatosplenomegaly
EXT b/l olecranon nodules , swollen fingers , no edema , distal pulses full , no rashes or petechiae
Rectal deferred
Neuro
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["spring 2069", "8/70"], "DEVICE": [], "DLN": [], "HOSPITAL": ["SGAH", "SLMC", "CCH"], "ID": [], "LOCATION": ["Cape Cod"], "NAME": ["Uher"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2136-12-05
HIGHLAND HOSITAL VISIT
PT: Ellen Law
date of visit: 12/05/36
CC: fu cards, htn, hyperlipidemia, DM
HPI: Since our last visit, saw Cardiology re her neck and jaw pain w exertion, Dr. Uphoff who feels that she has stable angina. he recommended that she optimize her medical management by increasing her BB and CCB. At this point, she has increased her BB to 2 pills 2x per day. she feels ok on this. no lightheadedness or dizziness. She is also going to start nitrates as soon as they arrive--imdur 30mg qd. still having intermittenly jaw discomfort walking up stairs. no chest pressure or jaw discomfort at rest.
she has not gained any wt. however, has not been able to increase her lantus bc she was not sent the correct amount and would run out if she increaesd to previously recommended dose.
also started pravastain since our last visit. has not noticed any muscle aches or generalized weakness. has only been on this for 2 weeks though.
no hypoglycemia; good energy; feeling well overall.
describes feeling pressure, fullness in left ear; slight decrease in hearing.
Problems
Diabetes mellitus
Malignant tumor of urinary bladder : stage 1, now s/p bcg treatment, followed by urology
Hypertensive disorder
Obesity
Retinal detachment : s/p repair Dr. Cleveland
Medications
Aspirin (ACETYLSALICYLIC ACID) 81 MG (81MG TABLET Take 1) PO QD #90 Tablet(s)
Cozaar (LOSARTAN) 50 MG (50MG TABLET Take 1) PO BID , Member ID # 55080437876 #180 Tablet(s)
Hydrochlorothiazide 25 MG (25MG TABLET Take 1) PO QD , Member ID # 033388269 #90 Tablet(s)
Imdur ER (ISOSORBIDE MONONITRATE (SR)) 30 MG (30 MG TAB.SR 24H Take 1) PO QD #90 TAB.SR
Lantus (INSULIN GLARGINE) 100 U/ML VIAL ML SC AS DIRECTED , 65U before breakfast and 10 units at night Member ID # 033388269 #3 Month(s) Supply
Metformin 1000 MG (1000MG TABLET Take 1) PO BID #180 Tablet(s)
Metoprolol TARTRATE 50 MG (50MG TABLET Take 1) PO QD AS DIRECTED , 2 PO QAM AND 1 PO QPM #180 Tablet(s)
Norvasc (AMLODIPINE) 5 MG (5 MG TABLET Take 1) PO QD x 90 days #90 Tablet(s)
Novolog flexpens SC AC AS DIRECTED , 10U before breakfast, 10U before lunch, 20U before dinner #15 prefilled pens
One touch ultra test strips 1 SC BID #3 Month(s) Supply
Pravastatin 20 MG (20MG TABLET Take 1) PO QHS #90 Tablet(s)
Solostar prefilled disposable lantus insulin pen 65 UNITS SC qd , Member ID# 033388269 #3 Month(s) Supply
Zostavax (ZOSTER VACCINE LIVE (PF)) 1 VIAL SC X1 x 365 days, 1. Reconstitute and inject 1 vial. Sub-cutaneous upper arm. 2. Please document vaccine administration in the LMR immunization module (or notify the practice in writing if no LMR access). #1 vial
Allergies
AZITHROMYCIN - Unknown
Ace Inhibitor - cough,
TOB: quit 2120; smoked 2ppd x 15 yrs
ETOH: none
IVDU/illict drugs: none
SH: originally from Mt. Married for 39 years to Friedman, describes marriage as
good, safe. Has 2 children and 8 grandchildren. Has 2 daugthers, 1 lives in
hartsville and 1 in nuku'alofa. no pets. fulltime author. husband has h/p
prostate CA.
FH:
(no known )h/o sudden death, hyperlipidemia
+ Dm in father (dxd in his 60-70)
+ mgm w stroke (
+CHF in ther mother
+mUncles x 2 with MIs (~ 60's_
(no known) h/o endometrial, ovarian, thyroid, melanoma, breast, prostate
+ colon cancer in her mother, dx'd 55-60yo
(no known )h/o osteoporosis/premature bone loss
(no known )h/o colon polyp, dysplasic nevi
(no known )h/o pe, DVT, miscarriages, bleeding disorders
(+)h/o glaucoma in mUncle
(no known ) h/o depression, suicide, schizophrenia
+ dementia in her mother
+alcoholis in 2 muncles
+ bipolar do in grandson
VS: 130/66 76 97.1 98%RA 250 lbs 57.25
general: well- appearing F in NAD
HEENT: anicteric, PERRL, EOMI, mmm; difficult to assess JVP, L TM w nearly obstructing cerumen; R w nl TM and light reflex.
PULM: CTAB w good air movement. no wheezes, rhonchi, or crackles
COR: rrr, nls1s1, no m/r/g
EXT: wwp, no edema
A/P: 61 yo F with PMH of HTN, hyperlipidemia, DM, obesity, bladder cancer presenting for fu of multiple medical issues.
1) DM: Dx'd ~ 2129, c/b diabetic retinopathy s/p laser tx and likely neuropathy. Most recent 10/36 HgbA1c: 7.0%, very near goal of <7.0% and improving compared to 7.8 % since increase in lantus dose. Did not bring FS log today but continues to report that her fasting glucose in AM still often above goal and that her largest meal and need for novolg is at dinner.
Previously recommended starting BID dosing of lantus and adding 10 units in PM, but not able to obtain yet from pfizer; discussed that for some individuals it dose not last for 24 hours adn that they get better glucose control w BID dosing. Discussed that she will likely need to decrease her PM dose of novolog
----recheck hgba1c ~ 1/2137
----continue metformin 1000mg BID, lantus 65units qam and novolog 70/30 but also adding 10 units of lantus in PM
----continue glucose monitoring for likely need for further adjustments to regimen
----7/36 urine microalbumin/crt: 35.9 above goal of <30; have made changes to BP regimen and BP now within goal; will recheck u microalb/crt in 1/2137
----OPTHO: followd by dr arias; reports uptodate
----PODIOTRY: pt w likely diabetic neuropathy and e/o oncychomycosis; referrred to podiotry for further care and monitoring at previous visit
----BP: within goal on HCTZ, Cozzar, metoprolol and norvasc
----2136 LDL: 114 above goal of <100, not on statin; started simvastatin which was dc'd 2/2 myalgias and generalized weakness (nl LFTS and CK); pt has started pravastain and appears to be doing well on this
----9/36 Gabriella Yockey
----discussed nutrition referral; pt declined but plans on joining south beach diet
----discussed importance of wt loss; pt to try south beach diet;
----PNEUMOVAX: 2136
----Flu shot/H1N1: flu shot uptodate; receiving h1n1 today
2) HTN: Dx'd in ~ 2129. BP very near goal today on current regimen of HCTZ 25mg qd, cozaar 50mg BId, metoprolol 100mg BID and norvasc 5 mg qd which appears to be well-tolerated. Will not make any additional changes since pt is planning on adding imdur 30mg as soon as she received it from Pfizer. 10/2136 chem 7, renal fxn, ca wnl.
-----encouraged low na diet, wt loss
----continue HCTZ 25mg qd, cozaar 50mg BId, and metoprolol 100mg BID, and norvasc 5 mg qd
----reviewed si/sxs for which she should seek immediate medical attention
3) dyslipidemia: 7/36 LDL 114 above goal of <100 given DM and likely CAD. Pt w brief 2 week trial of simvastatin self-dc'd 2/2 myalgias and generalized weakness but nl LFTS/CK/GFR. Pt now on pravastatin x 2 weeks and appears to be well-tolerated thus far. Again reviewed possible side effects and she knows to call w any concerns or questions
----continue pravastatin 20mg qhs; reivwed possible side effects and instructed to call w concerns
----pt instructed that she will need repeat lipids and LFTS in ~ 6-8 weeks after starting pravasatin; will check at next visit
----recommended low cholesterol diet
4) Likely stable angina/CAD; now s/p Cardiology, consult w Dr. Uphoff who feels that clinical presentation c/w stable angina/CAD and has recommended trial of optimizing medical management w nitrates and BB/CCB for now. Reviewed consult recs with patient. however, if this does not work, will consider possible cath/stress test. pt appears to be tolerating increase in BB and has not yet started imdur. recent LDL above goal but just restarted statin so will need fu measurement in ~ 4 weeks.
----continue asa 81 mg qd; increased metoprolol 100mg BID, ARB, and pravastatin 20mg qhs
----fu appt w dr uphoff in ~ 1 week
----pt to add imdur 30mg as soon as arrives from pharmacy
5) Left ear impaction: Left TM w nearly completely obstructing cerumen. Irrigated ear w full removal and visualizatino of nl TM post irrigation. Pt confirms complete resolution of sxs w return of nl hearing. pt felt well post irrigation w no dizziness. disucsed possible dizziness and she will sit in waiting room for a while and make sure that she does not experience.
6) HCM:
----recevied flu shot
----will give h1n1 today
---will give tdap today
To DO;
----fu on mammogram
---continue to discuss colonscopy
Pt to RTc in ~ 1 mos or sooner if needed.
<|output|>{"AGE": ["60", "70", "60's", "55", "60", "61"], "CONTACT": [], "DATE": ["2136-12-05", "12/05/36", "2120", "2129", "10/36", "1/2137", "7/36", "1/2137", "2136", "9/36", "2136", "2129", "10/2136", "7/36"], "ID": ["55080437876", "033388269", "033388269", "033388269"], "LOCATION": ["HIGHLAND HOSITAL", "Mt", "hartsville", "nuku'alofa", "pfizer", "south beach diet", "south beach diet", "Pfizer"], "NAME": ["Ellen Law", "Uphoff", "Cleveland", "Friedman", "arias", "Gabriella Yockey", "Uphoff", "uphoff"], "PROFESSION": ["author"]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Amiodarone hydrochloride , a new antiarrhythmic agent , has been associated with pulmonary toxicity characterized by cough , dyspnea and diffuse pulmonary infiltrates .
<|output|>{"drugs": [{"name": "Amiodarone hydrochloride", "reaction": ["pulmonary toxicity"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
DP and anti-tib are not appreciated .
Medications
captopril 50MG PO TID
ECOTRIN ( ASPIRIN ENTERIC COATED ) 325MG PO QD
insulin isophane
( nph ) 14units SC QPM
INSULIN N 28units QAM
ISORDIL PO TID
Lipitor 10MG PO QD
Lopressor 50MG PO BID
MAXAIR INHALER INH
NEURONTIN ( GABAPENTIN ) 300MG PO BID
NORVASC ( AMLODIPINE ) BID PO
NPH REGULAR 14units QAM
REGULAR INSULIN 10U INJ QAM
Disposition and Plans
I will ask him to FU Dr . Kiefer of Neurology , Dr . Ashley of Cardiology , Dr . Insley of Endocrinology He will follow an AMOD diet , low-salt/low-cholesterol diet , flexsig .
, stool cards .
FU with me in three month's time or sooner as needed .
He will FU with Dr . Scott of Opthalmology .
cc :
Drs .
Ashley / Cardiology #NAME? CCR 412
Snyder / Opthalmology #NAME?
Insley / Endocrinology #NAME? End 6
Lane / Neurology #NAME? NEU 265
J . Kiefer / NeuroSurgery
#NAME?
Record date : 2078-03-17
Patient Name : "JORGENSON,VIVIANLEE [ 47190847(JMH ) ] Date of Visit : 03/17/2078
CC : Syncope , Afib
HPI :
71 year old lady with a history of A fib was seen in clinic today for complaints of DOE and increased wt .
She was found to be in mild to moderate CHF and an increase in her torsemide dose was recommended .
On her way to a blood draw , while in the elevator , she had syncope and hit her head .
The fall was witnessed by her daughter .
There was no prodrome , no nausea , no incontinence with the fall .
<|output|>{"AGE": ["71"], "CONTACT": [], "DATE": ["2078-03-17", "03/17/2078"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["47190847(JMH"], "LOCATION": [], "NAME": ["Snyder", "Ashley", "Insley", "Lane", "Kiefer", "J . Kiefer", "Scott", "\"JORGENSON,VIVIANLEE"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2074-11-10
Patient Name: FALLON, SHARON; MRN: 1703242
Dictated on: 11/11/2074 by PATRICIA DRAKE, N.P., PH.D.
HISTORY: Mrs. Fallon returns to clinic for evaluation and management of a right posterior ankle ulceration. Since her last visit to the clinic, she was evaluated by Dr. Frederick Archer who admitted her for a diagnostic angiogram, which revealed that she had adequate perfusion to the ankle level
to heal the ulceration.
PHYSICAL EXAMINATION: On physical examination, Mrs. Fallon has ruborous discoloration of the distal half of her bilateral lower extremity with scattered vesicles on the anterior surface of her left lower extremity. The
ulceration is on the posterior aspect of the right ankle. It measured 1.2 cm x 1.2 cm. The tissue is moist yellow subcutaneous tissue, the margin is clear. In the setting of ruborous discoloration, it appears that Mrs. Fallon may have an acute flare of her chronic lipodermatosclerosis.
PLAN: Daily wound care per the following protocol; 1. Normal saline irrigation 30 cc x 3. A thin layer of 50% Diprolene ointment 0.05% with Bactroban cream to the wound bed and the wide periwound margin. Primary dressing will be Telfa covered with rolled gauze. Mrs. Fallon will return to clinic in 2 weeks unless the wound bed is closed and then she will follow up with Dr. Archer on Tuesday, November 26th.
______________________________
Patricia Drake, N.P., Ph.D.
DD:11/11/2074
DT:11/12/2074
DE:38535 :70
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["2074-11-10", "11/11/2074", "Tuesday, November 26th", "11/11/2074", "11/12/2074"], "ID": ["1703242", "DE:38535 :70"], "LOCATION": [], "NAME": ["FALLON, SHARON", "PATRICIA DRAKE", "Fallon", "Frederick Archer", "Fallon", "Fallon", "Fallon", "Archer", "Patricia Drake"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
11-30-1990 , 2074
HEARTLAND REGIONAL MEDICAL CENTER
4951 Arroyo Rd
Newport news , NY 47185
RE : Baal Gisel Sharise
Duncan Gibson presented to the office today for a second opinion
Duncan Gibson is a 78 - year-old woman with a longstanding history of
03-05-1972 which failed to document significant coronary artery disease
( done for evaluation of chest pain ), angiogram in 08-28-1987
myocardial infarction on 03-23-1979 at which time she
She underwent repeat catheterization in 09-03-2003 at the PRESENCE SAINT MARY OF NAZARETH HOSPITAL CENTER which showed diffuse native disease
underwent repeat cardiac catheterization in 08-27-1984 because of
She therefore was transferred to the ST . JOSEPH MEDICAL CENTER IN THE HEIGHTS
in early August where she underwent successful PTCA of her vein graft
Baal Gisel Sharise
MR # 6508-22-1996-5 - 2 - 11-30-1990 , 2074
Duncan Gibson is a 78 - year-old woman with significant
MR # 6508-22-1996-5 - 3 - 11-30-1990 , 2074
CONROE REGIONAL MEDICAL CENTER
11500 Space Center Blvd
Atlantic , NY 50158
DD : 23/06/74
DT : 24/12/74
DV : 23/06/74
/ Jonice Ithnan
Record date : 2100-04-05
April 05 , 2100
Elboa Tat Tyeisha , M.D .
2251 North Shore Dr
Re : Bergmans Lanelle Shawntavia
COMANCHE COUNTY MEMORIAL HOSPITAL Unit # : 682-57-49
I had the pleasure of seeing Bergmans Lanelle Shawntavia today with regards to callus formation over the plantar aspect of her left foot .
As you are aware , she is a 42 - year-old woman with a history of insulin-dependent diabetes mellitus and Charcot arthropathy of her left foot that has resulted in a rocker bottom deformity .
Her orthotics were made in November and seem to be working quite well for her .
Her past surgical history is significant for colostomy in 2095 , fistula repair in 2096 , coronary artery bypass surgery times four in 2097 , a kidney transplant in 2098 , and a fistula ligation in 2099 .
Date : April 05 , 2100
<|output|>{"AGE": ["78", "42"], "CONTACT": [], "DATE": ["November", "2096", "2098", "2100-04-05", "08-27-1984", "August", "April 05", "03-23-1979", "2097", "11-30-1990", "09-03-2003", "24/12/74", "03-05-1972", "2095", "23/06/74", "08-28-1987", "2099"], "DEVICE": [], "DLN": [], "HOSPITAL": ["ST . JOSEPH MEDICAL CENTER IN THE HEIGHTS", "PRESENCE SAINT MARY OF NAZARETH HOSPITAL CENTER", "HEARTLAND REGIONAL MEDICAL CENTER", "CONROE REGIONAL MEDICAL CENTER", "COMANCHE COUNTY MEMORIAL HOSPITAL"], "ID": ["682-57-49"], "LOCATION": ["Atlantic", "11500 Space Center Blvd", "2251 North Shore Dr", "4951 Arroyo Rd", "Newport news"], "NAME": ["Elboa Tat Tyeisha", "Jonice Ithnan", "Bergmans Lanelle Shawntavia", "Baal Gisel Sharise", "Duncan Gibson"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["50158", "47185"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Cor Regular rate and rhythm without any murmurs , rubs , or gallops
Abdomen Soft , nontender , and nondistended
Extrem No clubbing , cyanosis , or edema
Musc skel No bony deformities , but decreased range of motion of his bilateral shoulders and tenderness with extension of his left shoulder .
The patient also had some tenderness to palpation in the left lateral hip region .
There was good range of motion of his bilateral hips
Neuro He is alert and oriented x
3 . Cranial nerves II through XII are grossly intact
Assessment and plan
As above .
Disposition
Follow up in a few months .
Signed electronically by Chavez , Barbara on Mar 19 , 2164
Record date : 2079-05-08
CARDIOLOGY
ALGIERS MEDICAL CENTER
Reason for visit :
Mr . Cortez is seen in follow up for ASMI , sleep apnea , coronary risk factors , glucose intolerance , obesity .
Interval History :
The patient relates that he's been feeling reasonably well .
He complains of lightheadedness when he lies down which is lasting only seconds and disappears the instant he puts his head on his pillow .
He took one TNG over the past 6 months for indigestion like sensation .
He doesn't have any exertional syndrome to suggest angina .
No syncope , pre-syncope .
No palpitations , no recent weight loss .
Social history :
Continues to work .
Looking forward to Spring work in his garden .
Change in therapies and Renewals
ASA 325 mg po qd Start : 05/08/2079
Plavix 75mg po qd Start : 05/08/2079
Toprol XL 25mg po qd Start : 05/08/2079
Lipitor 10mg po qd Start : 05/08/2079
lisinopril 10 mg po qd Start : 05/08/2079
Prilosec 20mg po qd Start : 05/08/2079
Imdur 30 mg SR po qd Start : 05/08/2079
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["05/08/2079", "2079-05-08", "Mar 19 , 2164", "Spring"], "DEVICE": [], "DLN": [], "HOSPITAL": ["ALGIERS MEDICAL CENTER"], "ID": [], "LOCATION": [], "NAME": ["Chavez , Barbara", "Cortez"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
10/25 Bruce protocol was postive at 9 minutes , 64% PMHR .
Arranged for elective cardiac catheterization with Dr Fabian Holster .
25/5/94 :
Further plan per Dr Fabian Holster and Dr Caia Brandice .
Follow up with Dr Princella Brooklyn .
42353
Signed electronically by Quintesha Marala NP on Sep 27 , 2094
Record date : 2080-11-17
63 yo M with CAD , s/p CABG x 4 in 5/80 .
He presents with pain over the lower part of his chest since Thursday #NAME ?
Coronary artery disease : s/p CABG x 4 in 5/80
Vicodin Es 08-11-1978 ( HYDROCODONE 7.5mg #NAME ?
Compared with 10/79 #NAME ?
Discussed the case with the pt's cardiologist , Dr .
Elianna Savhanna Amberlynne , M.D .
Marchelle Sessions
6144315
01/31/2077
Tela Bon , M.D .
LOWELL GENERAL HOSPITAL
1505 8Th Street
Crane , OK 40086
I would like to give you followup on our mutual patient Marchelle Sessions .
We performed a catheterization on 01/30/2077 .
I plan on seeing her again on 03/12/2077 in followup .
Ryenne Loram Allayna , MD
eScription document : 7-6195093 IFFocus
DD : 01/31/77
DT : 01/31/77
DV : 01/31/77
Record date : 2083-07-04
July 04 , 2083
Tonie Franks , M.D .
1121 Ne 2Nd Avenue
Jackson , KY 26712
RE : Fitzhugh Yi
<|output|>{"AGE": ["63"], "CONTACT": [], "DATE": ["July 04", "2080-11-17", "03/12/2077", "Sep 27", "01/31/77", "5/80", "10/25", "08-11-1978", "01/30/2077", "25/5/94", "10/79", "01/31/2077", "Thursday", "2083-07-04"], "DEVICE": [], "DLN": [], "HOSPITAL": ["LOWELL GENERAL HOSPITAL"], "ID": ["42353", "7-6195093", "6144315"], "LOCATION": ["1121 Ne 2Nd Avenue", "Crane", "Jackson", "1505 8Th Street"], "NAME": ["Ryenne Loram Allayna", "Elianna Savhanna Amberlynne", "Quintesha Marala", "Fabian Holster", "Marchelle Sessions", "Tela Bon", "Caia Brandice", "Tonie Franks", "Princella Brooklyn", "Fitzhugh Yi"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["26712", "40086"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
PAIN LEVEL ( 0-10 ) 0
FATIGUE ( 0-10 ) 0
Gen--WD , WN , NAD
HEENT : EOMI , sclerae anicteric , pink conjunctivae
Neck : supple , no LAD .
Pulm : CTAB , no W/R/R
Breasts : Right breast has no dominant mass , axilla neg .
The left breast is smaller and has a well healed incision , axilla is negative .
No dominant mass , firmer in lower quadrant .
No suspicious skin lesions .
CV : RRR , S1 , S2 , no M/G/R
Back : no spinal or CVA tenderness
Abd : Soft , nt , nd , normoactive BS , no HSM appreciated
Ext : DP 2+ ;
no C/C/E
Skin : warm , dry , no rashes or lesions
IMPRESSION AND PLAN :
Stage II endocrine sensitive breast cancer , on adjuvant endocrine therapy with anastrazole .
Reviewed her follow up schedule : needs MD visit/mammogram in six months.Further chest imaging/treatment per Dr . Vernell-Paul if needed .
Patient and her son know to call in the interim with any additional questions or concerns .
Record date : 2077-11-10
CARDIOLOGY
GLENNON MEMORIAL HOSPITAL
Xiomara B Xanthos M.D .
53 Barrington Avenue , Suite 700
Connell , MO 38438
Dear Dr . Xanthos :
I had the pleasure of seeing Mr . Milton Horne in my office today for evaluation of coronary artery disease .
As you know , he is a very pleasant 64-year-old gentleman who has a history of coronary disease , admitted to GMH in June 2077 after a non-ST-elevation MI , and had a bare-metal stent placed in his LAD .
He has done well since that procedure .
He denies any exertional chest pain , dyspnea on exertion , PND , orthopnea , pedal edema , lightheadedness , dizziness , or loss of consciousness .
Medications :
Aspirin 325 mg daily .
Atorvastatin 80 mg daily .
Metoprolol 100 mg daily .
Lisinopril 2.5 mg daily .
<|output|>{"AGE": ["64-year-old"], "CONTACT": [], "DATE": ["June 2077", "2077-11-10"], "DEVICE": [], "DLN": [], "HOSPITAL": ["GLENNON MEMORIAL HOSPITAL", "GMH"], "ID": [], "LOCATION": ["53 Barrington Avenue", "MO", "Connell"], "NAME": ["Milton Horne", "Vernell-Paul", "Xanthos", "Xiomara B Xanthos"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["38438"]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
During the first treatment , dysarthria and ataxia were seen after completion of the patient 's eighth and final dose of HDARAC .
<|output|>{"drugs": [{"name": "HDARAC", "reaction": ["dysarthria"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Preoperative Hemodynamics and Diagnostic Testing
Echo
Elizabethtown State Hospital 2/2097
ejection fraction 71%
see report in chart .
ECG
SR 1st AV Block
LBBB
75bpm
Cath report
Report Number : OW974079 Report Status : Final
Type : Cardiac Catheterization
Date : 03/08/2097 09:15
CORONARY ANATOMY FINDINGS :
Dominance : Right
Left Main : The left main coronary artery is of moderate length ,
intermediate sized vessel .
It bifurcates into the LAD and LCX coronary
arteries .
The LMCA has a 50 % stenosis in its ostium .
LAD : The Proximal LAD has a diffuse 40-50 % stenosis .
The Mid LAD has
a 50 % stenosis .
Left Circumflex : The Proximal Circumflex has a 30 % stenosis .
RCA : The right coronary artery is a dominant vessel .
The Proximal RCA
has a tubular 50 % stenosis .
Carotid Non-Invasive Study
Report Number : EPW246325 Report Status : Final
Type : Vascular Study
Date : 06/18/2096 09:00
IMPRESSION
1 . Bilateral mild 20-49% stenosis of the internal carotid arteries .
2 . No significant stenosis in the external carotid arteries bilaterally .
3 . Antegrade flow in both vertebral arteries .
Social History
Other Notes : She lives in Mendon , ID with husband .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["03/08/2097", "2/2097", "06/18/2096"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Elizabethtown State Hospital"], "ID": ["EPW246325", "OW974079"], "LOCATION": ["Mendon", "ID"], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Iron
10 .
Xanax 0.25 BID
Allergies :
1 .
PCN
2 .
Cephalosporins-hives
3 .
HCTZ
4 .
Codeine
5 .
Zoloft
6 .
Azithro
7 .
Citalopram
8 .
Sertraline
9 .
Bactrim-hives
10 .
Cipro-hives
SH : Patient lives in the Santaquin area alone .
Daughter helps her do errands .
Tob : 1 ppd x 50 yrs .
Quit 7 years ago .
EtOH : Rare
Illicits : Negative
FH : Mom died at 57 w enlarged heart and low BP
Dad had CAD and DM
5 siblings all had CABG
Exam : VS : T=98.4 HR=78 BP=134/58 RR=36 SaO2= 99%2L .
Desats into low 80s on 2L when asked to stand-up .
Also appears more dyspneic and starts using accessory muscles of respiration .
<|output|>{"AGE": ["57"], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["Santaquin"], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2094-03-14
Youssef Null
Ludlow Medical Center
82 Manatee Street
Post, IN 86454
Dear Dr. Null,
I had the pleasure of seeing Nick Hall in WSH cardiology clinic today in follow-up of his recent admission to the ICMA. While I know that you are familiar with his history, please allow me to briefly review it for my records. He is a lovely 53 year old gentleman whose history is remarkable for Hodgkins, status post mantle radiation in the early 70's; coronary artery disease, status post-PCI to the LAD and RCA in '90 and '87, respectively, and recently diagnosed squamous cell lung cancer. MIBI done at LMC 1/24/94 showed normal EF without perfusion defects (no scar or ischemia); he exercised 10:30 on a standard Bruce iwthout symptoms. He was admitted 2/94 for elective left upper lobectomy for his squamous cell lung cancer (ASA was stopped 1 week prior to surgery; he was not on plavix preop); in PACU following resection, he had a VT/VF arrest and was taken emergently to the cardiac catheterization lab, where he was found to have a massive volume of thrombus extending throughout his RCA. After extensive suction catheter use and POBA, a good angiographic result was obtained; no stents were placed due to the heightened thrombotic state that he was in. Remarkably, echocardiogram revealed normal LV systolic function, with basal inferoposterior HK noted. His peak TnI was 33.6, his peak CK was 1710, and his peak MB was 87.2. He had a relatively unremarkable course post-catheterization; plavix initiation was delayed until his chest tube was removed, after which it was started without incident. He was discharged 2/11/94, and returns today for routine follow-up.
Regarding his squamous cell lung cancer, it is my understanding that he had no evidence of metastatic disease and that margins were negative; he is not currently planned for any adjuvant therapy, but will be closely followed. Regarding his remote history of Hodgkins, he is followed at RFPC, and is due for an annual visit there in the next 1-2 months.
He has been walking outside for the past ~2 weeks (since the weather improved), walking about 2 miles in around 30 minutes. He feels well, and has had no problems. He notes some mild dyspnea with increased exertion (climbing hills), but denies any unusual dyspnea. He denies chest pain, SOB at rest, orthopnea (stable 2 pillow use), PND, edema, palpitaitons, or claudication. He brings with him a handwritten record of his recent hemodynamics - his BP runs in the 100-120's/60-80's, with rare systolics in the 130's. His heart rate has been in the 70-80's.
His past medical history includes:
CAD s/p IMI '88 (totally occluded RCA with good collaterals, revascularized with 3 stents to the RCA), MI '90 (LAD stent), inferior STEMI 2/94 as above s/p POBA
VF arrest in setting of STEMI
Hodgkin's '81 - splenectomy, XRT
LUL squamous cell cancer s/p L upper lobectomy 2/94
hyperlipidemia (low HDL and high LDL - tried niaspan in the past without much benefit)
hypothyroid
basal cell skin CA
nephrolithiasis
His medications include:
Lipitor 80 mg
Plavix 75 mg
ASA 325 mg po QD
Lopressor 200 mg po BID
Prilosec 20 mg
He has a history of intolerance (dizziness) with lisinopril.
His family history is notable for hyperlipidemia and hypertension, but negative for CAD.
He works in consulting, and travels around the Midwest as part of his job. He is now back at work. He is married, and lives in Lincoln City. He and his wife have 4 children, ages 15 / 17 / 20 / 24; they have no pets. He has never smoked cigarettes. He drinks 3 glasses of wine/week, and a cup of coffee qam.
On physical exam today, he has a heart rate of 68 and a blood pressure of 134/75. He is a well developed well nourished gentleman in no apparent distress. His JVP is flat sitting at 90 degrees, and he has no carotid bruits. His lungs are clear to auscultation bilaterally. He has a regular rate and rhythm with a normal S1 S2, and no murmurs, rubs, or gallups. His abdomen is benign. He is warm and well perfused peripherally without significant edema, and with 2+ PT pulses bilaterally.
His EKG in clinic today is NSR at 68, with possible LAE, a nonspeciifc IVCD, and inferior Q waves in III/F, consistent with an inferior MI. He has increased voltages consistent with LVH.
His recent cardiac tests include:
- echo 2/94 - EF 60%, basal inferoposterior HK, normal atrai, no significant valvular disease
- cath 2/94 - right dominant system, patent LAD stent, proximal 60% LCx, proximal 90% thrombotic RCA occlusion (in-stent) with 100% ostial R-PDA thrombotic lesion s/p Angiojet/POBA with TIMI-3 excellent angiographic result
In summary, this is a 53 year old man who had a VF arrest in the setting of perioperative inferior STEMI, status post extensive angiojet and POBA of acute in-stent thrombosis of presumed bare metal stents in his RCA. He is asymptomatic from a cardiovascular standpoint, and somewhat remarkably did not take a large myocardial hit from this life-threatening event. Our attention now shifts to the prevention of future events. Given the degree of thrombus burden in his RCA at the time of cath, he is someone for whom we would strongly advise lifelong plavix and aspirin. Furthermore, he is not someone for whom I would be comfortable with even temporary discontinuation of one of these agents - we would advise that ANY future procedures be done on aspirin and plavix. His blood pressure and heart rate are well controlled on his current regimen, as demonstrated by his home records. I have taken the liberty today of changing him from lopressor 200 bid to toprol 200 bid to minimize any ups and downs in his beta blockade, but otherwise, would not make any changes to his regimen at this time. We will check a full set of labs today, but I suspect that no further changes will be required at this time.
Given his history of Hodgkin's, as well as his known CAD, he is clearly at risk for future events, and I suspect that we will take a rather aggressive stance in terms of monitoring for ischemia. Certainly, if he has any concerning symptoms, we would have a low threshold to pursue an aggressive course. At present, however, I am delighted with how well he is doing.
It was a pleasure to see Mr. Hall in cardiology clinic today. I will plan to see him in follow-up in 6 months time, but he knows to call sooner should he have any problems or concerns.
Regards,
_____________________________________________
Florence Heather Gil, M.D., Ph.D.
CC: Dr. Nick Golden
Thoracic Surgery
Wytheville South Hospital
Dr. Paul Reilly
Riverside Family Practice Center
<|output|>{"AGE": ["53", "15", "17", "20", "24", "53"], "CONTACT": [], "DATE": ["2094-03-14", "70's", "'90", "'87", "1/24/94", "2/94", "2/11/94", "'88", "'90", "2/94", "'81", "2/94", "2/94", "2/94"], "ID": [], "LOCATION": ["Ludlow Medical Center", "82 Manatee Street", "Post", "IN", "86454", "WSH", "ICMA", "LMC", "RFPC", "the Midwest", "Lincoln City", "Wytheville South Hospital", "Riverside Family Practice Center"], "NAME": ["Youssef Null", "Null", "Nick Hall", "Hall", "Florence Heather Gil", "Nick Golden", "Paul Reilly"], "PROFESSION": ["consulting"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Flu vaccine given today
PE 1 year
f/u March - April
#NAME?
Record date : 2093-02-28
Personal Data and Overall Health
Mrs .
Barr is a 57 years old lady with multiple significant medical problems new to KEKELA .
Chief Complaint
She is here today for a Physical Exam
History of Present Illness
Patient has HO HTN for years and CVA .
She has had 4 CVAs in the past .
First one in 2087 , 2088 , 2089 and 2090 .
She was not taking her BP meds those times and she has been smoking 1 PPD since then despite being told she had to quit smoking .
She was seen at the LDC ED twice in Jan 13 and 21/05 .
First visit she was taken by her son after he couldn't take care of her anymore .
Not doing anything at home , not caring about anything .
Was seen by psych and arranged to have a PCP , spoke about therapy as well .
Then 1/21/93 seen for chest pain .
EKG negative and was D/C home .
Had a MIBI done 1/23/93
1 . Clinical Response : Non-ischemic .
2 . ECG Response : No ECG changes during infusion .
3 . Myocardial Perfusion : Normal .
4 . Global LV Function : Normal .
She states she is supposed to be on Coumadin for the strokes and she self D/C it last year .
Previous PCP at EDUCARE-FARGO Dr . Nancy Odell .
Changing to KEKELA because her son thinks she can get better help here .
She looks depressed and I mentioned that to her .
She states " I always have looked the same .
After speaking for her for 20 minutes she tells me that at age 28 she had a miscarriage of her twins .
She was jumping rope and after coming back home her husband told her if she was trying to kill the twins .
That night she had a miscarriage and one baby was born in the toilet and the otherone was taken by the EMTs .
She was 4 months pregnant .
She had therapy then and meds and felt a little better .
Her husband died 6 years ago and before he died he reminded her that she had killed his twins .
<|output|>{"AGE": ["57", "28"], "CONTACT": [], "DATE": ["21/05", "2089", "2090", "2088", "March", "1/23/93", "April", "2087", "2093-02-28", "1/21/93", "Jan 13"], "DEVICE": [], "DLN": [], "HOSPITAL": ["EDUCARE-FARGO", "KEKELA", "LDC"], "ID": [], "LOCATION": [], "NAME": ["Barr", "Nancy Odell"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Adhesive capsulitis R shoulder ;
s/p arthroscopic surgical repair 10/3/2063
5 .
May Thurner Syndrome - seen by Dr . Jones - no intervention needed
6 .
GERD
7 .
Dyslipidemia
8 .
HTN
9 .
DM2 ( diet controlled ) - HgbA1C elevated for about 3 yrs
10 .
S/p Partial hysterectomy
11 .
h/o small bowel obstruction
12 .
COPD
Allergies : Augmentin - rash
Medications ( Confirmed ):
Advair HFA
aspirin
Chantix po bid
Coumadin
Lipitor 40 mg daily
Prilosec po daily
Toprol XL 25 mg daily
Ventolin HFA PRN
Family history :
Mother : died at 72 - colon CA
Father : died at 82 - ? PNA .
Hx of DM , COPD
Siblings : 12 siblings - all alive and well
Social history :
Divorced .
3 grown children .
Works at Calista Co . , veterinarian for exotic animals .
<|output|>{"AGE": ["72", "82"], "CONTACT": [], "DATE": ["10/3/2063"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Jones"], "ORGANIZATION": ["Calista Co ."], "PHONE": [], "PROFESSION": ["veterinarian for exotic animals"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
FH : Pt .
Lives alone , no kids not married
Physical Exam :
V : 98.1 , HR 75 , rr 18 O2 97% RA
Gen : AAO x3 nad , obese well appearing gentleman
HEENT : PERRL , EOMI , sclera anicteric .
Neck : Supple , no thyromegaly , no carotid bruits , JVP
Nodes : No cervical or supraclavicular LAN
Cor : ( difficult exam , pt obease ) RRR S1 , S2 nl .
No m/r/g .
No S3 , S4
Chest : CTAB
Abdomen : +BS Soft , ND .
No HSM , slight tenderness in super pubic region .
Midline ABD scar from SP to diaphragm .
+ CVA tenderness .
Genital : Normal genital with some tenderness in the epydidimis of the right teste .
No erthema .
Ext : No C/C/E .
Diminished light touch sensation on hands and feet .
Varicosities on L leg , painful to touch .
Skin : No rashes .
Neuro : non-focal
Labs and Studies :
U/S :
IMPRESSION :
1 .
Normal pulsed and color Doppler flow within both testes ,
Without evidence for torsion .
2 .
Bilateral hydroceles and a right varicocele .
3 .
Bilateral renal cysts
Test Name SMI
07/09/93
10:21
WBC 15.5(H )
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["07/09/93"], "DEVICE": [], "DLN": [], "HOSPITAL": ["SMI"], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
18/2/85 : 07-31-1998
28/01/85 : 12-07-2007
19/5/2084 : 09-25-1980
3/13/84 : 06-25-1977
27/7/82 : 45/50/20
9/29/82 : 406-02-1981
18/2/85 : PsA ( pan sensitive "), PsA ( pan sensitive "), PsA ( pan sensitive )
28/9/84 : MRSA ( S : linezolid , synercid , tetra , tigecycline , vanco "), PsA #1pan sensitive , PsA #2 ( S : cipro , zosyn , tobra "), PsA#3 ( S : amik , azt , ceft , cipro , gent , zosyn , tobra )
3/13/84
Assessment/Plan : Mr Kemar Oda Maroney is a 42 M with cystic fibrosis and CKD presenting with subacute CF exacerbation for IV antiobiotic cleanout .
1 ) Pulm/ID : Start Ceftaz 2 g IV q 12 , Cipro 500 mg po q 12 , Vanco 1 g IV q 25
6 ) Renal : Followed by Dr Sissy Duff #NAME ?
Maricella Koerlin , PA-C 58309
I have seen and examined Mr .
Rui Coe
Record date : 2073-12-02
40768088 Lonnette Riki Galang ^ 12/02/73 ^ Virgina Grills
The patient was seen in conjunction with resident Dr .
hemodialysis Thursday , Friday , and Friday .
Last BM was Sunday evening .
SOCIAL HISTORY : She was in an acute care facility as a Education officer , museum
Virgina Grills M.D .
D : 12/03/73
T : 12/03/73
Dictated By : Virgina Grills
eScription document : 1-1031594 BFFocus
Record date : 2157-09-02
Aldine Amber
58592924
09/02/2157
Garen Mckena Ranjiv , M.D .
KAISER FND HOSP - SANTA ROSA
8902 Floyd Curl Drive
1400 East Downing Street , NE 46286
We had the pleasure of caring for your patient , Aldine Amber , during his admission to the TOMAH MEM HSPTL from 09/01/2157 to 09/02/2157 for evaluation and treatment of his anginal symptoms .
As you know , Mr .
<|output|>{"AGE": ["42"], "CONTACT": [], "DATE": ["09-25-1980", "19/5/2084", "3/13/84", "27/7/82", "09/01/2157", "28/01/85", "9/29/82", "2073-12-02", "12/03/73", "09/02/2157", "28/9/84", "Friday", "12/02/73", "Sunday", "2157-09-02", "06-25-1977", "07-31-1998", "18/2/85", "12-07-2007", "Thursday", "25"], "DEVICE": [], "DLN": [], "HOSPITAL": ["KAISER FND HOSP - SANTA ROSA", "TOMAH MEM HSPTL"], "ID": ["58592924", "40768088", "1-1031594"], "LOCATION": ["8902 Floyd Curl Drive", "1400 East Downing Street"], "NAME": ["Kemar Oda Maroney", "Sissy Duff", "Rui Coe", "Virgina Grills", "Aldine Amber", "Garen Mckena Ranjiv", "Lonnette Riki Galang", "Maricella Koerlin"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Education officer , museum"], "ZIP": ["46286", "58309"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
MVI 1tablet PO once daily
8 .
Zinc supplements
ALLERGIES :
HCTZ - > ; hyponatremia
Social History :
Lives in Waupun , AL with his mother , Haley Vaughn
Occupation : Former Motor Vehicle Assembling Supervisor .
Currently Publishing Manager .
Tobacco : Denies
EtOH : Rare .
1 drink a year .
Illicits : Denies IVDU , all illicits , including marijuana .
ROS : Please refer to HPI for pertinent positives and negatives .
General : Denies fevers , chills , general weakness .
Denies light-headedness .
Skin : No changing moles , lumps .
Sacral and scrotal wounds stable and improving
Head : Occasional migraine headaches .
Denies trauma
Eyes : No visual changes or drainage
Nose : No epistaxis , obstruction , sinusitis
Mouth : No sores , no sore throat
Resp : No wheezing , hemoptysis , shortness of breath
CV : No CP , angina , DOE , PND , orthopnea , palpitations
GI : Denies ABD pain , constipation , diarrhea .
Colostomy site with good output and without bleeding
GU : No dysuria , nocturia , hematuria , frequency , urgency , hesitancy .
Denies urinary incontinence
Neuro : No dizziness , involuntary movements , syncope , loss of coordination , paralysis
PHYSICAL EXAM
VS : T : 97.6 P : 90 ( Regular ) BP : 126/72 RR : 18 O2 Sat : 98% on R.A . Wt : 298 lbs
GEN : In NAD .
Obese .
Comfortable , lying flat in bed .
HEENT : NC/AT .
PERRL .
<|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["AL", "Waupun"], "NAME": ["Haley Vaughn"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Publishing Manager", "Motor Vehicle Assembling Supervisor"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
CHEST:clear
COR : Noemal S1 , S4+ , no S3
ABDOMEN:benign
EXT:left thigh some open wound from the previous operation ( total excision of the graft )
OTHERS :
Labs :
Chemistry Comments
Weekly pre dialysis
Plasma Sodium 133 L ( 135-145 ) mmol/L
Plasma Potassium 3.8 ( 3.4-4.8 ) mmol/L
Plasma Chloride 95 L ( 100-108 ) mmol/L
Plasma Carbon Dioxide 22.5 L ( 23.0-31.9 ) mmol/L
Plasma Urea Nitrogen 13 ( 8-25 ) mg/dl
Plasma Creatinine 5.6 H ( 0.6-1.5 ) mg/dl
Plasma Glucose 67 L ( 70-110 ) mg/dl
Hematology Detail for IORIO , OLIVIA L
MEDIQUIK BLOOD 26-Apr-2085 12:47 Accession# 2593X73037
Test Description Result Flags Ref .
Range Units
WBC 4.7 ( 4.5-11.0 ) th/cmm
HCT 27.6 L ( 36.0-46.0 ) %
HGB 8.7 L ( 12.0-16.0 ) gm/dl
RBC 2.74 L ( 4.00-5.20 ) mil/cmm
PLT 537 H ( 150-350 ) th/cumm
MCV 101 H ( 80-100 ) fl
MCH 31.6 ( 26.0-34.0 ) pg/rbc
MCHC 31.3 ( 31.0-37.0 ) g/dl
RDW 19.2 H ( 11.5-14.5 ) %
Impression and plans:because of her immunocompromised status , any synthetic graft will not be a good option .
Transposition of the basilic vein and construction of AV fistula will be indicated under general anesthesia .
Thank you for allowing me to participate in the care of this patient .
If there are any questions or concerns , please feel free to contact me at any time .
_____________________________________________
Otto Schmitt , M.D .
Record date : 2137-03-20
HIGHLAND HOSITAL VISIT
PT : Ellen Law
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["2137-03-20", "26-Apr-2085"], "DEVICE": [], "DLN": [], "HOSPITAL": ["HIGHLAND HOSITAL", "MEDIQUIK"], "ID": ["2593X73037"], "LOCATION": [], "NAME": ["IORIO , OLIVIA L", "Otto Schmitt", "Ellen Law"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Cardiac RF's : DM , HTN , smoking , age .
Denies : CP , SOB , LE edema , orthopnea , PND .
Followed by Dr Ferraro ( Cardiology ).
Mibi 1/72 : 23% , 5 mets , neg .
NQWMI 10/70 .
Cath 10/70 : 30% RCA .
NEG ETT ' 68 .
4 ) CHF .
Hospitalized 11/73 for CHF .
Denies : CP , SOB , LE edema , orthopnea , PND since D/C home .
11/73 : EF 30-35% , global hk , trace AI , trace MR , trace TR , RVH .
CXR 6/73 : " pulmonary vascular engorgment without overt pulmonary edema , ? scarring LUL " PFT's 5/73 : poor-quality study , FEV1=1.36 ( 58% ), FVC=1.93 ( 66% ), FEV1/FVC=91% .
5 ) DM .
FS=114 in clinic today .
Given CHF and increasing Cr , D/C Metformin at last visit , pt currently only on Glyburide 5mg QD .
Fasting am FS 110-124 , has not been checking post-prandial FS .
6 ) EtOH .
Pt states he is drinking 1/2 pint of rum Qwk .
Recommended that he decrease this amount .
Discussed my concern that his EtOH was contributing to his heart disease .
Problems
Diabetes mellitus
Hypertension
CAD
NQWMI
Congestive heart failure
EtOH
COPD
Smoking
BPH , Elevated PSA
Prostatic nodule
Diverticula
OA of lumbar spine
Bladder mass
Health Maintenance
Cholesterol 04/04/2073 129 ( Desirable <200 , High >240 )
Cholesterol-HDL 04/04/2073 43
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["11/73", "10/70", "6/73", "5/73", "' 68", "04/04/2073", "1/72"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Ferraro"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
______________________________________
Francine Morales , PA-C
68626
Record date : 2064-04-20
OFFICE NOTE
Uher , Olga
258-16-49-2
04/20/64
She returns to clinic for follow up .
Unfortunately she missed her
entire appointment and did not bring her blood glucose log with
her .
She reports that at 4 a.m . last Thursday she woke up and felt
disoriented with sweats .
She checked her blood glucose , it was 50 ,
and she treated herself by eating .
This led to resolution of her
symptoms , although she said that she overshoots .
She has developed
a foot infection , has been seen by a podiatrist and started on
antibiotics .
She has also been taking a thyroid hormone but she
still feels that it is making her tired .
She just in general has
not been feeling as well as she had been previously .
Past Medical History :
1 .
IDDM .
Medications : See previous notes .
Allergies : Same .
Physical Examination : Not performed .
The patient had a special
orthopedic shoe on , her foot was wrapped .
Impression : Patient with IDDM with usual blood glucoses in the
200's and an elevated A1C .
Discussed the need for consistent meals
and exercise and need for more control .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["Thursday", "2064-04-20", "04/20/64"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["258-16-49-2"], "LOCATION": [], "NAME": ["Francine Morales", "Uher , Olga"], "ORGANIZATION": [], "PHONE": ["68626"], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Antibiotic-associated colitis ( pseudomembranous colitis ) developed in four patients with spinal cord injury and taking oral trimethoprim - sulfamethoxazole .
<|output|>{"drugs": [{"name": "sulfamethoxazole", "reaction": ["colitis"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Ht : 5'6
BMI : 44.5
Weight History : long Hx obesity highest bw 285#
Activity Level : ADL's just began walking per report q other d
Maintenance Calorie Needs : "2,400kcals/d
wt .
loss kcals : "1,900kcals/d
Diet History :
Calories #NAME?
% Protein #NAME?
% Fat #NAME?
% CHO #NAME?
% Sat Fat #NAME?
mg Chol #NAME?
mg Na #NAME?
Labs : HbAIC 8.10% 8/76
SMBG qd 120-140mg
Assessment : 48 yo class III obese m .
w/ HTN , type 2 DM interested in improving bp and wt .
Notes w/ past diets difficult to be on b/c some high in Na ( atkins he tried ) and others not good for DM .
Requests "2,000kcal diet which will comply w/ his med needs .
Also on the road often for work and eats most lunches out .
Recall reveals , he is careful w/ label reading yet some inconsistencies in cho intake and high fat , high Na choices when eating out which is qd .
Reviewed all basics today including meal plan w/ consistent CHO intake , fiber , and lean pro @ each meal
Treatment Plan :
5 small meals/d
consistent CHO intake @ each meal
lean pro w/ each meal
increase fiber goal 20-35g/d
label reading <250 mg Na
"<2,400mg/d Na goal
portion control
sat fat <7% kcals
healthful eating out guidelines
regular exercise
Recommended Additional visits :
prn
<|output|>{"AGE": ["48"], "CONTACT": [], "DATE": ["8/76"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": ["atkins"], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Children with acute lymphoblastic leukemia ( ALL ) , treated with L-asparaginase are at risk for cerebral thrombosis or hemorrhage because of coagulation protein deficiencies .
<|output|>{"drugs": [{"name": "L-asparaginase", "reaction": ["cerebral thrombosis"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
PCP : Wava Lyndie ( Internal Medicine )
Speciailists : Bertie Broaden ( Cardiology)Chief Complaint Abnormal stress testHistory of Present Illness 56 yo M with a history of IDDM , hypertension , hyperlipidemia , ESRD ( on HD ), h/o DVT ( positive lupus anticoagulant ), osteoarthritis was scheduled for elective hip surgery 5/15/77 .
For his pre-operative work-up , the patient had a stress PET exam on 5/26 that was notable for a medium-sized defect of moderate intensity in the mid and basal inferior and inferolateral walls that was reversible .
As a result , the patient was referred to Dr .
WarfarinAllergies Codeine , Cephalosporins , SimvastatinFamily History Is remarkable for father at 80 years of age who has had breast and prostate cancer more than 15 years ago and has chronic lung disease currently .
His mother died at 63 years of age after an operative intervention .
The patient reports having 10 children and 21 grandchildren , three of his children have diabetes.Social History Retired on disability and previously worked for Albertson's .
O x 3 ( place , person , time ), face symmetric , fluent speech , moving all extremities , sensation grossly intactSkin No gross abnormalities Nodes/Lymphatic No LADResults 5/28
5/27
141/11-17-1970/31/801-09-1997/192 , Ca 9
4101 Nw 89Th Blvd
Stress PET : The patient's PET-CT test results are abnormal and consistent with a medium sized region of moderate dipyridamole induced peprfusion defect in the distribution of an OM coronary artery.Assessment and Plan 56 yo M with a history of obesity , diabetes , hypertension , hyperlipidemia with a positive pre-operative stress test now s/p cardiac catheterization .
- coumadinContact Info Jordis Nevins ( significant other ) 782-423-5361 Code Status FULL CODE
Record date : 2070-03-18
Medicine Junior Admit Note ( Nicki Barnacle 443 )
Name Roxann Copper
MR# 704-01-2007
Date of Admission : March 17 , 2070
Cardiologist : Bullock Cortland
PCP : Jaicee Trilla Leanthony
CC : 79 yo male former smoker , hyperlipidemia with increasing frequency of chest pain over the past 4-5 days .
79 yo male ( CRF:former smoker , HTN , obesity ) present with 4-5 days of increasing chest pain .
Pain became unbearable and patient finally presented to PULASKI MEMORIAL HOSPITAL .
Evaluated by PULASKI MEMORIAL HOSPITAL Cardiologist and transferred to MASSENA MEMORIAL HOSPITAL CCU for further workup .
2062 ETT 12 METs , 37000 PDP , no perfusion defects
FH : mother and father died of MI's at age 92 and 63 both their first
Plasma Carbon Dioxide 19.6 L ( 11-04-2003.9 ) mmol/L
Troponin-T 4.32 H ( 0.05-26-1979 ) ng/ml
HCT 36.5 L ( 410-12-2007.0 ) %
HGB 12.8 L ( 07-26-1978.5 ) gm/dl
RBC 4.28 L ( 4.511-25-1976 ) mil/cmm
MCH 29.8 ( 02-07-2008.0 ) pg/rbc
MCHC 35 ( 12-03-1970.0 ) g/dl
RDW 13.6 ( 02-23-1984.5 ) %
Superstat PT 13.3 H ( 05-16-1974.1 ) sec
Superstat APTT 29 ( 02-11-1995.1 ) sec
<|output|>{"AGE": ["80", "79", "56", "92", "63"], "CONTACT": [], "DATE": ["05-16-1974.1", "11-04-2003.9", "07-26-1978.5", "02-23-1984.5", "2062", "2070-03-18", "12-03-1970.0", "March 17", "02-11-1995.1", "5/15/77", "5/26", "5/28", "5/27", "02-07-2008.0"], "DEVICE": [], "DLN": [], "HOSPITAL": ["PULASKI MEMORIAL HOSPITAL", "MASSENA MEMORIAL HOSPITAL"], "ID": ["782-423-5361"], "LOCATION": ["4101 Nw 89Th Blvd"], "NAME": ["Jaicee Trilla Leanthony", "Wava Lyndie", "Roxann Copper", "Nicki Barnacle", "Jordis Nevins", "Bertie Broaden", "Bullock Cortland"], "ORGANIZATION": ["Albertson's"], "PHONE": ["443"], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2075-03-16
Sunday, March 16, 2075
01:42
CC: 73 yo woman admitted with recurrent hypotension preventing hemodialysis
HPI: Putting together Ms. Falon's story from her personal history, she has had type 2 diabetes for many years and is now suffering from many of the complications of that disease, including retinopathy, neuropathy and nephropathy. This lead to ESRD and hemodialysis starting 18 months ago, using a left forearm AV fistula that recently required catheter based intervention after clogging for a second time. Also related, at least in part, to her diabetic disease is coronary artery disease leading to a non-ST elevation MI in December 2074. Since then she has had bouts of what appears to be her anginal equivalent- left ear pain and a sense of fullness in her lower chest that occur at rest and are fleeting, going away before she has time to try a SLTNG. In addition, Ms. Fallon states that her blood pressures have run much lower, on occasion preventing the removal of fluid during dialysis, which leaves her edematous and more fatigued than normal. She is on a STTh HD schedule, but came to the EW four nights ago with hypotension in the setting of HD. She did not go to HD today, as her SBP was again too low. Using a home machine, Ms. Fallon recorded SBPs in the 80's and complains of frequent periods of dizziness, especially when getting up from the seated position. She is unable to lie flat 2/2 to orthopnea. She denies recent fevers, chills, SOB or chest pain. Lower extremity swelling continues to be a problem and she is complaining of left heel pain.
PMH: ESRD as a result of DM on HD, DM related retinopathy/neuropathy; h/o infected tunneled catheter; hyperparathyroidism; HTN in the past; CAD s/p NSTEMI 12/74, echo in Jan 2074 showed EF 52%; CHF; PVD with RLE ulcer followed by Dr. Archer; h/o GI bleed with negative upper endoscopy , pending colonoscopy, umbilical and hiatal hernia, cervical CA 6 years ago s/p hysterectomy; gout; benign breast tumor; h/o DVT s/p filter placement; h/ hypercalcemia, depression
PSH: TAH 6 years ago; left arm AV fistula s/p thrombectomy x 2, most recently one week ago
Medications: Allopurinol 200 po qd, Mevacor 20 po qd, Quinine 350 po BID, Concerta 3 tabs qd, Colace, Pericolace, Tylenol #3 prn, Nephrocaps 1 tab po qd, ASA 81 po qd, Lantus insulin 50 units qam, Tums 1 tab po tid with meals
Alternative meds: None
Allergies: MSO4 cause SOB; Novocaine causes seizure
Family history: Non-contributory
Social history: Lives at home with husband of 34 years, two children from previous marriage live in the area, has grandchildren. Used to work in construction.
Risks: Never use tobacco, rarely used alcohol, no injection drug use
Review of systems: (+) some vaginal blood spotting recently. No recent HA, nausea, vomiting, fevers, chills, cough, sputum production, diarrhea, melena, hematochezia, dysuria, abdominal pain.
PE: Elderly, pale woman in NAD. T 97.7 degrees, BP 117/62, HR 84, RR 24, Sat 99% on RA. HEENT: NC,ST, PERRL, EOMI, anicteric, non-injected, arcus senilis no oto/rhinorrhea, oral mucosa moist, no cervical LAD or tenderness, no thyromegaly, neck supple, no supraclavicular LAD or bruits. HEART- RRR, Nl S1 and S2, no S3, S4 or murmur. PULM- CTA bilaterally with moderate to good BS bilaterally, no wheeze, rales or rhonchi. ABD- soft, NT, ND, BS+, reducible herniano HSM or masses, no aortic, hepatic or renal bruits. EXT- Bilateral brawny edema of LE. SKIN- changes if chronic venous statis of LE with tender shallow fissure of left heel. NEURO- A/O x 3, conversant, well-formed sentences, appropriate although somewhat flat, but laughed occasionally, CN 2-12 intact, visual fields intact bilaterally, DTRs 1+ and symmetric in triceps, biceps, quads and achilles, strength 4/5 bilateral U and LE
Data: Na 136, K 5.6, Cl 96, HCO3 29, BUN 69, Cr 10.2, Glu 96, Ca 9.3, PO4 6.9, Mg 2.0, Alb 2.9; WBC 12.2 no diff, HCT 32.7, PLT 247; PT 13.5, PTT 24
ECG: NSR with occasional ectopy, RBBB and 1st degree AV block, no e/o ischemia or infarction
Imaging: CXR today shows pulmonary venous hypertension with interstitial edema and small pleural effusions bilaterally. Patchy opacity at the left lung base most likely represents alveolar edema or atelectasis.
CODE status: Unknown
Focused problem list: Hypotension limiting hemodialysis s/p MI 3 months ago, DM, neuropathy, depression
A/P: 73 year old woman with likely autonomic instability resulting from long-standing diabetes. In order to effectively counter the level of hypotension that she experiences after HD, she may benefit from interventions that will raise the systemic BP.
1) Blood pressure
- Adenosine-stress MIBI today
- If the above is OK, plant to start midodrine 5 mg po tid
2) Renal failure
- Check lytes in AM
- To HD in AM
- Already received kayexalate in EW tonight
- Increase Tums to 2 tabs po tid with meals for hyperphosphatemia
3) Vaginal spotting
- Pt has a gynecologist here at RH, will contact re: imaging vs other, esp in setting of h/o cervical CA
- HCT stable
______________________________
Keith H. Neville, M.D.
<|output|>{"AGE": ["73", "73"], "CONTACT": [], "DATE": ["2075-03-16", "Sunday, March 16, 2075", "December 2074", "S", "T", "Th", "12/74", "Jan 2074"], "ID": [], "LOCATION": ["RH"], "NAME": ["Falon", "Fallon", "Fallon", "Archer", "Keith H. Neville"], "PROFESSION": ["construction"]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
However , given the clinically significant result to the interaction between tolazoline and cimetidine we report , the use of cimetidine in tolazoline induced upper gastrointestinal hemorrhage should deserve more attention .
<|output|>{"drugs": [{"name": "cimetidine", "reaction": ["upper gastrointestinal hemorrhage"]}]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2066-03-05
INTERNAL MEDICINE ASSOCIATES
OCHILTREE GENERAL HOSPITAL
History of present illness The patient is a 53year-old male returns for diabetes and evaluation of swelling in his right testicle. He was seen on 02/20/2066, given Levaquin for orchitis versus epididymis. The patient took the medicine and was seen by Urology. By the time, he saw Urology on 03/04/2066, the swelling had mostly resolved. The patient has no pain nor urinary symptoms. Urine culture was negative. He feels fine at this time. No polyuria or polydipsia. No chest pain or shortness of breath.
Major Problems
Impotence
Degenerative arthritis
Hyperlipidemia
Diabetes mellitus (adult onset)
Change in therapies and Renewals
Viagra PRN
Avandia 4 mg 1 tab qd
Naprosyn 500 mg bid PRN
Pravachol 20 mg QD
aspirin 325 mg 1 tab qd
Levaquin 500 mg po qd x10d QTY:10 Refills:0 Start: 2/20/2066 End: 3/05/2066 - Inactivated
Physical examination
Blood pressure 138/90
Weight 209 pounds
General appearance No acute distress
Chest Lungs clear
Cor Regular rhythm. S1 and S2 normal. No murmur, S3, or S4
Abdomen Soft and nontender. No masses
Genitalia Testicles, normal sized bilaterally. No pain or no swelling. No hernia
Extrem No edema
Assessment and plan Epididymis. Resolved. Return if symptoms recur Type 2 diabetes mellitus. Check hemoglobin A1c. Continue Avandia Hyperlipidemia. Continue Pravachol
Disposition
Return in three months.
Note transcribed by outside service Transcription errors may be present.
Signed electronically by Steven Thomson on Mar 10, 2066
<|output|>{"AGE": ["53"], "CONTACT": [], "DATE": ["2066-03-05", "02/20/2066", "03/04/2066", "2/20/2066", "3/05/2066", "Mar 10, 2066"], "ID": [], "LOCATION": ["OCHILTREE GENERAL HOSPITAL"], "NAME": ["Steven Thomson"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Record date : 2092-11-16
Team D Intern Admission Note
Date : 11/16/92
_______________________________________________________________________
CC/HPI :
Pt is 76 yo F with h/o CAD , HTN , hypercholesterolemia , COPD , many pack-years of smoking , and anxiety who presents with c/o SOB .
Pt was in her usual state of health about 1 week PTA , when she noticed gradually worsening SOB and developing cough productive of scant whitish sputum .
She had no fevers/chills , prior URI symptoms/sick contacts , CP/lightheadedness , N/V/abdominal pain , diaphoresis , increasing leg swelling , or orthopnea/PND symptoms .
She thought she might be developing bronchitis , discontinued smoking and called her PCP to ask for antibiotics .
She was told to come to the clinic but her SOB progressively worsened in the few hours PTA , and she called for EMS to go to the ED .
In ED :
a .
Lasix 40 mg IV x2 , NTG paste initial SOB improvement , small UO ;
b .
Lasix 40 mg IV x 2 improved , ready for floor transfer but develops an episode of worsening SOB/flush pulmonary edema on CXR ;
c .
Lasix 160mg IV Morphine 3mg IV + CPAP Atrovent/Albuterol Zaroxylin 5mg + Lasix 200mg IV improved , on Hi-Flow O2 ;
total UO : 1,100cc .
Also received : ASA , CTX 1gm IV , Azithromax 500mg po , Atrovent/Albuterol nebs .
PMHx :
1 .
HTN
2 .
CAD [old MI by EKG/imaging]
3 .
COPD
4 .
Hypercholesterolemia
5 .
DM , type II
6 .
Recurrent UTIs [cystocele/recurrent UTI]
7 .
Chronic LE edema [Doppler NEG]
8 .
Anxiety
9 .
<|output|>{"AGE": ["76"], "CONTACT": [], "DATE": ["2092-11-16", "11/16/92"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Check orthostatics daily .
3 .
Metastatic esophageal adenocarcinoma : Patient presents with known Stage IV-B metastatic esophageal adenocarcinoma with new CT findings suggestive of disease progression , particularly in the retroperitoneum .
Has been on Taxotere for the last six months .
a .
Patient does not know of new findings , to discuss with Dr . Otero in AM .
b .
Consider alternative therapies .
4 .
Anemia : Patient presents with microcytic anemia ( MCV=73 ).
Not known to be iron-deficient .
a .
Iron studies ( Iron , Ferritin , TIBC ) to assess iron deficiency versus anemia of chronic disease .
b .
Guaiac stool for evidence of occult blood .
5 .
HTN :
a .
Check orthostatics daily .
b .
Patient is stable on current regimen .
No changes to medications .
6 .
CAD/hypercholesterolemia :
a .
Continue with Lipitor 10 mg daily
b .
Cardiac enzymes negative times one .
Per Oncology fellow , no need to cycle given stability of TW changes in EKG and lack of anginal symptoms
c .
Low fat diet
7 .
Renal vein thrombosis :
a .
Stable on Coumadin .
b .
Clarify goal INR level .
<|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Otero"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
After 1 week of nefazodone therapy the patient experienced headache , confusion , and `` gray areas `` in her vision , without abnormal ophthalmologic findings .
<|output|>{"drugs": [{"name": "nefazodone", "reaction": ["headache"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Had R AVG ( 24/05 ) , now on HD x 1 month 3/wk .
DM1 since age 8
HgbA1C 7.6 % in 9/62
GTC in October last year and per family report , in August of this year - attributed to HTN .
MRI with embolic foci in October 2061
Used to work at PACCAR Inc in Lyondell Chemical , currently unemployed .
Sodium 136 135-145 mmol/L 10/15/62 17:13
Potassium 3.5 3.4-4.8 mmol/L 10/15/62 17:13
Chloride 99L 100-108 mmol/L 10/15/62 17:13 99(L ) 10/15/62 17:13
Carbon Dioxide 30.6 11-04-2003.9 mmol/L 10/15/62 17:13
BUN 24 8-25 mg/dl 10/15/62 12:81
Creatinine 5.0H 0.6-1.5 mg/dl 10/15/62 18:86 7.7(J ) 10/15/62 17:13
Glucose 91 70-110 mg/dl 10/15/62 73:66
0.8 0.0-1.0 mg/dl 10/15/62 81:59
0.3 0-0.4 mg/dl 10/15/62 47:07
Total Protein 8 6.0-8.3 g/dl 10/15/62 61:51
Albumin 3.8 3.3-5.0 g/dl 10/15/62 83:43
Globulin 4.2H 2.6-4.1 g/dl 10/15/62 73:57 8.9(B ) 10/15/62 17:45
ALT ( SGPT ) 11 10-55 U/L 10/15/62 17:45
AST ( SGOT ) 29 10-40 U/L 10/15/62 17:45
Alk Phos 76 45-115 U/L 10/15/62 17:45
0.8 0.0-1.0 mg/dl 10/15/62 84:78
0.3 0-0.4 mg/dl 10/15/62 41:28
WBC 14.9H 03-28-1994.0 th/cmm 10/15/62 17:12 14.9(H ) 10/15/62 17:12
RBC 3.88L 4.511-25-1976 mil/cm 10/15/62 17:12 3.88(L ) 10/15/62 17:12
Hgb 14.3 07-26-1978.5 gm/dl 10/15/62 20:81
HCT 41.2 410-12-2007.0 % 10/15/62 17:12
MCV 106H 80-100 fl 10/15/62 17:12 106(H ) 10/15/62 17:12
MCH 36.8H 02-07-2008.0 pg/rbc 10/15/62 17:12 36.8(H ) 10/15/62 17:12
MCHC 34.7 12-03-1970.0 g/dl 10/15/62 38:87
PLT 839H 150-350 th/cumm 10/15/62 17:12 839(H ) 10/15/62 17:12
RDW 17.1H 02-23-1984.5 % 10/15/62 17:12 17.1(H ) 10/15/62 17:12
Differential .
RECEIVED 10/15/62 17:09
Diff Method Auto 10/15/62 17:13
Neutrophils 88H 40-70 % 10/15/62 17:13 88(H ) 10/15/62 17:13
<|output|>{"AGE": ["8"], "CONTACT": [], "DATE": ["11-04-2003.9", "October", "07-26-1978.5", "02-23-1984.5", "August", "03-28-1994.0", "October 2061", "12-03-1970.0", "10/15/62", "24/05", "9/62", "02-07-2008.0"], "DEVICE": [], "DLN": ["41:28", "8.9(B", "20:81", "18:86", "47:07", "83:43", "84:78", "38:87", "12:81", "81:59", "73:66", "7.7(J", "73:57", "61:51"], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": ["PACCAR Inc"], "PHONE": [], "PROFESSION": ["Lyondell Chemical"], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
DATA SYNTHESIS : Genetic deficiencies in DPD , the rate-limiting enzyme responsible for 5-FU catabolism , may occur in 3 % or more of patients with cancer putting them at increased risk for unusually severe adverse reactions ( e.g. , diarrhea , stomatitis , mucositis , myelosuppression , neurotoxicity ) to standard doses of 5-FU .
<|output|>{"drugs": [{"name": "5-FU", "reaction": ["diarrhea"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Discussed with Senior resident Dr .
Record date : 2097-03-15
Deangello Tiffanymarie
98102548
3/14/97
Jolyne Labrina
HPI : 61 y/o man with PMH of stage IV CKD , HTN , CAD , RAS , DM , who was admitted to the CCU on 3/26 after an episode of bradycardia and PEA arrest at home .
IMPRESSION : 61 y/o man with stage IV CKD , DM , HTN , CAD , s/p bradycardia and PEA arrest , now intubated with oligoanuric acute on chronic renal failure .
Start citrate CVVH 105-06-1993 with DFL of 50cc/hr as BP tolerates
Please order renal Netherlands .
Angie Kenner
MENDOTA MENTAL HLTH INSTITUTE Renal Fellow
Pager 6-2824
Record date : 2094-07-06
Levins Armstead Stafani
# 17 53 01
7/6/94 at 11:30 am
Mr Marylou Alexanna Mainou is admitted to Cardiology clinic s/p cath and PTCA/stent ( 2.25 x 12 Taxus ) to the LAD
This 74 yo gentleman has a hx of CAD dating back several years .
He underwent CABG x 3 in 2093 at ASHEVILLE SPECIALTY HOSPITAL after being diagnosed with CAD after presenting with symptoms of jaw pain and SOB .
He began to have symptoms of jaw pain and dypnea within a few weeks of surgery and presented to MERCY HOSPITAL OZARK where he had cath within 6 weeks of CABG - at that time his LAD graft was down and his distal LAD was stenosed .
CABG x 3 2093 ( LIMA-> ;
Retired Product/process development scientist , works for son doing Oncologist
Father with heart problems - died at 85
Impression : 74 yo with CAD , s/p CABG with early graft stenosis , now s/p PTCA/stent to mid LAD w/DES
Further plans per Dr Devika Braydn Meya
Aylward Jaquez , MS , NP-C
B 16109
Record date : 2079-01-09
Arneta Lango
6045409
01/08/79
Aina Maryland
11937 Highway 271 North A INTERN
CC/ID : 42 yo F with no known h/o CHF or CAD , but with multiple cardiac risk factors , p/w dyspnea
She underwent L knee arthroscopy for medial meniscal tear on 01/05/79 without immediate complications .
<|output|>{"AGE": ["85", "74", "42", "61"], "CONTACT": [], "DATE": ["7/6/94", "3/26", "2097-03-15", "2094-07-06", "2093", "01/05/79", "01/08/79", "2079-01-09", "3/14/97"], "DEVICE": [], "DLN": [], "HOSPITAL": ["MERCY HOSPITAL OZARK", "MENDOTA MENTAL HLTH INSTITUTE", "ASHEVILLE SPECIALTY HOSPITAL"], "ID": ["17 53 01", "98102548", "6045409"], "LOCATION": ["11937 Highway 271 North", "Netherlands"], "NAME": ["Deangello Tiffanymarie", "Marylou Alexanna Mainou", "Levins Armstead Stafani", "Angie Kenner", "Jolyne Labrina", "Aylward Jaquez", "Aina Maryland", "Arneta Lango", "Devika Braydn Meya"], "ORGANIZATION": [], "PHONE": ["16109", "6-2824"], "PROFESSION": ["Oncologist", "Product/process development scientist"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
2 ) HTN .
Pt hypertensive today .
Pt admitted upon hospitalization 11/73 that he had not been taking his meds , states he is taking them now .
Refill Atenolol/Lisinopril , increase Amlodipine to 10mg QD .
Check Chem7 .
3 ) CAD .
Cardiac RF's : DM , HTN , smoking , age .
Denies : CP , SOB , LE edema , orthopnea , PND .
Followed by Dr Ferraro ( Cardiology ).
Mibi 1/72 : 23% , 5 mets , neg .
NQWMI 10/70 .
Cath 10/70 : 30% RCA .
NEG ETT ' 68 .
Refill ASA , Atenolol , Lisinopril .
Fasting lipids WNL 4/73 ( LDL=70 ), pt did not check at last visit , check this wk .
4 ) CHF .
Hospitalized 11/73 for CHF .
Denies : CP , SOB , LE edema , orthopnea , PND since D/C home .
On PE , wt=178lb ( up 6lb ), but JVP flat , lungs CTA B , no LE edema .
11/73 : EF 30-35% , global hk , trace AI , trace MR , trace TR , RVH .
CXR 6/73 : " pulmonary vascular engorgment without overt pulmonary edema , ? scarring LUL " PFT's 5/73 : poor-quality study , FEV1=1.36 ( 58% ), FVC=1.93 ( 66% ), FEV1/FVC=91% .
Consider chest CT , referral for cardiopulmonary testing .
Refill Atenolol , Lisinopril , Torsemide .
5 ) DM .
FS=114 in clinic today .
Given CHF and increasing Cr , D/C Metformin at last visit , pt currently only on Glyburide 5mg QD .
Fasting am FS 110-124 , has not been checking post-prandial FS-encouraged him to do this .
Refill Glyburide .
Last HgbA1C=6.5 in 4/73 , pt did not check at last visit , check this wk .
Urine microalbumin <30 in 5/73 , repeat at next visit .
Pt has ophthalmology appt next month .
6 ) EtOH .
Pt states he is drinking 1/2 pint of rum Qwk .
Recommended that he decrease this amount .
Discussed my concern that his EtOH was contributing to his heart disease .
Continue to follow .
Refill Thiamine , Folate , MVit .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["11/73", "10/70", "6/73", "4/73", "5/73", "' 68", "1/72"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Ferraro"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Social History : Retired flying instructor ;
worked in private airfield .
Appears younger than stated age .
Lives with wife who is well but does not drive .
2 daughters and 2 sons .
Tob : Quit 35 years ago
ETOH : none
Family History : Mom,died due to blood disorder , .
Dad died in young age .
Has 3 siblings , all healthy without medical problems .
No family history of kidney disease , HTN , DM , heart disease , CVA , or malignancy .
Review of Systems :
Constitutional : fair energy and appetite .
weight loss of 40lb over the past year .
Pulmonary : No asthma/COPD , no pneumonias , negative TB testing .
Cardiovascular : No MI , CHF , rheumatic heart disease .
No DOE , PND , or exertional chest pain .
No history of elevated cholesterol .
Gastrointestinal : No PUD , liver disease , gallbladder disease , melana , BRBPR , diarrhea or constipation .
GU : No UTI's , strong urine stream , no hesitancy or dribbling , no kidney infections .
Endocrine : diabetes
Skin : no rashes or easy bruising
Hematologic : No history of anemia , sickle cell disease/trait
Rheumatologic : No arthritis or gout
Vascular : No history of phlebitis , clots or varicose veins
Oncologic : No history of cancer , skin cancers , papilloma , PTLD
Neurologic : No headaches , history of seizures , or stroke
Psychiatric : No history of depression , anxiety or other psychiatric disorders
PHYSICAL EXAM
Weight : 95Kg
Temp : 98.7
BP : 160/70mmHg
HR : 69/min
Gen : Pleasant man in NAD .
HEENT : sclerae non-icteric , O&P clear and moist
Neck : supple , no LAD , no thyromegaly , CVP 10-12 cm
Lungs : CTA b/l
<|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["flying instructor", "private airfield"], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2079-02-03
Educare-Pullman Team D Intern Admit Note
Patient's name: IVORY, LORI O
MRN: 2097545
Date of Admission: 02/03/79
PCP: Helen Updike
Chief Complaint: CP, SOB
History Obtained From: Pt, chart
History of Present Illness: 51 yo w w/ PMHx sig for HTN and diastolic dysfunction and recent admission with CHF in the context of HTN who presented w/ CC of SOB and CP that she said radiated down both of her arms. The pain and SOB started on the eve before admission while pt was at rest. Upon arrival of EMS pt was hypertensive to 220 by report.Given ASA, Nitros and brought to the EDUCARE-FARGO ED. Daughter describes pt to be wheezing several days PTA. Pt c/o of nausea in the ED.
Pt denies F/C/V/ diaphoresis/ palpitations/ PND/ orthopnea/ diarrhea/ BRBPR/ melena/ dysuria/ hematuria/ myalgias/ arthralgias. No recent travel or sick contacts.
Diminished exersize tolerance 2/2 knee pain. Of note, pt has been known to be poorly compliant with her medical as well as dietary regimen. Pt did say that she stopped taking her lasix close to a month ago.
ED Course: VS: T=98.7; BP=160/78; HR= 87 ; RR=20; SaO2=91 % on RA
Lopressor 5 mg IV, Lopressor 25 mg PO, Nitropaste 1 inch, ASA 325, KCL 40 mEq x 2, MgSO4 2 gm x 1, Atenolol 25 mg, Lisinopril 40 mg, Zantac, Zofran 4 mg IV
UO 1850 cc.
Floor Course: NAD, Related the history above
Review of System:
See HPI
Past Medical History:
Diastolic Dysfunction: RVSP 43, EF 67 %, no valvular or SVMA; negative Adenosine MIBI in Nov 2078
Hypertension
Obesity
Peptic ulcer disease
Status post left knee meniscal repair
Depression
Anemia
Hypercholesterolemia.
Medications:
Atenolol 25 mg po qd
Zestril 40 mg po qd,
Prozac 20 mg po qd
Ibuprofen 800 mg po tid prn pain.
Allergies: NKDA
Family History:
No known family history of CAD; + diabetes in her father.
Social history: The patient works as an Railway Transport Operations Supervisor and lives with her husband.
Tobacco: The patient quit smoking 10 years ago, but had an 8-10
pack year history prior to quitting.
Alcohol: The patient drinks and with no history of alcohol withdrawal or seizures. 5-6 beers per night on weekends with her last drink many days ago
Drugs: previous use of cocaine and pot in HS
Other: denies
Physical Exam:
VS: BP=122/60 HR=73 RR=18 SaO2=99 % on 2 L Tmax= 98.2
General: in NAD
HEENT: NCAT, PERRL, EOMI, moist mucous membranes
Neck: supple, JVP flat
Chest: CTA b/l
Cor: Reg rhythm, nl rate, nl S1, S2, no S3, S4, murmurs or rubs
Abdomen: soft, non-distended, non-tendered; BS present;
Ext: 2+ DP/PT pulses bilaterally; no pedal edema or cyanosis.
Neuro: A&O x 3; cranial nerves II-XII intact; motor and sensory functions grossly normal; non-focal exam.
Labs:
Chemistry
Lytes/Renal/Glucose
Sodium 135 135-145 mmol/L 02/02/79 23:57
Potassium 2.9L 3.4-4.8 mmol/L 02/02/79 23:57
Chloride 103 100-108 mmol/L 02/02/79 23:57
Carbon Dioxide 28.9 23.0-31.9 mmol/L 02/02/79 23:57
BUN 19 8-25 mg/dl 02/02/79 23:57
Creatinine 0.8 0.6-1.5 mg/dl 02/02/79 23:57
Glucose 146H 70-110 mg/dl 02/02/79 23:57
General Chemistries
Calcium 8.8 8.5-10.5 mg/dl 02/03/79 00:34
Phosphorus 3.5 2.6-4.5 mg/dl 02/03/79 00:34
Magnesium 1.3L 1.4-2.0 meq/L 02/03/79 00:34
Bilirubin(Total) 0.4 0-1.0 mg/dl 02/03/79 00:34
Bilirubin(Direct 0.2 0-0.4 mg/dl 02/03/79 00:34
Total Protein 7.1 6.0-8.3 g/dl 02/03/79 00:34
Albumin 3.7 3.3-5.0 g/dl 02/03/79 00:34
Globulin 3.4 2.6-4.1 g/dl 02/03/79 00:34
Liver Function Tests
ALT (SGPT) 17 7-30 U/L 02/03/79 00:34
AST (SGOT) 17 9-32 U/L 02/03/79 00:34
Alk Phos 104H 30-100 U/L 02/03/79 00:34
Bilirubin(Total) 0.4 0-1.0 mg/dl 02/03/79 00:34
Bilirubin(Direct 0.2 0-0.4 mg/dl 02/03/79 00:34
Cardiac Tests
CK-MB(quant) NEGATIVE NEG 02/03/79 08:25
Troponin-I NEGATIVE NEG 02/03/79 08:25
Hematology
Complete Blood Count
WBC 6.4 4.5-11.0 th/cmm 02/02/79 23:08
RBC 3.94L 4.00-5.20 mil/cm 02/02/79 23:08
Hgb 11.8L 12.0-16.0 gm/dl 02/02/79 23:08
HCT 33.1L 36.0-46.0 % 02/02/79 23:08
MCV 84 80-100 fl 02/02/79 23:08
MCH 29.9 26.0-34.0 pg/rbc 02/02/79 23:08
MCHC 35.7 31.0-37.0 g/dl 02/02/79 23:08
PLT 242 150-350 th/cumm 02/02/79 23:08
RDW 12.9 11.5-14.5 % 02/02/79 23:08
Blood Differential %
Differential Req RECEIVED 02/02/79 23:05
Diff Method Auto 02/02/79 23:08
Neutrophils 68 40-70 % 02/02/79 23:08
Lymphs 25 22-44 % 02/02/79 23:08
Monos 4 4-11 % 02/02/79 23:08
Eos 3 0-8 % 02/02/79 23:08
Basos 0 0-3 % 02/02/79 23:08
Blood Diff - Absolute
Neutrophil # 4.28 1.8-7.7 th/cmm 02/02/79 23:08
Lymph# 1.61 1.0-4.8 th/cmm 02/02/79 23:08
Mono# 0.27 0.2-0.4 th/cmm 02/02/79 23:08
Eos# 0.21 0.1-0.3 th/cmm 02/02/79 23:08
Baso# 0.02 0.0-0.3 th/cmm 02/02/79 23:08
Anisocytosis None NORMAL 02/02/79 23:08
Hypochromia None NORMAL 02/02/79 23:08
Macrocytes None 02/02/79 23:08
Microcytes None 02/02/79 23:08
Coagulation
Routine Coagulation
PT 12.2 11.1-13.1 sec 02/02/79 23:14
PT-INR 1.0 02/02/79 23:14
PTT 22.6 22.1-35.1 sec 02/02/79 23:19
Microbiology:
NA
Radiology:
CXRAY:
Interstitial pulmonary edema, improved from the previous
examination.
EKG: Resolution of the previously Nov-2078 present ST Elevations in V1-V2; LVH
Assessment/Plan:
51 yo F with hx of diastolc dysfunction and recent admission with flash pul edema in the setting of elevated BP, p/w similar symptoms, i.e. acute CHF in setting of severe HTN, no troponin leak, no new ischemic EKG changes
1.CARDS
-Serial EKG's
-Cardiac monitor, telemetry
- Serial Markers
-ASA, Lopressor
-BP ctrl with ACE-I & B-blocker, aiming for SBP goal of 140's-160's for overnight (BP had been as high as 220's)
-Lipitor; Check fasting lipids
-Lasix as needed; Strict I/O's, qd wt's
-No need for ECHO or Adenosine-MIBI on this admission given no new EKG changes
2. HTN:
- seems to be well controlled at this time
- if becomes difficult to control will titrate BB up and consider affing another agent
- may need to be worked up for 2/2 cause of HTN, such as RAS
3. Hx of med noncompliance:
- will need repetitive reinforcement re importance of adherence to medical regimen
- will discuss potential benefit from being plugged into the CHF clinic
- consider nutrition consult
4. Anemia
-Guaiac all stools;
- Resend iron studies, peripheral smear, retic count, folic acid, B12
- Consider transfusing idf HCT < 30
5. FEN: Low Sodium, Low Cholesterol, Low Fat Diet; Replete lytes as needed
6. Prophylaxis:
Nexium
-------------------------------
Tammy Yon, M.D. x 60562
<|output|>{"AGE": ["51", "51"], "CONTACT": ["60562"], "DATE": ["2079-02-03", "02/03/79", "Nov 2078", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/03/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "02/02/79", "Nov-2078"], "ID": ["2097545"], "LOCATION": ["Educare-Pullman", "EDUCARE-FARGO"], "NAME": ["IVORY, LORI O", "Helen Updike", "Tammy Yon"], "PROFESSION": ["Railway Transport Operations Supervisor"]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2084-03-05
77 yo F one hour late for appt. She is planning parathyroid surgery. She is supposed to be taking ca and vit. D supplements. She took the vit. D for a few days, but that is all. She has fatigue and leg cramps attrib. to hyperparathyroidism.
Medications
Premarin (CONJUGATED Estrogens) 2 GM PV QHS : SIG ONE APPLICATOR FULL AT HSX 1WK THEN TWICE PER WEEK
Ativan (LORAZEPAM) 0.5MG, 1 Tablet(s) PNGT QD
Hydralazine Hcl 25MG, 1 Tablet(s) PO BID
GLYBURIDE 5MG, 1 Tablet(s) PO QD
ATENOLOL 50MG, 0.5 Tablet(s) PO QD
Aspirin (CHILDRENS) (ACETYLSALICYLIC Aci... 81MG, 1 Tablet(s) PO QD
Stopped cozaar b/o noncoverage, stopped nifedipine b/c did not agree w/ her.
Allergies
Codeine - GI upset
Sulfa - Rash
* lisinopril - cough
Penicillins - Rash
* hctz - cramps
Problems
Diabetes mellitus - does not do home glucometry b/c thinks she knows what her sugar is w/o testing it. Recent HBA1C<7%, LDL 124.
Hypertension - no CP, SOB, HA, edema, dizziness.
Renal cancer : incidentally discovered, s/p nephrectomy
Dyspepsia/ H Pylori : unable to tolerate bismuth, TCN, metronidazole or clarithromycin and metronidazole. No sx at this time.
Thyroid nodules : biopsy benign
Plantar Fasciitis
Osteoporosis : bone density 9/11/2082
Colonic polyps : tubular adenoma. g+ stool 5/83. Refusing f/u colo.
Diverticulosis
H/O Vitamin D deficiency
SH - mostly worried about husband's health problems.
PE - appears well
BP 170/100
HR 66
Lungs clear
Cor reg w/o MRG
No edema
IMP
HyperPTH - for surgery, but we need to control her BP first. She needs to take the supplements rec. by Dr Lawson.
HTN not controlled, not adherent to rx, various barriers.
DM pr. controlled, though does not check glycemia. Needs LDL<100
Anxiety
Hx colon polyps, f/u is recommended.
Hx renal ca, rec. f/u.
H. pylori, not treated, no current sx.
PLAN:
Given rec. for Caltrate 600+D to take bid.
Rx Benicar, ARB covered by free care.
Lipitor rx.
She agrees to resume furosemide, if can skip it on days she goes out, rx to RHC.
F/U 1-2 mo, BP, breast check, order abd/pelvic CT surveillance s/p renal ca, f/u labs.
She declines colo, despite stated risk of colon ca w/ polyps, but might consider it later.
She is advised to stop the asa 10 days prior to any surgery.
_____________________________________________
Patricia Lund, M.D.
cc:Dr Lawson
<|output|>{"AGE": ["77"], "CONTACT": [], "DATE": ["2084-03-05", "9/11/2082", "5/83"], "ID": [], "LOCATION": [], "NAME": ["Lawson", "Patricia Lund", "Lawson"], "PROFESSION": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Transient neurological disturbances induced by the chemotherapy of high-dose methotrexate for osteogenic sarcoma .
<|output|>{"drugs": [{"name": "methotrexate", "reaction": ["Transient neurological disturbances"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
MVI ( MULTIVITAMINS ) 1 CAPSULE PO QD
CALCIUM CARBONATE VIT D(1TABLET=250MG E .
.
.
500 MG PO TID
FOSAMAX ( ALENDRONATE ) 70MG 1 Tablet
( s ) PO QWEEK
NITROFURANTOIN 100MG 1 Capsule
( s ) PO QD
Allergies
NKDA
Review of Systems
No change in appetite .
No F/C , cough , SOB , CP , abd pain , diarrhea , constipation , dysuria , or joint pains .
Physical Exam
BP : 140/80 Weight : 133 lbs ( up 15 lbs since 12/90 )
General Appearance
Appears healthy ;
facial swelling .
Cor/Cardiac
RRR ;
S1S2 with II/VI SEM at LLSB ;
no rubs or gallops .
Laboratory Data
Neuropsychiatric testing ( summary of results ): Dementia of mild to moderate severity ;
pattern of deficits is consistent with primary neurodegenerative process ( i.e ., Alzheimer's );
will impact her ability to function independently .
Assessment and Plan
1 . Incontinence : F/u with Dr . Xuereb after completing course of nitrofurantoin .
2 . Cardiac : Stable on metoprolol , sotalol , and digoxin .
3 . PMR : Continue low-dose prednisone .
Discussed facial bloating as side effect .
Plan according to Dr . Inge is to taper prednisone slowly over a year .
Will check ESR today .
4 . Depression : Much better .
No physical signs/sx of depression right now .
Continue Remeron .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["12/90"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Inge", "Xuereb"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Clofibrate -induced myopathy in patients with diabetes insipidus .
<|output|>{"drugs": [{"name": "Clofibrate", "reaction": ["myopathy"]}]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2084-04-12
RACHAEL G. OBRYAN, M.D.
VALLEJO GENERAL HOSPITAL
ENDOCRINOLOGY DIVISION Workman, Edwin
534 Lunar Lane 61248040
Brookshire, MO 15345 4-12-84
Referring Physician: Dr. Kenyon, Dr. Elmer Ure, Vallejo General
Cardiology.
Referring Diagnosis: Status post cardiac transplant. Rule out
osteoporosis.
HPI: Patient is a 48-year-old gentleman with a history of lymphoma,
diagnosed in 2070 when he presented with left axillary enlargement. At
the time, he was staged by bone marrow transplant which was negative.
Whether this was a Hodgkin's or non-Hodgki's lymphoma is unclear to us,
but he was treated with bleomycin, adriamycin and prednisone for
approximately 26 weeks. At that point, he was believed to be in
remission and stayed in remission since then.
In 2077, the patient was first diagnosed with diabetes mellitus when he
presented with polyuria, polydipsia and blurred vision. Subsequently he
was treated with oral hypoglycemic agents for one to two years and since
that time has been on insulin therapy, currently on 64 units of NPH and
six of regular in the morning with 30 NPH and six of regular pre-supper.
He currently checks his blood sugars four times a day and runs in the
100-200 range with average being about 130 and is followed by Dr. Nicodemus
Paz of Queenstown, WI, his primary care doctor, for this. The patient's
complications of diabetes mellitus are possibly non-existent. There is
no peripheral neuropathy. There is no autonomic neuropathy. No retinal
disease. However, the patient does have renal disease, with baseline
creatinine currently of 2.4.
Recently the patient developed congestive heart failure with initial
symptoms in the early 80s. By June of 2082, the patient had fairly
severe symptoms requiring hospitalizations and in the period of July
2082 to June of 2083, the patient apparently had 5 myocardial
infarctions. In June 2083, the patient underwent orthotopic cardiac
transplant here at the VGH under the care of Dr. Quentin Fitzpatrick. Since
that time, the patient has done very well without evidence of rejection
with relatively good exercise tolerance and with basically a minimum
degree of symptoms.
The patient's current medications include cyclosporine 150 mg. twice a
day; prednisone 8 mg. a day. Azathioprine 250 mg. a day; Axid 150 mg.
twice a day; Cardizem 300 mg. a day; baby aspirin once a day; Cardura 4
mg. once a day; and amitriptyline 25 mg. a day for cramping in his legs.
Review of Systems: Has had one fracture of his right ring finger that
was from a trauma some years ago. Other past medical history includes
history of sleep apnea and depression and the things mentioned.
RACHAEL G. OBRYAN, M.D.
VALLEJO GENERAL HOSPITAL
ENDOCRINOLOGY DIVISION Workman, Edwin
179 Lunar Lane 61248040
Brookshire, MO 15345 4-12-84
Page 2
Family History: His sister, aged 54, and mother, have osteoporosis with
his mother having fairly severe osteoporosis with a normal of vertebral
collapses and some nerve damage. His father and mother have had
diabetes mellitus, his father dying of heart disease. There is a
19-year-old daughter who has a history of migraines. There is no
history of thyroid disease in the family.
Social History: He currently works at Belkin and has a desk job
there. He quit smoking and drinking 15-20 years ago. He has been
married for over 20 years. His review of symptoms revealed the absence
of GI symptoms. There were no orthostatic symptoms, no angina. Normal
sexual function. He denied any skin problems or rashes. He denied
numbness and tingling in his feet, etc. There is a history of
hypertension.
Other review of systems: His height has been stable at 6'2" tall.
Physical Examination: Blood pressure 130/93. Heart rate 96. The
patient is a well-appearing gentleman, somewhat obese. His height is
6'2". Weight 294 lbs. which is apparently steadily been increasing. He
has a mild Cushingoid appearance with a little bit of posterior cervical
and supraclavicular fat. Retina appeared without lesions. Normal
extra-ocular movements. His oral mucosa was moist without evidence of
thrush. Neck exam: He had a supple neck with no carotid bruits.
Normal thyroid. His chest exam revealed clear lung fields with normal
excretion. There was no bony tenderness or abnormalities on his back.
His cardiac exam: He had a soft, S1, S2. Cardiac exam otherwise
unremarkable. His abdomen was soft. He had some evidence of insulin
injections, but no significant hypertrophy. He injects both in his
abdomen and rotates with his arms. His extremities revealed minimal
stasis dermatitis, normal pulses, and were symmetric. No edema.
Neurologically he was diffusely hyporeflexic. He had normal to slightly
decreased vibratory sensation in his big toes.
Laboratory Exam: Most recent laboratories that I could find were
February 09, 2084. Sodium 141. K 5.1; chloride 105. Bicarb 20. BUN
39. Creatinine 3.4; glucose 136. His CK was 219. Calcium 9.7.
Albumin 4.3; phosphate 4.0. Alkaline phosphatase was 90. Uric acid
5.1; magnesium 1.9. TSH was 1.6. Cholesterol 242. Triglycerides 226.
His cyclosporine level was in the therapeutic range at 273. His CBC
revealed a hematocrit of 43 and a white count of 8.9 thousand with a
normal differential.
Assessment and Plan: This is a 48-year-old gentleman with a history of
multiple medical problems. The one's most pertinent to us currently are
RACHAEL G. OBRYAN, M.D.
VALLEJO GENERAL HOSPITAL
ENDOCRINOLOGY DIVISION Workman, Edwin
007 Lunar Lane 61248040
Brookshire, MO 15345 4-12-84
Page 3
the fact that he is post-transplant, has several risk factors for
osteoporosis, including prednisone use and a family history of
osteoporosis. The total amount of exposure to prednisone sounds like it
is about a year-and-a-half or so with half a year during his
chemotherapy 14 years ago and then about a year since his transplant.
The patient's history of never having had fractures, no bone pain, no
height loss and his body habitus are consistent with someone who might
be somewhat more resistant to osteoporosis than many transplant
patients. However, getting a bone density study in the patient like
this makes sense. We will therefore schedule a spinal bone density on
his follow up visit, since he cannot have one today for scheduling
reasons. We will also check vitamin D levels given patient's history of
renal failure and the fact that the one thing that we might be able to
do for him is to give him vitamin D. His calcium intake was estimated
to be about 1,000 mg. a day including one cup of milk, green leafy
vegetables and one cup of ice cream each day. We would be a little
reticent about starting higher doses of calcium given his renal failure,
without more information about this patient. The patient's diabetes
seems to be in pretty good repair at the moment with blood sugars under
fairly good control, sounding like they are in the 130 range although we
don't have access to hemoglobin A1C. Given the fact that it sounds like
he has got pretty good care by Dr. Paz, we will not pursue this at
the current time unless asked, and we will focus primarily on the bone
situation. Otherwise, we will see the patient back or at least talk to
RACHAEL G. OBRYAN, M.D.
VALLEJO GENERAL HOSPITAL
ENDOCRINOLOGY DIVISION Workman, Edwin
315 Lunar Lane 61248040
Brookshire, MO 15345 4-12-84
Page 4
the patient after we get a bone density and decide when he next needs to
be seen.
______________________________
Rachael Obryan, M.D.
______________________________
Edwin Foss, M.D.
cc: Nicodemus Paz, M.D.
Queenstown, WI
Kevin Kenyon, M.D.
Cardiology
Vallejo General Hospital
49 Pheasant Lane
Brookshire, MO 15345
Elmer Ure, M.D.
Cardiology
Vallejo General Hospital
02 Pheasant Lane
Brookshire, MO 15345
WJ:KY:1946
DD:4-12-84
DT:4-13-84
DV:4-12-84
******** Approved but not reviewed by Attending Provider ********
<|output|>{"AGE": ["48", "54", "19", "48"], "CONTACT": [], "DATE": ["2084-04-12", "4-12-84", "2070", "2077", "80s", "June of 2082", "June of 2083", "June 2083", "4-12-84", "February 09, 2084", "4-12-84", "4-12-84", "4-12-84", "4-13-84", "4-12-84"], "ID": ["61248040", "61248040", "61248040", "61248040", "WJ:KY:1946"], "LOCATION": ["VALLEJO GENERAL HOSPITAL", "534 Lunar Lane", "Brookshire", "MO", "15345", "Vallejo General", "Queenstown", "WI", "VGH", "VALLEJO GENERAL HOSPITAL", "179 Lunar Lane", "Brookshire", "MO", "15345", "Belkin", "VALLEJO GENERAL HOSPITAL", "007 Lunar Lane", "Brookshire", "MO", "15345", "VALLEJO GENERAL HOSPITAL", "315 Lunar Lane", "Brookshire", "MO", "15345", "Queenstown", "WI", "Vallejo General Hospital", "49 Pheasant Lane", "Brookshire", "MO", "15345", "Vallejo General Hospital", "02 Pheasant Lane", "Brookshire", "MO", "15345"], "NAME": ["RACHAEL G. OBRYAN", "Workman, Edwin", "Kenyon", "Elmer Ure", "Quentin Fitzpatrick", "RACHAEL G. OBRYAN", "Workman, Edwin", "RACHAEL G. OBRYAN", "Workman, Edwin", "Paz", "RACHAEL G. OBRYAN", "Workman, Edwin", "Rachael Obryan", "Edwin Foss", "Nicodemus Paz", "Kevin Kenyon", "Elmer Ure"], "PROFESSION": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
One patient who received clindamycin had liver biopsy findings of marked cholestasis , portal inflammation , bile duct injury and bile duct paucity ( ductopenia ) .
<|output|>{"drugs": [{"name": "clindamycin", "reaction": ["marked cholestasis"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Pellagra should be suspected whenever tuberculous patients under treatment with isoniazid develop mental , neurological or gastrointestinal symptoms , even in the absence of typical pellagra dermatitis .
<|output|>{"drugs": [{"name": "isoniazid", "reaction": ["mental , neurological or gastrointestinal symptoms"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Renal failure is a rare complication associated with the use of rifampicin for the treatment of tuberculosis , usually occurring well into the course of therapy .
<|output|>{"drugs": [{"name": "rifampicin", "reaction": ["Renal failure"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
While most physicians are aware of heparin -induced thrombocytopenia and skin necrosis , the association of heparin and hyperkalemia is less well recognized .
<|output|>{"drugs": [{"name": "heparin", "reaction": ["thrombocytopenia"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
13 .
Chantix 1 mg p.o . b.i.d .
14 .
Vitamin-B12 "1,000 mcg ( 1 mg ) p.o . b.i.d .
15 .
Hytrin 1 mg p.o . q .
a.m . and 2 mg p.o . q .
p.m .
Allergies :
Drug allergy PERCOCET causes pruritis .
Drug reaction CODEINE causes GI upset .
No known contrast allergy
Family history :
Positive for CAD ( paternal uncle had MI , but not premature-onset ).
Positive for DM
( father ).
Negative for any known family h/o CVD or PVD .
Social history :
The patient is married and lives in Wilkes-Barre , PA with his wife .
They have 3 grown adult children and 10 grandchildren .
He is currently on permanent disability , but previously worked as a landscaper .
The patient reports smoking cessation approximately 5 months ago , which he attributes to the effects of Chantix , and reports a past h/o smoking approximately 1 pack of cigarettes per day for roughly 35 years ( with past cigarette quit attempts and change to cigars for a period of time ).
He denies any recent or regular EtOH intake , having quit several yeas ago , but reports a past h/o excessive EtOH intake .
He denies any illicit drug use .
The patient also denies any regular or structured aerobic exercise .
Review of systems :
Positive for BLE claudication , plantar foot pain bilaterally at rest , LUE pain ( related to ulnar nerve compression "), depression , and anxiety .
Negative for recent constitutional symptoms , seizures , syncope , HAs , CP at rest or with exertion , palpitations , SOB at rest , orthopnea , PND , significant or activity-limiting DOE , pyrosis , dyspepsia , N/V , hematemesis , abdominal pain , melena , recent BRBPR , dysuria , polyuria , or nocturia .
Physical examination :
#NAME? BMI : 25.1 Overweight , moderate risk
#NAME? Pulse : 83 , regular
#NAME? resp .
rate : 16 , O2 Sat 96% ( on RA )
#NAME? height : 67 in .
#NAME? weight : 160 lbs .
#NAME? General : Alert , conversant , appropriate adult male in NAD .
#NAME? Skin : Warm and dry , anicteric , with no visible rashes .
<|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["PA", "Wilkes-Barre"], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["landscaper"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
He is currently on the lisinopril with apparently good control of his pressure .
He has had hypercholesterolemia and is now doing well on Lipitor .
He does not smoke cigarettes , but he is obese .
He has no known history of MI , angina , or shortness of breath .
His other risk is notable for his family history , which includes his father who died at the age of 72 of an MI as well as leukemia .
His mother died at the age of 74 of mesothelioma , and he has two sisters and one brother who are well .
He had an echo performed on February 2 , 2085 , in anticipation of his knee surgery in March 2085 , and this was notable for a mildly dilated left ventricle with mild concentric LVH .
Overall LV function is mildly-to-moderately reduced with an estimated ejection fraction of 40% .
The entire inferior and posterior walls were akinetic and thin consistent with myocardial scar .
The apical anterior wall , apical lateral wall , and left ventricular apex were hypokinetic suggestive of myocardial hibernation or scar .
The right ventricle was normal in size and function , the left atrium was mildly dilated , the aortic valve was unremarkable , the mitral valve was slightly thickened with mild-to-moderate mitral regurgitation , and the tricuspid valve was structurally normal .
His past medical history is notable for kidney stones , which he has had over the past 10 years or so .
He has had three or four attacks , the most recent one was two years ago .
He also has the severe osteoarthritis of the lower extremities predominantly affecting the knees .
Both Achilles tendons have been damaged as well apparently .
He is anticipating knee replacement with Dr . Oates on March 23 , 2085 .
Social history is notable for no cigarette or alcohol use .
He has a convenience store and frequently eats out of it throughout the day with poor dietary habits .
His review of systems is otherwise unremarkable .
On exam , he is obese but comfortable .
Blood pressure is 150/80 , heart rate of 67 and regular , and weight of 278 pounds .
Head and neck are unremarkable .
Chest is clear .
Cardiac exam shows no jugular venous distention at 30 degrees .
PMI is normal .
S1 and S2 are normal with a physiologic split .
There is an S4 and 1/6 systolic ejection murmur at the left lower sternal border .
Abdominal exam is unremarkable without organomegaly .
The abdomen is obese .
Extremities show no edema or cyanosis .
Carotid upstrokes are normal in contour and volume without bruit .
Distal pulses are normal .
His resting 12-lead electrocardiogram demonstrates normal sinus rhythm with evidence of previous inferior MI and poor R-wave progression , V1 through V3 .
He has a superior axis likely related to the inferior MI .
The QRS is increased with nonspecific intraventricular conduction delay .
Mr .
<|output|>{"AGE": ["72", "74"], "CONTACT": [], "DATE": ["March 2085", "March 23 , 2085", "February 2 , 2085"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Oates"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["convenience store"], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2133-08-02
Stallworth Rehabilitation Hospital/Newport Bariatric Surgery Program
Postop Nutrition Assessment
Patient: Uriel Jones DOB: 1/7/74
Date:
8/2/33
Surgeon: Dr. Black Surgical date: s/p gastric bypass 5/11/33
S:
Hx: Pt was seen by his request with his wife. Pt is married and 3 children ages 27, 22, and 19. Pt lives with wife and 2 children. Pt work as Small Equipment Mechanic.
Reported diet stage: 4
Adjustments: tried soda
Issues with current diet: chix, hamburger
Food intolerance: soda in can
Nausea
no
Vomiting
yes, x1 pace, occ,
with dry chix
Diarrhea
occ loose stools
Constipation occ needs more
Hydration
needs more
Other:
24-hour dietary recall:
B: yogurt Yoplait with fruit and pb and some granola
Sn:
L:
chix, BBQ small thigh and 2 wings, brown rice
Sn: oc carrots of fruit
D:
1-2 eggs with shrimp and toast with marg and jelly
Sn: none
Beverages: G2 on walk, water, iced coffee with cream
Supplements:
most days walk, 3 miles
O:
Age: 59 y Sex: male
Ht:
5’7.5” Wt:
255#
BMI: 39.4
Previous weight: 273# 6/20/33 / 295# 5/24/33
IBW: 138-168# Excess Wt: 87-117#
Preoperative weight: 333# 1/11/33 Cumulative Wt Change: down 78#
PMH:
edema, type 2 DM, OSA with CPAP, hypercholesterolemia, HTN, cardiac myopathy, OA in knees, open chole
Medications: lantus, humalog sliding scale, Coumadin
Current meds 5/24/33: CPAP, coumadin, ASA 81 mg, K citrate, furosemide, fluoxitine, cordarone, metoprolol, glucosamine and chondroitin, lisinopril, crestor, norvasc, pepcid
Current meds 6/20/33: off lantus, humalog,
Current meds 8/2/33:
CPAP, coumadin, ASA 81 mg, K citrate, furosemide, fluoxitine, cordarone,
metoprolol, d/c glucosamine and chondroitin, lisinopril, crestor, norvasc, pepcid
Labs: to be evaluated per surgeon, BS 110 am
Prescribed diet: stage 4
Patient educational material used: Dietary Guidelines for Gastric Bypass, protein list
A:
59 y.o. male referred to nutrition followup for gastric bypass.
Weight Assessment: Pt weighs 255 lbs and is 68 inches tall with BMI of 39.4. Obesity Class: 3
Est. Energy Needs:
BMR 1940 kcal/day, ~2700-3000 cal/day for weight maintenance.
Dietary Assessment:
Pt presents with h/o edema, type 2 DM, OSA with CPAP, hypercholesterolemia, HTN, cardiac myopathy, OA in knees, open chole and morbid obesity s/p gastric bypass surgery x 3 months compliant with fluid, protein and vitamin and mineral supplementation recommendations
Pt to cont on stage 4
Issues discussed:
x Diet stage: 4 x Protein intake: 60 grams/day x Fluid intake: >64 oz/day
x Multivitamin/mineral x Calcium w/Vit D: 1200-1500 mg calcium Vitamin B12
x Slowly eating and drinking, small portion sized, healthful food choices
x Protein foods, food preparation methods
x meal planning
P:
Recommendations:
Cont diet stage: 4
Expected adherence: good
Goals: >64 ounces fluid/day, >60 grams protein/day
Cont Multivitamin/mineral daily, cont 1200-1500
mg calcium with added vitamin D daily
Use protein list as guide
Increase food variety and consistency slowly
Cont current activity, increase as able
Call or email with any questions or problems
RTC 3 months postop surg, RD
Sonja Bauer, MS, RD, LDN
8/2/33
<|output|>{"AGE": ["27", "22", "19", "59", "59"], "CONTACT": [], "DATE": ["2133-08-02", "1/7/74", "8/2/33", "5/11/33", "6/20/33", "5/24/33", "1/11/33", "5/24/33", "6/20/33", "8/2/33", "8/2/33"], "ID": [], "LOCATION": ["Stallworth Rehabilitation Hospital", "Newport"], "NAME": ["Uriel Jones", "Black", "Sonja Bauer"], "PROFESSION": ["Small Equipment Mechanic"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Heent - NC , EOMI , PERLA , no LAD , OPC
Cor - RRR , nml S1S2
Lungs-CTA b/l , no wheezing , no rhonchi
Abd - s/nt/nd , NABS
Ext - No leg edema
Neuro - A&O x 3
Today's Labs :
Date/Time NA K CL CO2
12/18/2080 131 (*) 5.2 (*) 99 28
12/17/2080 130 (*) 4.9 98 26
Date/Time BUN CRE EGFR GLU
12/18/2080 46 (*) 2.2 (*) 31 [1] 132 (* # )
12/17/2080 41 (*) 2.4 (*) 28 [2] 298 (*)
Date/Time ANION
12/18/2080 4
12/17/2080 6
Date/Time CA PHOS TBILI TP
12/18/2080 9.9
12/17/2080 9.4 2.4 0.8 7.1
Date/Time ALB GLOB LDH
12/17/2080 3.9 3.2 156
Date/Time ALT/SGPT AST/SGOT ALKP TBILI
12/17/2080 12 24 162 (*) 0.8
Date/Time LDH
12/17/2080 156
Date/Time WBC RBC HGB HCT
12/18/2080 4.58 4.02 (*) 11.3 (*) 34.5 (*)
12/17/2080 5.36 4.07 (*) 11 (*) 35.3 (*)
Date/Time MCV MCH MCHC PLT
12/18/2080 85.7 28.2 32.9 332
12/17/2080 86.8 27 31.1 (*) 314
Date/Time RDW
12/18/2080 13.4
12/17/2080 13.5
Date/Time %POLY-A %LYMPH-A %MONO-A %EOS-A
12/17/2080 72.8 17.9 (*) 7 1.9
Date/Time %BASO-A
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["12/18/2080", "12/17/2080"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Blood pressure right arm sitting 105/78 , heart rate 70 and regular , respirations 14 and unlabored , and weight is pending .
The neck is supple .
JVP is flat .
Carotids are 2+ with very soft bilateral referred murmurs .
Chest is clear .
Cardiac exam shows normal S1 , physiologically split S2 with 1/6 systolic ejection murmur radiating from the apex to the base , and a 1-2/6 holosystolic murmur radiating from the apex to the axilla .
No significant diastolic murmur or rub .
The abdomen is benign .
Extremities reveal trace bipedal edema .
Peripheral pulses are diminished but detectable .
Electrocardiogram is pending .
Impression : Ms . Vance remains relatively stable from a cardiovascular perspective .
However , as you know , her last echocardiogram did show evidence of at least moderate mitral regurgitation with significantly reduced left ventricular systolic function .
She has made it quite clear that under no circumstances would she consider repeat cardiac surgery to treat her valvular heart disease .
Nonetheless , I think it would be helpful for her to undergo repeat echocardiogram to help gauge the current status of her left ventricle and degree of regurgitation , which may allow for additional modifications to her therapeutic regimen .
Beyond this , her condition is actually relatively stable from a cardiovascular standpoint .
I have not further altered her medical regimen .
Thank you very much for allowing me to assist in her care .
Sincerely yours ,
______________________________
Timothy Quarterman , M.D .
Dictated By : Timothy Quarterman
eScription document:6-0437424 GFFocus
CC : John Koontz MD
489 MONICA STREET
MINERVA , TN 41694
DD : 05/10/73
DT : 05/11/73
DV : 05/10/73
#NAME?
Record date : 2080-09-20
EDVISIT ^ 35093053 ^ Dodd , Steven ^ 09/20/80 ^ FARMER , F . KELLY
TIME OF DICTATION : 6:40 a.m .
HISTORY OF PRESENT ILLNESS : This patient is a 65 -year-old male
who presents to Douglas Community Hospital Department of
Emergency Medicine with complaints of chest pain .
The chest pain
<|output|>{"AGE": ["65"], "CONTACT": [], "DATE": ["05/10/73", "05/11/73", "2080-09-20", "09/20/80"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Douglas Community Hospital"], "ID": ["document:6-0437424", "35093053"], "LOCATION": ["MINERVA", "TN", "489 MONICA STREET"], "NAME": ["FARMER , F . KELLY", "Vance", "Dodd , Steven", "Timothy Quarterman", "John Koontz"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["41694"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
EDVISIT ^ 93810175 ^ Mliss Anderson ^ 07/30/73 ^ Fransisca Jabs
The patient is a 61 - year-old gentleman who presents complaining
seen in conjunction with resident physician , Cleta Daisy .
The patient's management was discussed with Dr .
Fransisca Jabs M.D .
D : 07/30/73
T : 07/30/73
Dictated By : Fransisca Jabs
eScription ZWCHENID:7-8242353 IFFocus
Record date : 2092-12-01
EDVISIT ^ 61443154 ^ Luan Rumpf ^ 12/01/92 ^ Sutphin Dyer
CHIEF COMPLAINT : A 56 - year-old male with vomiting .
Sutphin Dyer MD
D : 12/01/92
T : 12/01/92
Dictated By : Sutphin Dyer
eScription document : 0-0867619 BFFocus
Record date : 2081-02-21
Reason for Visit : 67 yo M with Stage 3B lymphocyte depleted Hodgkin's who presents for cycle 3B of ABVD chemotherapy .
He was admitted to SHELBY BAPTIST MEDICAL CENTER on 27/12/80 at which point a fever workup was negative but CT scans revealed bulky lymphadenopaty in his neck and abdomen as well as splenomegaly .
He continues to go to the 2900 N River Rd daily .
Lacunar CVA in 5/78 for which he is maintained on coumadin
Former Information systems manager .
67 yo M with lymphocyte depleted HD , at least stage IIIB who presents to clinic today for cycle 3B of ABVD chemotherapy .
He agreed to improve his diabetic diet and refused meeting with a Armed forces technical officer .
Record date : 2173-03-23
Loanne Rim
REFERRING PHYSICIAN : Cleavland Matti , M.D .
DATE OF VISIT : 19/5/2173
REASON FOR VISIT : Reassessment of progress , s/p postoperative adjuvant radiation therapy in combination with concurrent chemotherapy for esophageal adenocarcinoma , T2N1 stage IIB , s/p left thoracoabdominal esophagectomy ( 28/02/69 ) with pathologic tumor stage T2N1M0 ( 5/23 involved lymph nodes ).
This treatment was administered in combination with chemotherapy between May 15 , 2170 , and Jun 16 , 2170 .
He has had about a dozen similar episodes since then , which have generally resolved within 12-31-1993 minutes without regurgitation .
In 11/69 his PCP prescribed a PPI , which helped somewhat , but he continued to have dysphagia .
On 12/02/69 EGD at HOLY SPIRIT HOSPITAL demonstrated a partially-obstructing distal esophageal mass 34-39 cm from the incisors , associated with Barrett’ ;
On 12/03/69 CT of the chest and abdomen showed prominent thickening of the distal esophagus .
On 12/07/69 repeat CT of the chest showed an 8 mm LLL nodule and R-sided pleural thickening .
<|output|>{"AGE": ["67", "56", "61"], "CONTACT": [], "DATE": ["May 15", "12/01/92", "5/23", "12-31-1993", "5/78", "2081-02-21", "Jun 16", "2092-12-01", "19/5/2173", "12/02/69", "12/03/69", "27/12/80", "2173-03-23", "11/69", "28/02/69", "12/07/69", "07/30/73"], "DEVICE": [], "DLN": [], "HOSPITAL": ["SHELBY BAPTIST MEDICAL CENTER", "HOLY SPIRIT HOSPITAL"], "ID": ["93810175", "0-0867619", "61443154", "ZWCHENID:7-8242353"], "LOCATION": ["2900 N River Rd"], "NAME": ["Mliss Anderson", "Fransisca Jabs", "Luan Rumpf", "Loanne Rim", "Cleta Daisy", "Cleavland Matti", "Sutphin Dyer"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Armed forces technical officer", "Information systems manager"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
HEPATOBILIARY : No focal hepatic lesions .
No biliary ductal dilatation .
There are stable findings of porcelain gallbladder .
SPLEEN : No splenomegaly .
PANCREAS : No focal masses or ductal dilatation .
ADRENALS : No adrenal nodules .
KIDNEYS/URETERS : No hydronephrosis , stones , or solid mass lesions .
Two left renal exophytic lesions are identified , stable in size compared with the prior examination and consistent with renal cysts .
PELVIC ORGANS/BLADDER : There is a Foley catheter in place .
There is a fibroid uterus .
PERITONEUM / RETROPERITONEUM : No free air is seen .
There is trace free fluid .
LYMPH NODES : No lymphadenopathy .
VESSELS : There are scattered vascular calcifications .
An IVC filter is in place .
GI TRACT : There is diffuse dilation of the proximal and mid small bowel with multiple air fluid levels .
There are loops of nondilated distal small bowel and the colon is not dilated .
There has been a prior a prior colostomy .
There is diverticulosis .
BONES AND SOFT TISSUES : Unremarkable .
IMPRESSION : Findings concerning for distal small bowel obstruction though no discrete transition point is identified .
Alternately , this could reflect ileus .
Close clinical follow up advised .
EKG : NSR at 94bpm , leftward axis , biatrial enlargement , normal PR interval , narrow QRS , LVH , TWIs in I , aVL
ASSESSMENT & ;
PLAN
Ms .
Wilhelm is a 74 year-old woman with a history of HOCM , hypertension , sarcoidosis , diabetes , who underwent a Hartmann’ ;
s procedure with small bowel resection on 10/18 and was re-admitted on 11/17 with a saddle PE and large RLE DVT for which she was managed with IVC filter and anticoagulation who now presents with several days of nausea and vomiting and concern for small bowel obstruction on CT .
SBO : Her clinical presentation and CT findings are concerning for small bowel obstruction ( although ileus remains a possibility .
Lactate was within normal limits so small bowel ischemia unlikely .
Also abdominal exam remains benign at this time .
Appreciate surgery input
NGT to low wall suction
NPO except meds for bowel rest
Serial abdominal exams
Check colostomy output guaiac
<|output|>{"AGE": ["74"], "CONTACT": [], "DATE": ["11/17", "10/18"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Wilhelm"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Anaphylactoid shock , disseminated intravascular coagulation , and anuric renal failure requiring dialysis occurred in a patient receiving zomepirac sodium for toothache .
<|output|>{"drugs": [{"name": "zomepirac", "reaction": ["Anaphylactoid shock"]}]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2093-01-13
Team X Intern Admission Note
Name: Hendrickson, Ora
MR# 7194334
Date: 01/13/93
PCP: Oliveira, Keith MD
CC/RFA: SOB.
HPI: Pt is a 76 yo F with a h/o CAD, HTN, hypercholesterolemia, COPD, CHF who developed acute SOB while at home PM of admission. Pt reports no dietary discretions and excellent adherence to medications. She was out evening of admission at a social gathering and noticed symptoms when she returned home and had difficulty climbing an internal staircase in her home She ascended the staircase and was unable to regain her breath. She reports she developed profound dyspnea and tachycardia. She denies chest pain, diaphoresis, dizziness or LOC. She has had a cough productive of clear sputum x 1 week with no fever, night sweats, rigors or chills during this time. She has had no vomiting or diarrhea. She does not recall wheezing, and asserts the only symptoms during the episode consisted in SOB and tachypnea.
Of note, pt had 2 vessel CABG in 11/92. Catheterization on 11/18/92 revealed 100% obstruction of the left proximal circ, 70% proximal LAD obstruction, and 100% obstruction of the mid RCA.
Course in ED:
En route to BBH pt received Lasix 40 mg, TNG x 3. She was described as pale, cool, and diaphoretic. She was unable to complete full sentences. She received Lasix 40 mg IV and 20 mg IV 2 hours later, ASA 325 x 1, Zofran 8 mg IV, and 0.5 nitropaste. Initial vitals were T 98 P 93 BP 148/67 RR 24 93 % on 6 L and 100% on BiPap (brief).
PMHx:
1. HTN
2. CAD [old MI by EKG/imaging]
3. COPD
4. Hypercholesterolemia
5. DM, type II
6. Recurrent UTIs [cystocele/recurrent UTI]
7. Chronic LE edema [Doppler NEG]
8. Anxiety
9. GERD
ALLERGIES:
Penicillin/Cephalosporins - hives
MEDS:
Atenolol 100 mg PO qd
Lipitor 10 mg po qd
Cozaar 50 mg po qd
Furosemide 20 mg po qde
Prilosec 20 mg po qd
ECASA 325 mg po qd
Nifedipine XL 60 mg po bid
Klonazepam 0.5 mg po bid
SHx: lives alone, independent with ADLs PTA
FHx: no CAD, DM, stroke
PHYSICAL EXAM:
Gen: Supine, c/o nausea.
Vitals: T 96.8 P 87 BP 132/64 RR 20 SaO2 93% 6 L NC.
HEENT: PERRL. Sclerae anicteric, conj pale. MMM, no exudates. JVP 7 cm.
Chest: Fine inspiratory crackles inf of lung field; anterior end-expiratory wheeze.
Heart: RRR. Nl S1/S2, I/VI SM. Carotid bruit on left, right clear. Left pedal pulses 1 + uniformly; right not palpable.
Abd: NABS, obese, NT, no organomegaly.
Extr: Trace pretib edema. DJD hands.
Skin: No lesions.
Neuro: No gross deficits.
LABS:
Calcium 9.0 8.5-10.5 mg/dl
Phosphorus 3.7 2.6-4.5 mg/dl
Magnesium 1.6 1.4-2.0 meq/L
Total Protein 7.9 6.0-8.0 g/dl
Albumin 3.1 3.1-4.3 g/dl
Globulin 4.8 H 2.6-4.1 g/dl
Direct Bilirubin 0.1 0-0.4 mg/dl
Total Bilirubin 0.4 0-1.0 mg/dl
Alkaline Phosphatase 293 H 30-100 U/L
Transaminase-SGPT 17 7-30 U/L
Amylase 29 3-100 units/L
Lipase 1.8 1.3-6.0 U/dl
Creatine Kinase Isoenzy 2.4 0.0-6.9 ng/ml
CPK Isoenzymes Index 0.0-3.5 %
Result Text:
CPK and/or CKMB too low to calculate Relative Index.
Troponin-T 0.01 0.00-0.09 ng/ml
Transaminase-SGOT 33 H 9-25 U/L
Creatine Kinase 40 40-150 U/L
Sodium (Stat Lab) 138 135-145 mmol/L
Potassium (Stat Lab) 3.8 3.4-4.8 mmol/L
Chloride (Stat Lab) 109 H 100-108 mmol/L
CO2 (Stat Lab) 25.0 24.0-30.0 mmol/L
BUN (Stat Lab) 14 8-25 mg/dl
Creatinine (Stat Lab) 0.8 0.6-1.5 mg/dl
Glucose (Stat Lab) 222 H 70-110 mg/dl
WBC 11.1 H 4.5-11.0 th/cmm
HCT 36.7 36.0-46.0 %
HGB 11.2 L 12.0-16.0 gm/dl
RBC 4.68 4.00-5.20 mil/cmm
PLT 313 150-350 th/cumm
MCV 78 L 80-100 fl
MCH 23.8 L 26.0-34.0 pg/rbc
MCHC 30.4 L 31.0-37.0 g/dl
RDW 15.8 H 11.5-14.5 %
Superstat PT 12.6 11.1-13.1 sec
Superstat APTT 29.4 22.1-35.1 sec
DIFFERENTIAL REQUEST RECEIVED
Diff Method Auto
Poly 73 H 40-70 %
Lymphs 23 22-44 %
Monos 2 L 4-11 %
EOS 1 0-8 %
Basos 1 0-3 %
Absolute Neuts 8.19 H 1.8-7.7 th/cmm
Absolute Lymphs 2.48 1.0-4.8 th/cmm
Absolute Monos 0.26 0.2-0.4 th/cmm
Absolute EOS 0.09 L 0.1-0.3 th/cmm
Absolute Basos 0.06 0.0-0.3 th/cmm
Aniso None NORMAL
Hypo 3+ NORMAL
Macrocytes None
Microcytes 1+
CXR:
Bilateral effusions, left > right. Pulmonary edema.
Cardiac US: 11/17/92
ANATOMIC REGION STATUS ROUTINE DIMENSIONS REGIONAL WALL MOTION
(normal) (completed only if abn.)
MITRAL VALVE ABN SEGMENT BASE MID APEX
LEFT ATRIUM ABN LA 39 (25-38mm)
AV. A0. LVOT ABN AO 33 (24-39mm) anterior
LEFT VENT. ABN LVIDd 50 (37-53mm) ant.sep.
TV. RA. VC. NORM LVIDs 39 mid.sep. H
PV. INF. PA. NORM PWT 13 ( 7-11mm) inf.sep. H H
RIGHT VENT. NORM IVS 13 ( 7-11mm) inferior A A A
IAS. IVS. ABN inf.pos. A A
COMPLEX CHD NORM EF 33 % ( >50 %) pos.lat. H
CORONARIES UV lateral
PERICARDIUM ABN
Wall Motion Abbreviations: N=Normal H=Hypokinetic A=Akinetic D=Dyskinetic
MITRAL VALVE
There is calcification of the posterior mitral annulus. There is no evidence
of mitral valve prolapse. There is mild mitral regurgitation by color and
spectral Doppler.
LEFT ATRIUM
The left atrium is dilated.
AORTIC VALVE, AORTA, LVOT
There is thickening of the bases of multiple aortic leaflets. The aortic
valve is tricuspid. There is no evidence of aortic insufficiency by color or
spectral Doppler. There are irregular echoes along the aortic wall c/w
atheroma.
LEFT VENTRICLE
The left ventricular cavity size is normal. The left ventricular systolic
function is impaired. There is symmetric left ventricular hypertrophy. There
is segmental left ventricular dysfunction (see wall motion plot). This
involves the lateral,inferior and apical territory. There is a false tendon
within the LV cavity which is a normal variant. The estimated ejection
fraction is 33 %.
TRICUSPID VALVE - IVC, SVC
There is color and spectral Doppler evidence of trace tricuspid insufficiency.
PULMONARY VALVE, INFUND., P.A.
There is evidence of trace pulmonary insufficiency by color and spectral
Doppler.
RIGHT VENTRICLE
The right ventricle is not dilated. The right ventricular systolic function
is within normal limits.
PERICARDIAL DISEASE AND EXTRACARDIAC MASSES
There is a small circumferential pericardial effusion. There is increased
intrapericardial pressure without evidence of frank tamponade. There is
diffuse fibrin deposition on the visceral pericardium. There is evidence of a
pleural effusion.
CONCLUSIONS
Compared to the report of 6/5/2089,the left ventricular systolic function is
impaired with new wall motion abnormalities. Also a new pericardial effusion
is visualized.
EKG:
NSR, 90 bpm. ST elevations V1-V6.
_______________________________________
ASSESSMENT AND PLAN:
76 yo F with PVD, CAD, s/p CABG, CHF, with acute onset SOB, likely CHF exacerbation.
CV:
Pt has diffuse CAD with propensity for failure, most likely etiology for SOB being CHF.
Pump 33%. Continue beta blocker, CCB.
Daily weights, Is and Os, diurese with goal of -0.5 liters QD.
PT/OT for chronic deconditioning 2/2 failure.
Ischemia. H/o CABG, PVD. Cont ASA, statin.
Cycle enzymes.
Serial EKGs.
AdenoMIBI to identify ischemia, assess CABG grafts, risk for failure.
Rhythm: sinus.
Place pt on monitor given hx.
DM:
Sliding scale insulin.
HTN:
Beta blockade.
Anxiety:
Uses Klonopin 0.5 mg BID.
GERD:
Prilosec.
FEN:
Cardiac diet; follow electrolytes given active diuresis.
<|output|>{"AGE": ["76", "76"], "CONTACT": [], "DATE": ["2093-01-13", "01/13/93", "11/92", "11/18/92", "11/17/92", "6/5/2089"], "ID": ["7194334"], "LOCATION": ["BBH"], "NAME": ["Hendrickson, Ora", "Oliveira, Keith"], "PROFESSION": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Severe systemic hypersensitivity reaction to ibuprofen occurring after prolonged therapy .
<|output|>{"drugs": [{"name": "ibuprofen", "reaction": ["Severe systemic hypersensitivity reaction"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Pulmonary hemorrhage is an uncommon feature in the HUS , and seems to appear especially in the HUS associated with MMC therapy .
<|output|>{"drugs": [{"name": "MMC", "reaction": ["Pulmonary hemorrhage"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Osteoarthritis
Dizziness
amputation : 3rd left toe
Depression : with psychotic features
Lumbar disc disease : s/p discectomy
Cholecystectomy : s/p open procedure
H/O Atrial fibrillation : vs . atrial tachycardia -- s/p cardioversion 2/68
Diabetes mellitus : type 2
Pulmonary embolism : bilateral ;
tx'd at Buzan Chiropractic Clinic
Myocardial infarction : NQWMI with inferolateral/apical depressions 5/31/69 - 6/04/69 at Buzan County Clinic ;
no cath or f/u ETT done there as pt requested conservative management
O : bp 144/82 r sitting .
hr 68 reg rr
20 . chest clear , cor no MRG , ext 1-2+ edema , callus on heal improved , no open areas , infection .
A/P : call to castro , message left with daughter re need to get lasix and add to med boxes asap , no message machine working and no answer with alaniz 's number .
will return 4 days to check on situation with meds .
castro will check on patient daily over that time .
_____________________________________________
Kay K . Edge ,RNC,ANP
Record date : 2115-12-14
Physical exam :
CC :
HPI : Accompanied by sister in law Amelia Travis 220-523-4413
( h );
199-683-8353
( cell ).
54 y/o female with uncontrolled DM , HTN , hyperlipidemia , left breast suspicious masses , CVD , and recent hospitalization for CVA , here for follow up and adjustment of her meds .
She does not bring in her glucometer or log book .
She does bring in some of her meds .
Denies change in appetite , problems sleeping , night sweats , fevers , headaches , visual changes , dysphagia , shortness of breath , orthopnea , PND , cough , chest pain , lower extremity edema , abdominal pain , nausea , vomiting , diarrhea , constipation , blood in stool , black stool , dysuria , nocturia , urinary or fecal incontinence , rashes , joint pain , or depressed mood .
no vaginal discharge , no pelvic pain .
Problems
s/p left leg surgery 2097
Diabetes mellitus type 2
Cerebrovascular disease : Multiple strokes on MRI
Cerebrovascular accident : 11/15
<|output|>{"AGE": ["54"], "CONTACT": [], "DATE": ["5/31/69", "2/68", "6/04/69", "2115-12-14", "2097", "11/15"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Buzan County Clinic", "Buzan Chiropractic Clinic"], "ID": [], "LOCATION": [], "NAME": ["Kay K . Edge", "alaniz", "castro", "Amelia Travis"], "ORGANIZATION": [], "PHONE": ["220-523-4413", "199-683-8353"], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Marked sinus tachycardia resulting from the synergistic effects of marijuana and nortriptyline .
<|output|>{"drugs": [{"name": "nortriptyline", "reaction": ["sinus tachycardia"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
obstruction .
He was given levofloxacin and vancomycin .
He was
also given Tylenol .
He got some IV fluids .
He had an INR of 2.6
which was about baseline .
The plan was to admit him to the
hospital .
Transplant was subsequently called .
DIAGNOSIS : Pyelonephritis .
______________________________
OCASIO , WANDA M.D .
D : 10/26/70
T : 10/26/70
Dictated By : OCASIO , WANDA
eScription document: 5-6955464 BFFocus
Record date : 2096-09-05
Stonybrook Team 2
Admission Note
PATIENT : Dalley , Wade
MRN : 5694653
ADMIT DATE : 09/05/96
PCP : Dr . Xavier
CONTACT : Dr . Xavier
CC : Diarrhea and cough
HPI : This is a 61 y.o male w/ h.o of aspiration PNA ( says he has had many bouts over past 2 yrs and though due to dyskienisa and all studies in past negative ), PE , Promyel .
Leukemia in remission since 2090 , TIA ( on coumadin 7.5mg ), dyskinesia , DM2 who presents with non productive cough x2 days w/ diarrhea and mild nausea .
Diarrhea began at 1:00am night before he was seen by PCP .
Had hamburger and hot dog the night before .
No history of C . Diff in past , was not on abx at the time , and only sick contact was wife who had bronchitis that began 2 days prior but she did not have any GI symptoms .
He was seen by PCP dr . xavier the next day who though he had a PNA and felt GI symptoms were food or PNA related .
He was started on augmentin 875/125 which did not help him .
The diarrhea worsened but denied BRPR , melena , Hematoschezia .
Colonsocopy in past only significant for diverticulosis .
He took his temp at home and was 102.8 and had episode of chills but no CP , SOB , Ab Pain , or other symptoms .
No recent travel , sputum was clear and minimal , and no hemoptysis .
<|output|>{"AGE": ["61"], "CONTACT": [], "DATE": ["10/26/70", "2096-09-05", "2090", "09/05/96"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Stonybrook"], "ID": ["5-6955464", "5694653"], "LOCATION": [], "NAME": ["OCASIO , WANDA", "Xavier", "xavier", "Dalley , Wade"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2097-01-17
Patient Name: KEATING,FRANK [ MRN: 4832978HOB ]
Date of Visit: 1/17/2097
BCH SURGERY EW EVALUATION
HPI: Mr. Keating is a 75 year-old male with a complex medical history which includes a history of a stage 4 sacral decubitus ulcer, secondary to being bedridden due to paraplegia (due to injury in 2066). His ulcer was eroding into his rectum and therefore he underwent sigmoid colostomy 8/96 for diversion. He is also s/p ileal loop urostomy in the distant past. Was seen in plastics clinic today, decub progressing well, but poor POs, referred for admission. Denies N/V, has had normal ostomy output, denies abd pain, though he did have some cramping several days ago. His main complaint is long-standing back pain. Of note, he had been readmitted about 2 weeks postop with distention and pain, CT showing partial SBO and a pelvic fluid collection, which was drained, cultures were sterile. Wife noted some discharge from midline wound several days ago, but this has ceased.
PMH: Paraplegia, secondary to compression fracture in 2066;
Cervical spondylosis;
Chronic obstructive pulmonary disease;
Coronary artery disease, status post coronary artery bypass graft times 3
in 2087;
Ileal loop, complicated by recurrent pyleonephritis;
History of transient ischemic attack, status post bilateral carotid
endarterectomies;
Hypercholesterolemia;
Insulin dependent diabetes mellitus;
Disc herniation at the L4-5, L5-S1 levels;
History of peptic ulcer disease with upper gastrointestinal bleed in 2089,
requiring packed red blood cells transfusion;
Hemorrhoids;
History of candida infection involving his ileal conduit;
Status post left tibia fracture;
Depression;
Peripheral vascular disease, status post bilateral iliofemoral bypass.
H/o Acute renal failure after cardiac catheterization
Spinal cord infarction from embolic event
PSH:
1. C5-6 and C6-7 right foraminotomy in 2081
2. Laminectomy at L4-5 and L5-S1 in 2081
3. Bilateral carotid endarterectomies in 2081
4. Coronary artery bypass grafting in 2087
5. 11/24/95 underwent bilateral iliofemoral and renal artery stent placement
6. 11/28/95 cardiac catheterization with a stent placed in the left circumflex artery
7. Diverting colostomy 8/23/96
Meds:
o SIMVASTATIN (ZOCOR ) 20 MG PO QHS Last Dose Given: 10/24/96 at 08:00 am
o CLOPIDOGREL (PLAVIX ) 75 MG PO QD Last Dose Given: 10/24/96 at 08:00 am
o ESOMEPRAZOLE (NEXIUM ) 40 MG PO QD Last Dose Given: 10/24/96 at 08:00 am
o ZOLPIDEM TARTRATE (AMBIEN ) 10 MG PO QHS PRN: insomnia
o PAROXETINE (PAXIL ) 30 MG PO QD Last Dose Given: 10/24/96 at 08:00 am
o INSULIN NPH HUMAN 10 UNITS SC QAM BEFORE BREAKFAST Last Dose Given: 10/24/96 at 08:00 am
o INSULIN NPH HUMAN 16 UNITS SC QPM BEFORE SUPPER 10/21/2096 (Thu) Routine x1 Last Dose Given: 10/23/96 at 08:00 am
o INSULIN REGULAR HUMAN Sliding Scale If BS <= 200 give 0 Units ; For BS from 201 to 250 give 4 Units ; For BS from 251 to 300 give 6 Units ; For BS from 301 to 350 give 8 Units ; For BS from 351 to 400 give 10 Units ; For BS > 400 give 12 Units and Call House MD ; SC QID (AC + HS) Last Dose Given: 10/24/96 at 12:00 pm
o OXYCODONE 5 MG/ACETAMINOPHEN 325 MG (PERCOCET 5 MG/325 MG ) 1-2 TAB PO Q4-6H PRN: pain Last Dose Given: 10/24/96 at 03:00 pm
o AMLODIPINE (NORVASC ) 5 MG PO QD Last Dose Given: 10/24/96 at 08:00 am
o LISINOPRIL (ZESTRIL ) 40 MG PO QD Last Dose Given: 10/24/96 at 08:00 am
o DALTEPARIN SODIUM (FRAGMIN ) 5000 UNITS SC QD <DI>
o METOPROLOL SUCCINATE EXTENDED RELEASE (TOPROL XL ) 400 MG PO QD <DI>
o ISOSORBIDE MONONITRATE (SR) (IMDUR ) 60 MG PO QD Last Dose Given: 10/24/96 at 08:00 am
o GABAPENTIN (NEURONTIN ) 100 MG PO QHS
All: benzocaine spray -> methgbemia
ROS: no neuro changes, weakness, slurred speech, etc
no cough, SOB
no chest pain, DOE
has been seen for penile d/c by Dr Regan, who did not think he had any active lower urinary infection
no diarrhea, vomiting
PE: 97.1 129/51 58 18 99ra
comfortable, NAD
Abd soft, NT, ND, well-healed midline incis with small dark scab, no fluctuance, no erythema, no discahrge
urostomy clean, pink; ostomy pink, viable, thin tan stool, guiaic neg
Labs:
WBC 15.3 H (4.5-11.0) th/cmm
HCT 26.2 L (41.0-53.0) %
PLT 375 H (150-350) th/cumm
Poly 87 H (40-70) %
Sodium (Stat Lab) 128 L (135-145) mmol/L
Potassium (Stat Lab) 5.0 H (3.4-4.8) mmol/L
Chloride (Stat Lab) 110 H (100-108) mmol/L
CO2 (Stat Lab) 13.8 L (23.0-31.9) mmol/L
BUN (Stat Lab) 148 H (8-25) mg/dl
Creatinine (Stat Lab) 3.2 H (0.6-1.5) mg/dl
Glucose (Stat Lab) 109 (70-110) mg/dl
LFTs, amylase, lipase, Lactic Acid all normal
Arterial pH 7.27 L (7.35-7.45)
Arterial PCO2 23 L (35-42) mm/Hg
Arterial PO2 113 H (80-100) mm/Hg
Osmolality 324 H (280-296) mOsm/kg
Urine Sodium 28 (NOTDEF) mmol/L
Urine Creatinine 0.39 mg/ml
FENA 1.73%
UA-SED-RBC 5-10 (0-2) /hpf
UA-SED-WBC 20-50 (0-2) /hpf
UA-SED-Bacteria Moderate (NEG) /hpf
CXR: clear lungs
CT (I-O+): mild R and moderate L hydro, mild perinephric fat stranding R>L, no abnormal pelvic fluid collections, no bowel thickening or abscess, some thickened distal sigmoid colon
A/P: 75yr man s/p sig colostomy for diversion, s/p IR drainage of postop collection, now with FTT, acute renal failure with FENA>1% and possible UTI, non-gap metabolic acidodis
--Check C-dif
--UTI Rx, directed towards the gram negatives he has grown in the past
--Agree with transfusion given CAD hx
--Routine ostomy care, ostomy nurse consult for any ostomy related questions. The ostomy itself appears very healthy, so I doubt the thickening represents hypoperfusion to the distal bowel
--Please contact BCH Surgical Service with any questions
______________________________
Earl N. Morrow, M.D.
<|output|>{"AGE": ["75", "75"], "CONTACT": [], "DATE": ["2097-01-17", "1/17/2097", "2066", "8/96", "2066", "2087", "2089", "2081", "2081", "2081", "2087", "11/24/95", "11/28/95", "8/23/96", "10/24/96", "10/24/96", "10/24/96", "10/24/96", "10/24/96", "10/21/2096", "Thu", "10/23/96", "10/24/96", "10/24/96", "10/24/96", "10/24/96", "10/24/96"], "ID": ["4832978"], "LOCATION": ["HOB", "BCH", "BCH"], "NAME": ["KEATING,FRANK", "Keating", "Regan", "Earl N. Morrow"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Record date : 2079-06-14
EDVISIT ^ 46103196 ^ HART , MATTHEW ^ 06/14/79 ^ NAPOLITANO , URSULA
HISTORY OF PRESENT ILLNESS : The patient is a 56 -year-old male
with a history of end-stage renal disease on hemodialysis ,
history of coronary artery disease , diabetes , hypertension , and
DVT on Coumadin who comes in to the ER because he has recently
missed dialysis appointment and he feels increased abdominal
girth and shortness of breath .
He said that his father has been
sick , so he has been spending a significant amount of time
helping him and because of that had a short dialysis on Wednesday
and missed his Friday dialysis run .
Today is Sunday and he
generally gets dialysis on Sunday as well .
When I asked if he
has been having chest pain , he says he has not had chest pain ,
but he did have a tickling in his chest that lasted seconds and
was not accompanying with any diaphoresis or radiation of the
pain .
Even he was ambulatory into the ED , he had no chest pain
when he was exerting himself .
He does feel slightly increased
shortness of breath and worse when he walks around , but he thinks
that because of increased fluids .
He has had no fevers or
chills , no lightheadedness , no nausea , vomiting and no diarrhea .
PAST MEDICAL HISTORY : End-stage renal disease on hemodialysis ,
coronary artery disease , hyperlipidemia , osteoarthritis ,
diabetes , DVT on Coumadin , hypertension , bladder cancer ,
substance abuse and GERD .
PAST SURGICAL HISTORY : AV fistula in 01/2078 .
SOCIAL HISTORY : No tobacco , rare alcohol and occasional cocaine
use .
FAMILY HISTORY : Breast cancer and prostate cancer .
REVIEW OF SYSTEMS : As mentioned in HPI , otherwise negative .
MEDICATIONS : Reviewed , please see the list .
<|output|>{"AGE": ["56"], "CONTACT": [], "DATE": ["2079-06-14", "Wednesday", "Sunday", "01/2078", "06/14/79", "Friday"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["46103196"], "LOCATION": [], "NAME": ["NAPOLITANO , URSULA", "HART , MATTHEW"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Although myelosuppression is mild , immunosuppression and superinfection are potential hazards of treatment with DCF .
<|output|>{"drugs": [{"name": "DCF", "reaction": ["immunosuppression"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Staff Cardiologist : Triplett , Jackson
Referring Physician : Avalos , Holly
History of Presenting Illness
Mrs .
Cantu is a 60 year old female with a history of peripheral arterial disease , aortic stenosis , diabetes , hypertension , hyperlipidemia , and coronary artery disease .
For the past year she has had dyspnea on exertion , especially with a flight of stairs .
She must stop at the top to rest .
She denies chest pain , lightheadedness , orthopnea , paroxysmal nocturnal dyspnea , syncope , or lower extremity edema .
A recent echocardiogram in February revealed an ejection fraction of 71% , mild mitral regurgitation , aortic stenosis with a peak gradient of 45mmHg , mean of 29mmHg , and a valve area of 0.8 sq cm .
There are no wall motion abnormalities of the left ventricle .
A stress test in February revealed a reduced exercise capacity with a small area of mild apical ischemia and ejection fraction of 77% .
A cardiac catheterization on 3/8 revealed 50% left main stenosis , 40-50% left anterior descending , 30% circumflex and 50% right coronary artery stenosis .
Aortic valve area was noted at 0.98 sq cm .
Carotid non-invasive studies revealed bilateral 20-49% stenosis .
She was referred to Dr . Gonzalez for an aortic valve replacement and coronary artery bypass graft surgery .
She presents today for preoperative testing and evaluation .
She currently notes dyspnea on exertion with two flights of stairs .
She denies chest pain , dizziness , or diaphoresis .
Indications
Dyspnea
Pre-operative risk factors
Weight
( lb ): 134.9
Height
( in ): 59
Smoker
Diabetes type : Diabetes Mellitus Type II
Diabetes Control : Oral
Dyslipidemia
Preop Creatinine : 0.71
Hypertension
Chronic Lung Disease : No
Peripheral Arterial Disease : Claudication , Arterial vascular reconstruction
Prior CV Interventions
Other Past Medical/Surgical History
Hypertension
Carotid Disease 20-49% stenosis bilaterally in the ICA bilaterally
<|output|>{"AGE": ["60"], "CONTACT": [], "DATE": ["3/8", "February"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Triplett , Jackson", "Avalos , Holly", "Cantu", "Gonzalez"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
In case no . 2 , the pathogenic mechanism seemed to be persistent light reaction preceded by systemic photoallergy , as he had taken mequitazine for 6 months , and there were strong positive photopatch test results with immediate erythema reaction , cross-reaction to promethazine promethazine , decreased MED to both UVA and UVB , and persistence of the photosensitivity over a 3-year follow-up period after discontinuation of the mequitazine .
<|output|>{"drugs": [{"name": "mequitazine", "reaction": ["erythema"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Cimetidine -induced fever .
<|output|>{"drugs": [{"name": "Cimetidine", "reaction": ["fever"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
UA-pH 7.5 ( 5.0-8.5 )
UA-WBC Screen 3+ ( NEG )
UA-Nitrite POSITIVE ( NEG )
UA-Albumin Trace ( NEG )
UA-Glucose NEGATIVE ( NEG )
UA-Ketones NEGATIVE ( NEG )
UA-Urobilinogen NEGATIVE ( NEG )
UA-Bili NEGATIVE ( NEG )
UA-Occult Blood Trace ( NEG )
UA-SED-WBC 20-50 /hpf
UA-SED-RBC 0-2 /hpf
UA-SED-Bacteria Many /hpf
UA-SED-Bladder Cells Few /hpf
UA-SED-Amorphous Crystals Many /hpf
Microbiology :
CXR : The findings are consistent with pulmonary venous hypertension with possible early interstitial edema .
Head CT :
1 . No significant change compared to prior CT Brain- 04/18/2066 .
No change in ventricle size .
No acute infarct ;
although , this is
better assessed with MR with diffusion .
2 . Patchy low attenuation areas in the centrum semiovale
bilaterally which are more prominent now and most likely are due
to chronic microangiopathic changes in this agroup .
EKG : Normal sinus rhythm , normal axis , normal intervals .
Flattened T-waves , but not changed from prior exam .
No evidence of acute ischemia .
Impression : 70 yo woman with compromised baseline neurologic function , admitted with complicated UTI and possible change in mental status .
Mental status changes : given likely undertreated UTI 8/09/66 , pt likely has recurrent complicated UTI and may have some mental status alterations from this source .
Important to rule out VP-shunt complication as cause of mental status chage , but CT appears unchanged from 4/66 .
Hyponatremia may also be contributing somewhat to mental status changes .
#NAME? will treat UTI and pursue possibility of urosepsis with blood cultures
#NAME? will check TSH and am cortisol which could also contribute to mental status changes , particularly given pts history of hypothyroidism
UTI
#NAME? likely UTI #NAME? tx
#NAME? will send blood cultures to assess for sepsis from urinary source
<|output|>{"AGE": ["70"], "CONTACT": [], "DATE": ["8/09/66", "4/66", "04/18/2066"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Plasma Carbon Dioxide 39.8 H ( 23.0-31.9 ) mmol/L
Plasma Anion GAP 9 ( 3-15 ) mmol/L
Calcium 9.8 ( 8.5-10.5 ) mg/dl
Phosphorus 4.4 ( 2.6-4.5 ) mg/dl
Magnesium 1.8 ( 1.4-2.0 ) meq/L
Plasma Urea Nitrogen 51 H ( 8-25 ) mg/dl
Plasma Creatinine 1.04 ( 0.60-1.50 ) mg/dl
eGFR 57 mL/min/1.73m2
Plasma Glucose 183 H ( 70-110 ) mg/dl
Total Protein 7.4 ( 6.0-8.3 ) g/dl
Albumin 3.9 ( 3.3-5.0 ) g/dl
Globulin 3.5 ( 2.3-4.1 ) g/dl
Direct Bilirubin 0.2 ( 0-0.4 ) mg/dl
Total Bilirubin 0.5 ( 0.0-1.0 ) mg/dl
Alkaline Phosphatase 88 ( 30-100 ) U/L
Transaminase-SGPT 13 ( 7-30 ) U/L
NT-proBNP 42 ( 0-900 ) pg/ml
Transaminase-SGOT 15 ( 9-32 ) U/L
Lipase 20 ( 13-60 ) U/L
WBC 13 H ( 4.5-11.0 ) th/cmm
HCT 32.8 L ( 36.0-46.0 ) %
HGB 11 L ( 12.0-16.0 ) gm/dl
RBC 4.13 ( 4.00-5.20 ) mil/cmm
PLT 286 ( 150-400 ) th/cumm
MCV 80 ( 80-100 ) fl
MCH 26.5 ( 26.0-34.0 ) pg/rbc
MCHC 33.4 ( 31.0-37.0 ) g/dl
RDW 17.6 H ( 11.5-14.5 ) %
Diff Method Auto
Poly 85 H ( 40-70 ) %
Lymphs 8 L ( 22-44 ) %
Monos 6 ( 4-11 ) %
EOS 1 ( 0-8 ) %
Basos 0 ( 0-3 ) %
MICROBIOLOGY :
Blood cultures and urine cultures from ED on 3/4 pending
No respiratory sample sent .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["3/4"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
3 . Thus , the decreased plasma cortisol level during alprazolam treatment of panic disorder was suggested to be caused not by symptom alleviation due to alprazolam but by alprazolam administration itself .
<|output|>{"drugs": [{"name": "alprazolam", "reaction": ["decreased plasma cortisol level"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
( 2 ) Cigarette smoking .
Discussed .
( 3 ) Hypertension .
Under good control .
( 4 ) Elevated lipids .
Will check FLP .
( 5 ) Worried about dementia .
Will check B12 , TSH , RPR for now .
( 6 ) Status-post knee replacement .
Gets occasional Vicodin from his
orthopedist .
Says he wanted 8 Percocet for the next month or two
that he will take on rare occasions when his pain is more severe , and I
did give him 8 Percocet .
P : Follow up with Dr . Hobbs in 3 months .
Gilbert P . Perez , M.D .
GPP / church / olinger
#NAME?
Record date : 2092-10-05
OFFICE NOTE
Rickey George
MR# 1131414
October 5 , 2092
Reason for visit : scheduled follow up status post MCH hospitalization .
PROBLEMS :
PVD : since last visit he was admitted to MCH with gangrene in his left second toe .
Admitted MCH 8/29 through 9/9/92 .
Treated by Dr . Randall .
Underwent extensive revascularization including right common and external artery transluminal balloon
angioplasty and stenting , bilateral common and profunda femoral artery
endarterectomies , right and left femoral to femoral bypass graft , left femoral to above
knee popliteal bypass graft .
With this surgery , only his left second toe remained
gangrenous and he was able to avoid BKA .
He will likely either auto-amputate or will require amputation of his left second toe
which remains gangrenous but he has reasonable perfusion to the remainder of his left
foot and has follow up scheduled next week with Dr . Randall .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["8/29", "9/9/92", "October 5 , 2092", "2092-10-05"], "DEVICE": [], "DLN": [], "HOSPITAL": ["MCH"], "ID": ["1131414"], "LOCATION": [], "NAME": ["olinger", "Rickey George", "church", "GPP", "Hobbs", "Randall", "Gilbert P . Perez"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2149-01-11
MS III Admission Note
Patient: Eubanks, Larry
MRN: 7744323
DOB: 10/03/2080
Admit Date: 01/10/49
PCP: Talbert, Nicholas (783)508-2821
Sources: Patient, wife, reliable; past medical records from Pennsylvania Hospital
CC: chest pain
HPI:
Mr. Eubanks is a 68 year-old man with hypertension, mild diabetes mellitus type II, and gout who presents with 2 hours of burning chest pain prominent in the left anterior chest and radiating to both arms and to the center of the back.
In addition to HTN and DM, Mr. Eubanks cardiac risk factors include a family history of CAD (brother, sister) and prior history of mild, spontaneously resolving chest pain in early 2147. He received a cardiac workup for the chest pain including baseline EKG, exercise tolerance test, and Myoview study. Baseline EKG was unremarkable with normal sinus rhythm but the ETT was positive with inverted T waves, ST segment downsloping depressions in the anterolateral and inferior leads, and PVC s in recovery. The patient had no chest pain and good exercise capacity during the ETT, which was terminated after 9 minutes because of leg fatigue. On the Myoview study, a small area of ischemia with possibly minimal scaring was noted in the inferior wall although wall motion was normal. Estimated left ventricular ejection fraction was 62%. A subsequent exercise echo was normal. Baseline blood pressures at the time of the workup measured 160/68 with systolic pressures noted as high as 180. His blood pressure has been since controlled on atenolol and was measured per patient account to be around 148/80 at his most recent visit to his PCP in August. Hemoglobin A1C in 2147 was 6.2 and diabetes has been managed with only diet. He was previously using daily aspirin but stopped in October 2148 for a dermatologic surgery and did not restart.
Mr. Eubanks was in his usual state of health until 3 days prior to admission when he developed two episodes of low grade chest pain, once in the morning and once in the evening. These episodes lasted only 1-2 minutes, and seemed to him to be related to his ongoing issues with gout. The chest pain was not associated with shortness of breath and seemed to improve with indomethacin, which he typically takes for acute exacerbations of gout. His course over the next two days was unremarkable and he went to bed comfortable the night prior to admission. He was awakened near 3 am by 8/10 burning chest pain and pressure in the left anterior chest and radiating to both arms and to the center of his back but not to the neck or jaw. Associated with the chest pain were chills and a feeling of increased heart rate although the patient denies shortness of breath, sweating, nausea or vomiting, headache, lightheadedness, fever, or vision changes. The pain persisted for 2 hours without improvement or alleviating factors, prompting the patient to have his wife drive him to BBH ED from his Cheney home.
Review of systems was positive for polyuria, increased thirst, mild non-productive cough, post-nasal drip, and intermittent mild diarrhea in past months. The patient denies recent or past history of edema, GERD, claudication, clots, hemoptysis, hematemesis, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, wheezing, fatigue, appetite or weight changes, or night sweats.
In the emergency department, the patient was given aspirin, lopressor, sublingual nitroglycerin, and 2L O2 by nasal cannula, and chest pain subsequently resolved. EKG on presentation showed a poor baseline in sinus rhythm with ventricular ectopy. Subsequent EKG s revealed continued PVC s and PAC s with biphasic T-waves in V4-5. A chest x-ray was negative for pneumonia or acute CHF and showed no evidence of widened mediastinum. CT scans with and without contrast which were negative for aortic dissection. Cardiac enzymes x 2 sets were negative, but D-dimer was elevated at 816. Stool sample was guiac positive, although CBC was stable with HCT 44.6.
PMH:
Hypertension, treated with atenolol
Diabetes mellitus type II, managed with diet
Gout, treated with colchicine and indomethacin
Basal cell carcinoma on right ear, s/p excision in Oct 2148
Recurrent sinusitis
PSH:
Basal cell carcinoma excision, Oct 2148
Nasal septum repair
Meds (on admission):
Atenolol (dose unknown)
Colchicine 5 mg qday
Indomethacin 50 mg prn gout exacerbation
Allergies:
Allopurinol hives
Hay fever
FH:
Patient has relatively poor recollection of his family history.
Mother: died at 89 yo, h/o heart disease requiring pacemaker, osteoporosis
Father: died young of brain tumor
Brother: died of cardiac arrest March 2147; h/o catheterization with stent
Sister: probable heart disease
Grandparents: grandmother lived into 80s
SH:
Non smoker
Occupational exposures (i.e. mold) through work as an economic policy analyst
Social drinker, very mild
Denies IV or other drug use
Denies sick contacts, remarkable travel history
Lives at home with wife; has two children 18, 25
Happy, does not have problems with mood
ROS: As above in HPI. Also hearing changes, dizziness, sore throat, neck stiffness, palpitations, dysphagia, diarrhea, constipation, melena, hematachezia, dysuria, hematuria, weakness, leg swelling, easy bruising, bleeding from gums, epistaxis, heat/cold intolerance, changes in mood or sleep habits.
PE:
VS: Tm , Tc , HR , BP , RR , O2 Sat
General: NAD, lying in bed
Derm: Small, red, macular spots diffusely on back, non-tender
HEENT: Conjunctivae clear, sclerae anicteric, mucous membranes moist, oropharynx benign, no ptosis.
Pupils equal, round, and reactive to light. Extra-ocular movements intact.
Oral: Dentition intact. Tongue midline.
Neck: Supple, full range-of-motion, no thyroid enlargement or masses, trachea midline, no lymphadenopathy, carotid pulses 2+ bilaterally and no bruits
Breasts: No gynecomastia
Chest/Back: Chest wall non-tender, Spine non-tender w/o deformity. No costovertebral-angle tenderness.
Lungs: Respirations unlabored without accessory muscle use. Symmetrical bilateral diaphragmatic excursions. Clear to auscultation bilaterally.
CV: Regular rate and rhythm with distant S1 and S2. Physiologically split S2. Multiple PVC s detectable. No murmurs, gallops or rubs. No heaves, thrusts or thrills. 2+ Carotid pulses. JVP flat.
Abdomen: + bowel sounds, soft, non-tender, non-distended, no rebound or guarding, no hepatosplenomegaly.
Rectal Exam: Guaiac + stools in ED.
Extremities: No cyanosis, clubbing or edema, warm and well-perfused. No cords or tenderness to palpation. Negative Homans sign. 2+ radial, femoral, PT and DP pulses bilaterally. 5/5 strength bilaterally in upper and lower extremities.
Genital: Deferred.
Musc/skel: Joints non-focal, full range-of-motion, minimal swelling and erythema in left big toe.
Neuro: AOX3 and grossly non-focal. CN II-XII intact. Motor and sensory exams unremarkable. 2+ patellar DTR s. Negative Babinski.
Labs:
Chemistry (01/10/49 05:39): Na 141, K 3.7, Cl 103, HCO3 27.3, BUN 19, Cr1.1,
Glu 159, Ca 9.4, Mg 1.4, PO4 3.5
Hematology (01/10/49 05:39): WBC 6.2 (59% poly, 30% lymphs), Hct 44.6, Plt 174, MCV 85, RDW 13.5, PT 12.7, PTT 28.1, INR 1.1, D-Dimer 816
U/A (01/10/49 06:54): pH 5.0, sp grav 1.010, neg WBC, 1+ bld, 1+ prot, neg nitrite.
Cardiac Enzymes (01/10/49)
01/11/49 01/10/49 01/10/49 01/10/49 01/10/49
00:03 15:16 08:27 05:39 05:36
NT-BNP 440(T)
CK 53(L)
CK-MB Negative Negative
TROP-I Negative Negative
TROP-T 0.04 0.01
Diagnostic Studies:
EKG (01/10/49): Serial studies. Normal sinus rhythm with multiple PVC s, evolving to TWI in V4-V5
CXR (01/10/49): No acute CHF or pneumonia. Subsegmental atelectasis involving the right lower lung.
CT (01/10/49): With and without contrast. No evidence of aortic dissection. 5 mm left lower lobe pulmonary nodule, for which three month follow up chest CT is recommended to exclude malignancy. Choelithiasis without cholecystitis. Punctate calcification in the left kidney, without evidence for hydroureteralnephrosis, likely vascular, though renal calculus is possible.
Assessment:
Mr. Eubanks is a 68 year-old man with HTN, DM II, and gout, who presents with 2 hours of severe chest pain. The differential for chest pain is broad and includes cardiac ischemia, myocardial infarction, aortic dissection, pneumothorax, pulmonary embolus, bronchitis, pleurisy, GERD/esophageal spasm, musculoskeletal/chest wall pain, and anxiety. The sudden onset of severe chest pain, awaking him from sleep, raises the probability of an acute cardiac or pulmonary event such as MI, aortic dissection, or PE. The patient has elevated D-Dimer but otherwise lacks physical exam findings (dyspnea, pleuritic chest pain, cough, hemoptysis, tachypnea, signs of DVT) or CT/CTA imaging features consistent with pulmonary embolism. The patient s HTN is a risk factor for aortic dissection, but this diagnosis can be ruled out by negative CXR and CTA scans, which have 80 95% sensitivity. In addition, he lacks a number of other clinical manifestations of dissection, including syncope, pulse deficits, and new murmur. The distribution of the pain is anginal in distribution and is relieved by nitroglycerin + aspirin. Moreover, the patient has had two similar but less severe attacks a few days ago, and has multiple cardiac risk factors. This makes unstable angina or myocardial infarction the most likely diagnosis.
EKG changes lacked ST segment elevation, although T-wave inversions were present in some leads. The patient s cardiac enzymes were negative from the ED x 2 sets with a third troponin negative on the floor. The patient may have either a non-ST elevation MI or unstable angina. The plan will be to continue monitoring closely for chest pain and EKG changes, with the next step likely to involve stress test or catheterization in the morning tomorrow. Cardiology is following closely and has provided recommendations that are incorporated into the plan.
Plan:
1. Chest pain
Telemetry, cardiac monitor
Troponin, CK, CK-MB q8h x 3
LDH on next draw
EKG if chest pain reemerges or in AM if no chest pain flare
ASA 325 mg po qd
Metoprolol 37.5 mg PO q8h
Nitroglycerin 0.3 mg 1 tablet prn chest pain
If chest pain continues, enzymes positive, EKG changes add IV heparin
If chest pain flare, enzymes positive, or EKG changes, consider catheterization. Otherwise exercise-MIBI in AM.
NPO except MEDS after midnight; diabetic diet before midnight
Hold AM B-Blocker dose for exercise MIBI
Check in AM for fasting lipids, A1C
2. Ventricular Ectopy
Replete K, Mg to meet goals (K = 4.0, Mg = 2.0)
3. GI bleed
Guiac positive stools
HCT stable
AM labs: CBC (HCT),Diff,Lytes,Glucose,BUN/Creatinine,Calcium,Phosphorus,Magnesium
4. Diabetes
Stable, controlled by diet at home
Blood glucose fingersticks AC + HS
HgA1C in AM
Urinalysis in AM (proteinuria per prior notes)
5. Prophylaxis
Sennosides
Docusate sodium
6. Code Status: Full Code
The assessment and plan were discussed with the senior teaching resident.
Robert Rich
MS III
Pager: #81852
Intern Addendum: I have interviewed and examined the pt with the medical student. In brief, the pt is a 67M w HTN gout and DM who woke up at 3am today with chest pressure and pain that radiated to both arms. He did feel slightly SOB but there was no N, V, diaphoresis or lightheadedness at this time. The episode lasted less than one minute and he felt better after he took indomethacin. Upon further questioning, he thinks he had two similar episodes last week. He has not had any DOE, PND, or LE edema. He does recall having chest pressure and chest pain in Feb 2147 when he had a cardiac evaluation at the Pennsylvania Hospital. He does not know the details of the workup. Of note the pt does not smoke, is not on ASA, and has several family members with CAD but no men <55 or women<65. He is on atenolol but unsure of the dose.
In the ED, he did have some chest pain but it was relieved after 1 nitro. HR was 85 and BP 135/82. He was given ASA and a BB. Initially, his EKG was read as normal but later the T waves became biphasic in leads V4-6. Repeat EKGs when he was chest pain free, showed flipped Ts in V4-6. There were no old EKGs available for comparison. He was seen by cardiology who recommended holding off on heparin bolus as he was found to be guaiac + (Hct 44). A dissection protocol CT was performed and was neg for dissection and for a central PE. (the ddimer was elevated). His first two sets of cardiac enzymes were negative and he was sent to the floor for further evaluation. On exam, he was in NAD and was CP free. Heart was RRR, lungs CTAB and he had no lower extremity edema. ASA and BB were cont. The third set of cardiac enzymes came back negative and the pt was scheduled for a stress test. However, the patient did experience some chest discomfort this morning and therefore cardiology felt it was best to take him to cath instead. This is planned for this morning. Please note this pt is allergic to Allopurinol.
V. A. Nunes MD 32043
Internal Medicine Intern
<|output|>{"AGE": ["68", "89", "80s", "68", "67", "55", "65"], "CONTACT": ["(783)508-2821", "81852", "32043"], "DATE": ["2149-01-11", "10/03/2080", "01/10/49", "2147", "August", "2147", "October 2148", "Oct 2148", "Oct 2148", "March 2147", "01/10/49", "01/10/49", "01/10/49", "01/10/49", "01/11/49", "01/10/49", "01/10/49", "01/10/49", "01/10/49", "01/10/49", "01/10/49", "01/10/49", "Feb 2147"], "ID": ["7744323"], "LOCATION": ["Pennsylvania Hospital", "BBH", "Cheney", "Pennsylvania Hospital"], "NAME": ["Eubanks, Larry", "Talbert, Nicholas", "Eubanks", "Eubanks", "Eubanks", "Eubanks", "Robert Rich", "V. A. Nunes"], "PROFESSION": ["economic policy analyst"]} |