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10529596-RR-19 | 104 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
year old woman with pneumonia, volume overload, effusion on
previous CXR. Evaluation for infiltrate, edema, and effusion.
## FINDINGS:
Right-sided PICC remains in similar position with tip extending to the mid
SVC. Again seen is a large hiatal hernia with adjacent atelectatic lung
parenchyma. Cardiomediastinal silhouette is stable. Mild bibasilar opacities
likely represent a combination of atelectasis and perhaps trace left effusion.
The upper lung fields are clear without focal consolidation. No pneumothorax.
## IMPRESSION:
1. Mild bibasilar opacities likely represent a combination of atelectasis and
perhaps trace left effusion.
2. Large hiatal hernia with adjacent atelectasis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10529596", "visit_id": "29538919", "time": "2187-05-30 14:28:00"} |
12689121-DS-4 | 1,693 | ## HISTORY OF PRESENT ILLNESS:
yo female with history of HTN, HL, and CAD s/p PCI with
stents years ago presents with substernal chest pressure. She
notes that she is tired at baseline, but that she has felt
extreme fatigue x3-4weeks. She has also noticed lightheadedness
and dizziness and suffered a mechanical fall about weeks
ago. During this time, she also noticed a sensation of SOB, but
never had increased work of breathing. Three days ago she saw
her PCP for this reason and at that point EKG revealed new T
wave changes different from baseline. D dimer was normal. She
was scheduled for an outpt stress test on . However, she
developed substernal chest pressure around noon after unloading
groceries. She notes this was less in severity and a different
type of pain than the last time she had chest pain when she was
stented. In , she had a painful band like sensation under
her breasts and around her flanks, and was found to have a 95%
LAD stenosis. She denies radiation of pain, SOB, but notes
lightheadedness. This chest pain lasted for two hours until she
arrived in the emergency room and layed down. Of note, she
recently stopped statin therapy in . She was on Lipitor for
a while until she stopped in for leg cramps. She has also
tried simvastatin and another statin, but not pravastatin.
.
In the ED, initial vitals were 97.4 84 137/79 15 100% RA. Labs
and imaging significant for EKG with TWI in V1-V3, no ST
changes. CXR was within normal limits. Patient was given
aspirin. She was guaiac negative and started on a heparin gtt.
She was subsequently chest pain free. Vitals on transfer were 68
123/83 13 95% on RA. On arrival to the floor, the patient is
nervous but chest pain free.
.
Cardiac review of systems is notable for DOE after blocks
which is new for the patient as she previously could walk
without restriction. She denies paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope.
.
## ROS:
+mild nausea, facial discomfort
-F/C, cough, vomiting, diarrhea, constipation, abdominal pain,
trouble urinating, visual changes, headache, any prior history
of stroke, TIA, deep venous thrombosis, pulmonary embolism,
bleeding at the time of surgery, myalgias, joint pains, cough,
hemoptysis, black stools or red stools.
## 2. CARDIAC HISTORY:
Coronary artery disease
-CABG:
-PERCUTANEOUS CORONARY INTERVENTIONS: Bare metal stent in LAD in
when she had a catheterization that showed 95% mid-LAD
stenosis
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
Hypertension
Hyperlipidemia
Crohn's disease
Chronic facial neuralgia s/p stereotactic ablation of the
trigeminal ganglion that did not work
Hypothyroidism
Osteoporosis
.
## PSH:
carpal tunnel release
bilateral breast augmentation in
radiofrequency ablation
surgical treatment for left elbow fracture
## FAMILY HISTORY:
Father died of coronary artery disease at age . Her mother
died of vascular dementia and pneumonia. One of her first
cousins has a genetic syndrome causing hypercholesterolemia. No
family history of arrhythmia, cardiomyopathies, or sudden
cardiac death; otherwise non-contributory.
## GENERAL:
WDWN female in NAD. Oriented x3. Mood, affect
appropriate.
## HEENT:
NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
## CARDIAC:
PMI located in intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
## LUNGS:
No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
## ABDOMEN:
+BS, soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
## EXTREMITIES:
Trace edema bilaterally to ankles.
## SKIN:
No stasis dermatitis, ulcers, scars, or xanthomas.
## GENERAL:
WDWN female in NAD. Oriented x3. Mood, affect
appropriate.
## HEENT:
NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
## CARDIAC:
PMI located in intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
## LUNGS:
No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
## ABDOMEN:
+BS, soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
## EXTREMITIES:
Trace edema bilaterally to ankles.
## SKIN:
No stasis dermatitis, ulcers, scars, or xanthomas.
## EKG:
NSR at 78, TWI in V1-V3, TW flattening in III and
aVF, STD in V4-V5
## CXR:
Both lungs appear well inflated with no focal
consolidation, pleural effusion or pneumothorax. The cardiac,
mediastinal and hilar contours are within normal limits.
Incidental note is made of bilateral breast implants.
## IMPRESSION:
No evidence of acute cardiopulmonary process.
## CARDIAC CATH:
1. Coronary angiography in this right
dominant system
demonstrated no angiographically apparent disease. The LMCA,
LAD, CX
and RCA had no angiographically apparent disease. The stent in
the
mid-LAD was patent. 2. Limited resting hemodynamics revealed
normal
systemic arterial blood pressures with a central aortic pressure
of
99/42 mmHg. 3. Left ventriculography revealed a normal LVEF.
## TTE:
The left atrium is normal in size. The estimated
right atrial pressure is mmHg. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic stenosis or
aortic regurgitation. The mitral valve leaflets are mildly
thickened. The estimated pulmonary artery systolic pressure is
normal. There is a trivial/physiologic pericardial effusion.
## BRIEF HOSPITAL COURSE:
yo female with history of HTN, HL, and CAD s/p PCI with
stents years ago presents with substernal chest pressure and
EKG changes that were similar to that of her prior ACS. This was
concerning for ACS or instent restenosis of her prior LAD lesion
however cardiac cath was normal.
.
# CORONARIES: History of CAD with prior 95% LAD stenosis s/p
stenting in . Her risk factors include HTN, HL,
postmenopausal female, and recently stopping her statin therapy.
She has had DOE for the past month, which may be an anginal
equivalent. She presented with chest pain with T wave changes on
EKG. However, troponin was negative x3 and cardiac cath was
within normal limits. She was continued on aspirin 81 daily,
started on metoprolol succinate 12.5mg daily, and pravastatin
20mg. She will follow up with Dr. as an outpatient.
.
# PUMP: No history of heart failure and last cath revealed EF
63% in . However, she has lower extremity edema on exam
likely a result of amlodipine. TTE within normal limits.
.
# RHYTHM: Normal sinus rhythm on EKG. She was monitored on
telemetry.
.
# Hypertension: Stable. Amlodipine was discontinued. She was
continued on valsartan with metoprolol.
.
# Hyperlipidemia: Previously on multiple statins with
intolerance, namely leg cramps. She was started on pravastatin
20mg which she has not previously tried as her LDL was found to
be 153. Her outpatient providers should watch for the
development of myalgias as an outpatient.
.
# Crohn's Disease: Stable without symptoms. She was continued
on her home regimen on pentasa, keflex, vitamin d, and iron.
.
# Hypothyroidism: Stable without symptoms. Continued
levothyroxine.
.
# Chronic trigeminal neuralgia: Minimal pain during admission.
She was continued on her home regimen of methadone, cymbalta,
zoloft, and carbamazepine suppositories.
.
# Osteoporosis: She was continued on calcium and vitamin d.
.
# Code Status: During this admission, she was confirmed full
code, with no prolonged measures.
## MEDICATIONS ON ADMISSION:
Methadone 10 mg TID
Zoloft 200 mg Daily
carbamazepime suppository 175mg q4h - patient has home med
Cymbalta 40 mg daily
aspirin 81 mg Daily
calcium citrate-vitamin D3 315 mg-200 2 Tablet(s) Twice Daily
ergocalciferol (vitamin D2) 50,000 unit q2weeks
iron 40 mg daily
Multivitamin one Tab daily
amlodipine-valsartan 5 mg-320 mg 1 Tab daily
levothyroxine 88 mcg Daily
Pentasa 500 mg Cap 3 capsules am, 2 capsules noon, 3 capsules
evening
Keflex mg Once Daily
## 1. CARBAMAZEPINE (BULK) POWDER SIG:
One Hundred
(175) mg Miscellaneous Q4H (every 4 hours).
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. ferrous sulfate 300 mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
4. levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig:
Tablet Extended Release 24 hr PO once a day.
Disp:*15 Tablet Extended Release 24 hr(s)* Refills:*2*
6. mesalamine 250 mg Capsule, Extended Release Sig: Six (6)
Capsule, Extended Release PO BID (2 times a day):
In the AM and
the .
7. mesalamine 250 mg Capsule, Extended Release Sig: Four (4)
Capsule, Extended Release PO DAILY12 ():
##
AT NOON.
8. MULTIVITAMIN CAPSULE SIG:
One (1) Capsule PO once a day.
9. cephalexin 250 mg Capsule Sig: One (1) Capsule PO Q24H (every
24 hours).
10. pravastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
11. valsartan 320 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
12. ergocalciferol (vitamin D2) 50,000 unit Capsule Sig: One (1)
Capsule PO q2weeks.
13. calcium citrate-vitamin D3 315-200 mg-unit Tablet Sig: One
(1) Tablet PO twice a day.
14. methadone 10 mg Tablet Sig: One (1) Tablet PO three times a
day.
15. sertraline 100 mg Tablet Sig: Two (2) Tablet PO once a day.
16. duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO once a day.
## PRIMARY DIAGNOSIS:
Chest Pain, Coronary Artery Disease,
Hyperlipidemia
## SECONDARY DIAGNOSIS:
Crohn's Disease, Chronic Facial Neuralgia,
Hypertension
## ACTIVITY STATUS:
Ambulatory - Independent.
Chest pain free.
## DISCHARGE INSTRUCTIONS:
It was a pleasure taking care of you during your stay here at
.
You were admitted to with chest pain. You had a cardiac
catherization that showed no obstructing lesions in your
coronary arteries. There was no narrowing of your known stents
to explain the pain. The pain may be due to a spasm of your
blood vessels that feed the heart.
The following changes were made to your medications:
## START:
Metoprolol succinate 12.5 mg by mouth daily.
## START:
Pravastatin 20 mg by mouth daily at night.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12689121", "visit_id": "27414059", "time": "2198-06-10 00:00:00"} |
16451262-RR-147 | 105 | ## INDICATION:
year old woman with hx of fibroids experiencing pelvic pain//
Please evaluate pelvic anatomy
## FINDINGS:
The uterus is anteverted and measures 10.9 cm x 6.8 cm x 7.7 cm, previously
9.9 x 7.3 x 5.6 cm. Redemonstration of multiple myometrial masses compatible
with fibroids, the largest of which if intramural in the posterior fundus
measuring 2.7 x 2.3 x 2.0 cm. The endometrium is homogenous and measures 5
mm.
The ovaries are normal. There is no free fluid.
## IMPRESSION:
Redemonstration of a fibrous uterus, increased in size as compared to prior
study of .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16451262", "visit_id": "N/A", "time": "2163-12-12 10:45:00"} |
12542274-RR-74 | 219 | ## EXAMINATION:
BILAT LOWER EXT VEINS
## INDICATION:
year old man with history of recurrent DVTs with bilateral leg
pain, worse with dorsiflexion, who came in subtherapeutic on warfarin // ?dvt
## LEFT:
There is normal compressibility, color flow, and spectral doppler of the left
common femoral vein. Nonocclusive thrombus is seen within the mid aspect of a
femoral vein. The other femoral vein is patent. Nonocclusive thrombus is
additionally seen within the popliteal vein. Normal color flow and
compressibility are demonstrated in the posterior tibial veins. The peroneal
veins are not well visualized.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa ( ) cyst.
## RIGHT:
There is normal compressibility, color flow, and spectral doppler of the right
common femoral and femoral veins. Nonocclusive thrombus is seen within the
popliteal vein. Normal color flow and compressibility are demonstrated in the
posterior tibial veins. Normal color flow is demonstrated within the peroneal
veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa ( ) cyst.
## IMPRESSION:
Nonocclusive thrombus within the left femoral and popliteal veins.
Nonocclusive thrombus within the right popliteal vein.
## RECOMMENDATION(S):
The findings were discussed with , m.D. by
, M.D. on the telephone on at 7:32 pm, 1 minutes after discovery
of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12542274", "visit_id": "N/A", "time": "2136-08-24 18:27:00"} |
17332406-RR-50 | 93 | ## LEFT SHOULDER, THREE VIEWS:
Axillary and external rotation views are provided
without internal rotation view. A slightly comminuted fracture of the distal
clavicle demonstrates displacement and superior distraction of the proximal
clavicle. The AC joint appears maintained. No other fracture is identified
and the glenohumeral joint appears normal. The visualized portion of the left
lung appears clear.
## IMPRESSION:
Slightly comminuted and displaced fracture of the distal left
clavicle with superior distraction of the proximal clavicle.
These findings were discussed with the Tan and the patient was sent to
the emergency room.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17332406", "visit_id": "N/A", "time": "2163-09-19 11:22:00"} |
16752897-RR-86 | 355 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
year old man with multiple recent ischemic strokes, now with
more somnolence and upward eye gaze, evaluate for stroke, hemorrhage
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 2.0 s, 8.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
373.7 mGy-cm.
2) Sequenced Acquisition 0.4 s, 4.0 cm; CTDIvol = 18.3 mGy (Head) DLP =
73.2 mGy-cm.
3) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 1,194 mGy-cm.
## FINDINGS:
Study is mildly degraded by motion.
There has been continued interval evolution of extensive left ACA territory
infarction involving the medial left frontal lobe and medial left parietal
lobe with encephalomalacia and areas of cortical hyperdensity consistent with
cortical laminar necrosis. Hyperdensity in the posterior medial left frontal
lobe may represent cortical laminar necrosis or hemorrhagic conversion, likely
present and unchanged from . Confluent subcortical hypodensity
involving the right frontal lobe with associated ex vacuo dilatation of the
right lateral ventricle is likely related to prior chronic infarction,
unchanged. Hypodensity within the right basal ganglia is also unchanged and
likely related to prior lacunar infarction. There is no evidence for acute
vascular territory infarction.
There is global atrophy with grossly stable enlargement of the sulci and
ventricles.
There is no evidence of fracture. Aside from mild mucosal thickening of the
anterior ethmoidal air cells and maxillary sinuses, the visualized portion of
the paranasal sinuses, mastoid air cells, and middle ear cavities are clear.
The visualized portion of the orbits are unremarkable.
## IMPRESSION:
1. Study is mildly degraded by motion.
2. Continued evolution of extensive left ACA territory infarction with left
frontal and with cortical laminar necrosis and questioned areas of hemorrhage.
If concern for acute hemorrhage, consider short-term follow-up imaging for
stability evaluation.
3. No evidence for new acute vascular territory infarction. Please note MRI
of the brain is more sensitive for the detection of acute infarct.
4. Extensive encephalomalacia involving the right frontal lobe and right basal
ganglia likely related to prior infarction.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16752897", "visit_id": "20984674", "time": "2151-02-01 16:08:00"} |
10109085-RR-74 | 128 | LEFT SHOULDER RADIOGRAPH PERFORMED ON .
## CLINICAL HISTORY:
Left shoulder pain status post fall, question fracture or
dislocation.
## FINDINGS:
A total of six images of the left shoulder were provided including
a Y view and axillary view. There is an acute minimally displaced fracture of
the surgical neck of the left humerus. There is no associated dislocation at
the glenohumeral joint, with the humeral head appearing to articulate normally
with the glenoid fossa. There is a small calcific density adjacent to the
greater tuberosity of the left proximal humerus, which likely indicates
calcific tendinopathy. Prominence of the left distal clavicle at the AC joint
is likely related to chronic left AC joint arthropathy. Soft tissues are
diffusely prominent at the left shoulder.
## IMPRESSION:
Acute left humeral neck fracture.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10109085", "visit_id": "N/A", "time": "2184-10-17 09:31:00"} |
11370310-RR-160 | 195 | ## INDICATION:
Skin necrosis and pain at the site of right lower extremity
amputation in a patient with multiple previous grafts.
## FINDINGS:
An anechoic fluid collection is seen without flow measuring
approximately 29 x 49 x16 mm in the right groin. Please note that examination
of the arteries and bypass is limited on this study. Within that constraint,
an iliofemoral bypass graft is visualized, with no evidence of internal flow.
A jump graft connecting this graft to the profundus femoris artery is also
visualized, showing only trace flow in the profunda artery as well as in the
stump of this jump graft and otherwise no evidence of arterial flow.
Thereafter, there is a second jump graft with evidence of a second graft
medially extending to the popliteal artery, corresponding to that depicted on
the comparison CT. This second longer graft also shows no evidence of
internal vascularity. Limited assessment of the common femoral vein and
superficial femoral vein is unremarkable.
## IMPRESSION:
1. Limited study, with no evidence of flow in the distal popliteal graft or in
the jump graft connecting the iliofemoral graft to the profunda femoris.
2. Left groin fluid collection as above.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11370310", "visit_id": "26661965", "time": "2150-10-16 04:35:00"} |
19605487-RR-108 | 127 | ## INDICATION:
Cirrhosis; increasing ascites.
Limited ultrasound scan of the abdomen shows a large amount of ascites. A
suitable site for percutaneous aspiration in the left lower quadrant was
marked under ultrasound guidance. Written consent was obtained from the
patient prior to procedure explaining risks and benefits. A timeout was
performed prior to the procedure confirming patient identity by three
parameters and the procedure to be performed.
The patient was prepped and draped in usual sterile manner. The superficial
tissues were infiltrated with 15 mL of 1% Lidocaine. A 5 catheter
was inserted percutaneously. 8 liters of yellow fluid were aspirated. No
significant complications occurred during the procedure.
The attending radiologist, Dr. was present and supervising.
## IMPRESSION:
Successful ultrasound-guided percutaneous aspiration of 8 liters
ascites.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19605487", "visit_id": "N/A", "time": "2133-08-15 14:45:00"} |
11111333-RR-123 | 107 | ## INDICATION:
year old woman with new ascites, omental caking, R adnexal
mass, eval mass // year old woman with new ascites, omental caking, R
adnexal mass, eval mass
## FINDINGS:
Both transabdominal and transvaginal ultrasound were performed.
Transabdominal ultrasound shows presence of a large quantity of ascitic fluid
a bowel appears to be tethered to the posterior wall.
The uterus shows multiple calcified fibroids with dense posterior shadowing.
Otherwise the contents of the pelvis could not be evaluated either
transabdominally or transvaginally. The CT shows the pelvic anatomy better
than the ultrasound.
## IMPRESSION:
Technically limited scan. Ascites. Heavily calcified fibroid uterus prevents
adequate evaluation of pelvic structures
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11111333", "visit_id": "24197325", "time": "2207-01-07 08:56:00"} |
13663763-DS-11 | 1,574 | ## HISTORY OF PRESENT ILLNESS:
Patient is a y/o F with history of depression who is brought
in to by her boyfriend for symptoms of sore throat, cough,
runny nose, ear pain, symptoms most consistent with upper
respiratory illness. During medical work up in ED, patient
disclosed that she broke up with her boyfriend yesterday and she
has depression with chronic SI. She was unable to contract for
safety.
Upon interview with patient, she initially states her depression
is the same as it always has been, and actually improved since
. Patient states she has had depression with SI since age
. Her parents never wanted her to see a therapist when she was
younger. Until age , she would take excessive amounts of
codeine to sleep because of her depression and nightmares,
wanting to be able to sleep. She states she has never taken an
overdose as a suicide attempt. She states her SI is related to
her purpose in life. "I constantly struggle with why I am here.
I
bring myself through a cycle of questions because I don't see a
purpose. SO, I do service jobs, serving people. It makes me feel
needed." Patient graudated from , in .
Since then, her first job was Teach for . Patient had a
terrible experience at this job, and her depression worsened
signficantly. She tears up while talking about this experience.
She states she lost belief in herself and her abilities during
this job. She treated her depression with alcohol and MJ. She
was
binge drinking with up to 7 drinks . She quit this job
and moved to to work for in of this
year. She states her job is very stressful, and they are
understaffed. Regarding her work she states, "I'm always
disappointed in myself" and she begins to cry. She states that
although she thinks of SI and various plans to do it, ie
overdose, she has never had any intent. She states, "I would
never want to hurt my family."
Her only support locally is her boyfriend. When describing her
realationship with her boyfriend, she states there are "ups and
downs. I'm always changing my mind about whether to be together
with him because of my mood swings." Patient was not feeling
well
yesterday with URI symptoms and she did not pick up his phone
calls. He came to her apartment because she was not answering
the
phone and they got into a verbal arguement. BF's found out
yesterday that his mother was diagnosed with cancer. Patient
becomes tearful again reflecting on her guilt in this
relationship.
Patient states she feels she suffers from mood swings. She has
previously noticed that she would become more depressed around
the time of her period. She took birth control for this and her
moods stabilized. However, when her father was diagnosed with a
clotting disorder, she discontinued the birth control.
Patient reports significant daily anxiety, particularly
regarding
work and her relationship. She also endorses having panic
attacks, lasting about 15 minutes. During these attacks, she
feels SOB, choking, nausea, numbness, sweating, impending doom.
She endorses anxiety about having another panic attack.
She endorses depressed mood with SI, hoplessness, helplessness,
guilt, worthlessness, decreased sleep, interest, motivation,
energy, and appetite.
## PAST MEDICAL HISTORY:
PAST MEDICAL HISTORY (INCLUDE HISTORY OF HEAD TRAUMA, SEIZURES,
## OR OTHER NEUROLOGIC ILLNESS):
none
PSYCHIATRIC HISTORY (INCLUDE PRIOR HOSPITALIZATIONS, OUTPATIENT
TREATMENTS, MEDICATION/ECT HISTORY, RESPONSE TO TREATMENT,
## HISTORY OF HOMICIDAL/SUICIDAL/ASSAULTIVE BEHAVIOR):
- Dx depression.
-Saw a therapist while in college at , last seen
. She has never seen a psychiatrist.
- Started on Wellbutrin by a PCP in for 4 weeks and it
was discontinued. She did not find this to be helpful.
- No prior SA/SIB
- No prior psychiatric hospitalizations
## SOCIAL HISTORY:
SUBSTANCE ABUSE HISTORY (INCLUDE HISTORY OF D.T.'S, WITHDRAWAL
SEIZURES, BLACKOUTS, DETOX TREATMENT, I.V. USAGE):
- EtOH- 2 drinks/month. In , drank up to 7drinks
- MJ- Used in , currently none
- other illicits- none
- tobacco- none
SOCIAL HISTORY (FAMILY OF ORIGIN, CHILDHOOD, PHYSICAL/SEXUAL
ABUSE HISTORY, EDUCATION, EMPLOYMENT, RELATIONSHIPS, SEXUAL
HISTORY/STD RISKS, MILITARY RECORD, LEGAL HISTORY, ETC.):
- Born in , raised in NC
- States that her relationship with her family is better now
than
when she was younger. Her parents never wanted her to see a
therapist as a teenager. She has one brother who is , ,
whom she has a good relationship with.
- Graduated from , . After graduation in ,
had first job with in . She was very unhappy
with this job and self medicated her depression during this
period with MJ and alcohol. When she quit this job, she moved
back with her parents in and worked at 2 clinics. She moved
to
in to work with Americorp.
- No religious affiliation
- no legal issues
- no access to weapons
- no hx of trauma
## FAMILY PSYCHIATRIC HISTORY:
- parents never spoke about mental illness in the home. She
believes her dad had a problem with alcohol in the past, now
sober. She also believes he has deppression.
- Mother was depressed when her child was mo old and took
antidepressants.
- Strong family history of alcohol dependence and addiction
## --APPEARANCE:
fair grooming with good eye contact, disheveled
hair
--behavior/attitude: cooperative,calm coughing intermittently
--speech: normal rate and tone, decreased volume and raspy voice
--mood (in patient's words): "fine, just tired"
--affect: dysthymic; appropriate to the context
--thought content (describe): no obvious delusions, paranoia,
Denies AVH
--thought process: linear, goal directed
--SI/HI: Denies SI at this time, Denies HI, verbalized safety
plan
--insight: fair
--judgment: fair
## COGNITIVE EXAM:
please see my Initial Psychiatry Evaluation note dated .
## GENERAL:
Well-nourished, in no distress, appears uncomfortable
## HEENT:
Normocephalic. PERRL, EOMI. Oropharynx clear.
## NECK:
Supple, trachea midline. No adenopathy or thyromegaly.
## BACK:
No significant deformity, no focal tenderness.
## LUNGS:
Clear to auscultation; no crackles or wheezes.
## CV:
Regular rate and rhythm
## ABDOMEN:
Soft, nontender, nondistended; no masses or
organomegaly.
## EXTREMITIES:
No clubbing, cyanosis, or edema.
## SKIN:
Warm and dry, no rash or significant lesions.
## II:
Pupils equally round and reactive to light
bilaterally. Visual fields are full to confrontation.
## III, IV, VI:
Extraocular movements intact bilaterally
without
nystagmus.
## V, VII:
Facial strength and sensation intact and
symmetric.
## VIII:
Hearing intact to voice.
## XI:
Sternocleidomastoid and trapezius normal bilaterally.
## XII:
Tongue midline without fasciculations.
*Motor- No gross focal motor or sensory deficits, normal gait.
*Reflexes- B T Pa-1+ b/l
*Coordination- Normal on finger-nose-finger
## PSYCHIATRIC:
Pt was initially very labile, tearful in the hallways, heard
crying in her bed, but denied suiciality on the unit. She was
started on 25 mg of zoloft qday on , transitioned to 50 mg
of zoloft. She initially was appearing anxious and was written
for ativan 0.25 mg PRN QHS. On hospital day 3 she reported on
the morning after she used it she had somnolence, decreased
concentration, "memory problems" which all disappeared when pt
stopped taking ativan. Pt had an episode of nausea and
near-syncope during blood draw once. These symptoms were
transient and prior to discharge pt was not complaining of any
adverse effects of zoloft.
She appeared brighter prior to discharge and her affect was more
stable. She denied any suicidality, was motivated and
future-oriented.
She attended group therapy and was socializing with other
patients, especially one of her roommates.
## #RECURRENT URIS:
pt presented to the ED with what appeared to be
viral URI, clear to auscultation, clear CXR. When she was
admitted to floor she had NL WBC count but mild thrombocytopenia
(140) which resolved prior to discharge. She was congested, c/o
sore throat, runny nose, and cough, mostly at night. On PE she
had clear pharynx, no LAD, clear lungs, non-tender over sinuses,
some crusty skin around nares appearing from use of tissues. She
remained afebrile and her Sx were consistent with URI while on
the floor. However pt reported that these Sx have been waxing
and waning for 6 weeks. Pt was advised to f/u with PCP if do
not resolve
We provided symptomatic relief with cepacol, guaifenesin,
supportive measures.
## SAFETY:
pt remained on q15 min checks
## FAMILY:
father was involved and had regular discussions with
team; team also had a discussion with mother
on :
albuterol sulfate PRN
## DISCHARGE MEDICATIONS:
1. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q4H (every 4 hours) as needed for
shortness of breath, wheezing.
Disp:*1 container* Refills:*0*
2. sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
## DISCHARGE DIAGNOSIS:
I MDD vs dysthymia vs "double depression"
II deferred
III URI
IV isolation from family, financial stressors, stress at work
V 35
## MENTAL STATUS:
Clear and coherent. Appropriately groomed, good
eye contact, no abnormal movements, slow to normal speech,
dysthymic affect, lucid cognition, no AVH, no SI, good insight
and judgement.
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
It was a pleasure to have worked with you, and we wish you the
best of health!
-Please follow up with all outpatient appointments as listed -
take this discharge paperwork to your appointments.
-Please continue all medications as directed.
-Please avoid abusing alcohol and any drugs--whether
prescription drugs or illegal drugs--as this can further worsen
your medical and psychiatric illnesses.
-Please contact your primary care doctor at or
other providers if you have any concerns.
-Please call or go to your nearest emergency room if you
feel unsafe in any way and are unable to immediately reach your
health care providers.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13663763", "visit_id": "23009473", "time": "2113-03-09 00:00:00"} |
13205054-RR-4 | 230 | ## INDICATION:
female with free air at outside hospital. Evaluate
for perforated viscus.
## CT ABDOMEN WITH IV CONTRAST:
Dependent subsegmental atelectasis is noted at
the lung bases which are otherwise clear.
There is free air in the abdomen, predominantly in the perihepatic region and
central mid to lower abdomen. The liver, pancreas, spleen, and bilateral
adrenal glands are normal. Kidneys enhance and excrete contrast symmetrically
without evidence of hydronephrosis or hydroureter. The gallbladder is
surgically absent. Non-opacified stomach and intra-abdominal loops of small
and large bowel are normal. No mesenteric or retroperitoneal lymphadenopathy
meeting CT criteria for pathologic enlargement is noted. The aorta is normal
caliber throughout. No free fluid in the abdomen.
## CT PELVIS WITH IV CONTRAST:
In the left lower quadrant, there is a segment of
sigmoid colon with wall thickening, best seen on the coronal reformats. There
is associated fat stranding. In addition, multiple locules of gas are noted
within the mesocolon. No drainable fluid collection.
The urinary bladder is collapsed around a Foley catheter. Distal ureters,
uterus, adnexa, and rectum are normal. No free fluid in the pelvis. No
pelvic or inguinal lymphadenopathy meeting CT criteria for pathologic
enlargement is noted.
## BONE WINDOWS:
No suspicious lytic or sclerotic osseous lesion is identified.
Sacralization of L5 is ntoed.
## IMPRESSION:
Pneumoperitoneum with likely source being perforated
diverticulitis of the sigmoid colon. No drainable fluid collection.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13205054", "visit_id": "29137933", "time": "2178-04-01 01:21:00"} |
19131769-RR-19 | 119 | ## INDICATION:
Advanced maternal age complicating pregnancy.
Transabdominal imaging demonstrates an intrauterine gestation sac with a
single living embryo. There is thinning of the myometrium in the left fundal
region measuring 2-3 mm. The crown-rump length of the embryo is 64.5 mm. This
represents a gestational age of 12 weeks 4 days. Menstrual age is 11 weeks 2
days.
The nuchal translucency measures 1.4 mm. The certified NT sonographer is E.
.
The ovaries are normal.
## IMPRESSION:
Size 9 days greater than dates, new is .
Thin myometrium in the left fundal region measuring 2-3 mm.
Findings were discussed with Dr. at the conclusion of the
examination. She will contact the patient for further management.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19131769", "visit_id": "N/A", "time": "2171-03-29 10:06:00"} |
19706408-DS-21 | 1,563 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
line placement and removal
## HISTORY OF PRESENT ILLNESS:
Mrs is a yo f with h/o HTN, CHF, COPD, Afib, and
aortic stenosis who presents for evaluation for possible AVR.
Patient presented to the hospital in with shortness of
breath, fluid overload, and hypotension. She was found to have
critical aortic stenosis. She underwent valvuloplasty with
suboptimal results. Patient was discharged to rehab with
moderate improvement of her symptoms. After discharge patient
reevaluated her options and decided she was not content with her
quality of life. Her edematous legs and pulmonary edema has made
it impossible for her to be independently mobile. She requires
assistance for nearly all ADLs. She decided she was willing to
undergo surgical repair of her aortic valve in attempt to
improve her symptoms. She was seen by her physician who
recommended hospital admission for aggressive diuresis and a
complete preop evaluation.
.
On arrival to the floor, patient states she is comfortable and
without any pain. She thinks her shortness of breath has been
stable since her recent discharge but is unsure because she has
not been as mobile. She admits to significant increase in
bilateral lower extremity edema. She denies chest pain, nausea,
lightheadedness or diaphoresis. She denies any recent illness
with the exception of 1 day of diarrhea last week. She admits to
no other changes in her medical history since her last
admission. The patient denies palpitations or syncope,
claudication-type symptoms, melena, rectal bleeding, or
transient neurologic deficits. No change in weight or urinary
symptoms. No cough, fever, night sweats, arthralgias, myalgias,
headache or rash. All other review of systems negative.
.
## # HTN
# CHF
# COPD:
recently diagnosed by Dr. at
# stable goiter
# afib on coumadin
# ? aortic stenosis
# GERD
# osteoporosis
# basal cell under left eye
# s/p resection of childhood tumor "behind heart"
## HEENT:
PERRL, EOMI, NCAT, mmm
## NECK:
large nontender goiter on R, no JVD visible
## CV:
holosystolic murmur with loss of S2 consistent
with severe AS, no delayed upstrokes
## LUNGS:
bibasilar crackles, good air movement
## ABD:
+ bs, Soft, NTND
## EXT:
BLE 3+ pitting edema
## SKIN:
warm, dry, weeping edematous BLE
## NEUROLOGIC:
no focal deficits, CN grossly intact
## PERTINENT RESULTS:
Na 138 / K 3.5 / Cl 89 / CO2 42 / BUN 35 / Cr 1.2 / BG 118
ALT 13 / AST 27 / LDH 269 / Alk Phos 74 / TB 1.8
Alb 3.5 / Ca / Mg 2.1 / Phos 2.8
WBC 7.9 / Hct 30.8 / Plt 222
INR 5.7
CXR - Marked widening of right superior mediastinal
contour is consistent with intrathoracic extension of a goiter
as reported on recent CT. Heart remains enlarged. Mild pulmonary
vascular engorgement and new perihilar haziness are likely due
to congestive heart failure. Multifocal patchy and linear
opacities in the left mid and both lower lungs favor
atelectasis. Small pleural effusions are present bilaterally.
Echo
The left atrium is moderately dilated. The right atrium is
markedly dilated. There is mild symmetric left ventricular
hypertrophy with normal cavity size. Overall left ventricular
systolic function is moderately depressed (LVEF= 35-40%). The
right ventricular cavity is moderately dilated with mild global
free wall hypokinesis. There is abnormal systolic septal
motion/position consistent with right ventricular pressure
overload. The ascending aorta is moderately dilated. The aortic
valve leaflets (3) are severely thickened/deformed. There is
severe aortic valve stenosis (area <0.8cm2). Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. The mitral valve shows characteristic rheumatic
deformity. There is mild valvular mitral stenosis (area
1.5-2.0cm2). Severe (4+) mitral regurgitation is seen. Moderate
[2+] tricuspid regurgitation is seen. There is severe pulmonary
artery systolic hypertension. The end-diastolic pulmonic
regurgitation velocity is increased suggesting pulmonary artery
diastolic hypertension. There is no pericardial effusion.
.
## IMPRESSION:
Mild LVH with moderate global systolic dysfunction.
Mild right ventricular systolic dysfunction. Severe aortic
stenosis. Mild aortic regurgitation. Mild valvular mitral
stenosis. Severe mitral regurgitation. Moderate tricuspid
regurgitation. Severe pulmonary hypertension.
## BRIEF HOSPITAL COURSE:
year old female with a history of HTN, CHF, COPD, Afib, and
aortic stenosis s/p valvuloplasty was admitted for evaluation of
aortic valve replacement.
.
1. Aortic Stenosis:
She was diagnosed with critical stenosis during a prior
admission. At that time, she was not interested in surgical
aortic valve repair but did agree to a cardiac catheterization
with valvuloplasty. She had minimal improvement in her aortic
valve after valvuloplasty. She tolerated the procedure well and
was discharged to rehab. Given her persistent symptoms, she did
ultimatly agree to surgery. Unfortunately she was thought to be
a very high risk for surgery due to likelihood of a difficult
extubation and prolonged ventilator wean, and she was no longer
a candidate for surgical aortic valve repair. Given her limited
other medical options, she was not interested in additional
therapy. She was made DNR/DNI/ Do not rehospitalize and was
discharged to rehab with plans to transition to hospice.
.
2. Congestive Heart Failure:
Ms. was in acute on chronic systolic heart failure upon
arrival to likely worsened related to her severe aortic
stenosis. She was diuresed aggressively with a lasix drip and
then transitioned to oral lasix prior to discharge. She was
initially on 4L upon admission, required BiPap briefly, and was
back to upon discharge. Her furosemide was transitioned
from a lasix drip to 120mg oral furosemide.
.
3. Hypoxia
Her hypoxia was likely multifactorial and related to her
congestive heart failure, valvular disease, kyphosis, and her
thyroid enlargement.
.
4. Atrial fibrillation
She has chronic atrial fibrillation and was maintained on a beta
blocker for rate control with coumadin for anticoagulation. She
was continued on her beta blocker and warfarin for symptomatic
control of her symptoms secondary to atrial fibrillation.
.
5. Goals of Care
Patient was initially full code upon admission to in
anticipation of an aortic valve repair; however, when surgical
aortic valve repair was no longer an option, Ms. was
clear that she would not like any further interventions. She is
interested primarily in symptom control. She now has a do not
resuscitate, do not intubate, and do not rehospitalize order.
Her health care proxy, , is aware of these wishes
and in full agreement. Palliative care was very helpful in
assisting with these discussions.
## MEDICATIONS ON ADMISSION:
1. Raloxifene 60 mg Tablet Sig: One (1) Tablet PO daily ().
2. Lovastatin 40 mg Tablet Sig: One (1) Tablet PO at bedtime.
3. Calcium 600 + D(3) 600 mg(1,500mg) -200 unit Tablet Sig: One
(1) Tablet PO twice a day.
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO twice a
day.
5. Acetaminophen 325 mg Tablet Sig: Tablets PO four times a
day as needed for fever or pain.
6. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day: Every
day except .
7. Warfarin 3 mg Tablet Sig: One (1) Tablet PO once a day: Take
only.
8. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
9. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
10. Furosemide 20 mg Tablet Sig: One (3) Tablet PO DAILY
(Daily).
## DISCHARGE MEDICATIONS:
1. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
2. Sodium Chloride 0.65 % Aerosol, Spray Sig: Sprays Nasal
QID (4 times a day) as needed.
3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO Q6H
(every 6 hours).
5. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
## NEBULIZATION SIG:
One (1) Inhalation Q4H (every 4 hours) as
needed.
6. Warfarin 2 mg Tablet
## SIG:
One (1) Tablet PO Once Daily at 4
.
7. Furosemide 80 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
8. Quetiapine 25 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime).
9. Morphine 10 mg/5 mL Solution Sig: 2.5-5 mg PO Q2H (every 2
hours) as needed for shortness of breath or wheezing.
10. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
## SIG:
One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
## PRIMARY DIAGNOSIS:
1. Congestive Heart Failure
2. Aortic Stenosis s/p valvuloplasty
3. Atrial Fibrillation
## DISCHARGE CONDITION:
Stable. Patient is tolerating of oxygen with adequate
saturations. She is alert and can speak clearly intermittently
throughout the day
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital with shortness of breath. This
was thought likely related to your heart failure and severe
valvular disease. Unfortunately you are not a candidate to have
surgical repair of your valve. Given that your symptoms will
likely not improve significantly without surgery, you were not
interested in further treatment of your medical problems in a
hospital setting. We fully support you in these brave and
difficult decisions and wish you the best of luck.
.
We have made several changes to your medications to align with
your current goals of care.
- raloxifene, lovastatin, calcium, aspirin - we have
discontinued these medications as they do not seem to be
treating your current symptoms.
- morphine - this is a medication you can use as you need for
pain control or shortness of breath.
- seroquel - this is a medication to help you sleep at night.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19706408", "visit_id": "21861645", "time": "2180-09-11 00:00:00"} |
15392711-RR-11 | 115 | ## EXAMINATION:
EARLY OB US <14WEEKS
## INDICATION:
year old woman with uncertain dates// Dating ultrasound
## FINDINGS:
An intrauterine gestational sac is seen and a single living embryo is
identified with a crown rump length of 33 mm representing a gestational age of
10 weeks 1 days. This is size greater than the menstrual dates of 9 weeks 0
days by more than 1 week. Patient is off dates. The by ultrasound is . The uterus is normal. The ovaries are normal.
## IMPRESSION:
Single live intrauterine pregnancy measuring at 10 weeks and 1 day gestational
age which is size greater than dates by more than 1 week. Patient is off
dates and the by ultrasound is .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15392711", "visit_id": "N/A", "time": "2111-07-24 15:25:00"} |
10521546-RR-28 | 142 | ## INDICATION:
year old man with pancreatic cancer and hyponatremia // any
cause of hyponatremia
## FINDINGS:
The ventricles and extra-axial spaces are normal in size. There is no evidence
of midline shift, mass effect or hydrocephalus. There are no acute infarcts.
There is no evidence of focal abnormalities. The vascular flow voids are
maintained. The visualized paranasal sinuses are clear except for a tiny
retention cyst in the left maxillary sinus. . Following gadolinium
administration there is no evidence of abnormal parenchymal, vascular and
meningeal enhancement seen.
Images through the sella and hypothalamus demonstrate no abnormal enhancement
in the region of hypothalamus. There is no mass lesion identified within the
sella or parasellar region.
## IMPRESSION:
No significant abnormalities are seen on MRI of the brain with and without
gadolinium. No evidence of mass or abnormal enhancement in the hypothalamus
or pituitary gland.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10521546", "visit_id": "N/A", "time": "2127-11-05 18:15:00"} |
10651616-RR-14 | 155 | ## REASON:
gentleman with coronary artery disease.
## FINDINGS:
A mild amount of heterogeneous plaque was seen in the bilateral
internal carotid arteries, with gray-scale ultrasound.
On the right side, peak systolic velocities were 52 cm/sec for the proximal
internal carotid artery, 51 cm/sec for the mid internal carotid artery, 50
cm/sec for the distal internal carotid artery, 53 cm/sec for the common
carotid artery and 33 cm/sec for the vertebral artery. The right ICA/CCA
ratio was 0.98.
On the left side, peak systolic velocities were 67 cm/sec for the proximal
ICA, 50 cm/sec for the mid ICA, 40 cm/sec for the distal ICA, 62 cm/sec for
the CCA and 58 cm/sec for the vertebral artery. The left ICA/CCA ratio was
1.0.
Both vertebral arteries presented antegrade flow.
## IMPRESSION:
Less than 40% stenosis of the bilateral extracranial internal
carotid arteries.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10651616", "visit_id": "22636628", "time": "2182-03-14 12:43:00"} |
12534382-RR-17 | 211 | ## HISTORY:
Left low back pain after acute trauma, rule out herniation
fracture. Please obtain views of the SI joint on left too.
## LUMBAR SPINE TWO VIEWS:
SI joint single view, not including the lower sacrum.
Assessment of fine bony detail slightly limited by underpenetration and
patient body habitus. There are five non-rib-bearing vertebral bodies. There
is straightening of usual lordosis. Vertebral body heights are preserved.
The posterior elements are not visualized due to over-penetration. No
subluxation is identified. There is moderate narrowing at L4/5 and L5/S1. A
tiny calcific structure (5.4 mm) in the right costovertebral angle is noted,
unlikely to relate to acute trauma. The SI joints and sacrum are grossly
unremarkable. The SI joint view itself is somewhat limited due to positioning
and overlying clothing.
## IMPRESSION:
1. Limited assessment of posterior elements. Allowing for this, no fracture
is detected involving the lumbar spine and no subluxation. Disc space
narrowing at L4 through S1 which suggests the presence of disc pathology of
indeterminate acuity.
2. Somewhat limited assessment of sacrum and SI joints, but no SI joint
diastasis or sacral fracture is identified on these views. If there is
continuing high suspicion for that, then further assessment with CT would be
recommended.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12534382", "visit_id": "N/A", "time": "2129-07-24 16:30:00"} |
13900251-RR-106 | 178 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## INDICATION:
with abd distension?// budd chiari?
## LIVER:
Redemonstration of hepatic cirrhosis. A 1.1 cm hypoechoic nodule with
better characterized on prior MRI from . An anechoic cyst 0.6 cm
left hepatic lobe is likely a small biliary cyst/hamartoma. The main portal
vein is patent with hepatopetal flow. There is moderate ascites.Underlying
right effusion.
## BILE DUCTS:
There is no intrahepatic biliary dilation.
## GALLBLADDER:
There is no evidence of stones or gallbladder wall thickening.
Minimal pericholecystic fluid is likely secondary to cirrhosis.
## PANCREAS:
The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
## KIDNEYS:
Limited views of the kidneys show no hydronephrosis.
## RETROPERITONEUM:
The visualized portions of aorta and IVC are within normal
limits.
## IMPRESSION:
1. Cirrhotic liver. Moderate ascites 1 cm. Hypoechoic lesion is stable from
the prior study and better evaluated on a MR from . Borderline
splenomegaly. Underlying right effusion.
2. Patent hepatic vasculature. No evidence of occlusive thrombus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13900251", "visit_id": "N/A", "time": "2179-05-22 16:35:00"} |
11817018-RR-20 | 168 | ## INDICATION:
year old man s/p ureteral reimplant. Cystogram to assess for
leak.// s/p ureteral reimplant. Cystogram to assess for leak.
## ACC AIR KERMA:
18.6 mGy; Accum DAP: 386 uGym2; Fluoro time: 0 min, 32
sec.
## FINDINGS:
Initial AP, oblique, and lateral scout images prior to administration of
contrast show a Foley catheter within the bladder and a left-sided double-J
stent.
Intermittent fluoroscopy was performed while approximately 250 cc of
Cysto-Conray water soluble contrast was instilled through the patient's
catheter into the bladder. Filling of the bladder was terminated when the
patient began to experience discomfort. With a distended bladder, imaging was
performed in AP, oblique, and lateral projections. The patient's catheter was
then reconnected to the urinary bag, and the patient was able to evacuate the
bladder through the catheter. Post-evacuation images were then obtained.
There is no evidence of contrast extravasation from the bladder. No ureteral
contrast reflux was seen.
## IMPRESSION:
No evidence of bladder leak.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11817018", "visit_id": "N/A", "time": "2126-10-23 08:28:00"} |
10427288-RR-43 | 145 | ## INDICATION:
year old woman with on CKD with reported bilateral
hydronephrosis at OSH// Eval for hydro/obstructive etiology
## FINDINGS:
Study is slightly limited secondary to patient body habitus. The study was
terminated early secondary to patient request.
There is no hydronephrosis or stones bilaterally. There is a 2.1 cm simple
appearing cyst within the right kidney. Views of the left kidney were
somewhat suboptimal. There is normal cortical echogenicity and
corticomedullary differentiation seen bilaterally.
Right kidney: 11.3 cm
Left kidney: 10.1 cm
The bladder is only minimally distended and can not be fully assessed on the
current study.
## IMPRESSION:
1. Suboptimal study secondary to patient body habitus. The study was
terminated early secondary to patient request.
2. Within the limits of the study, there is no hydronephrosis or evidence of
renal stone or mass lesion. The bladder was not visualized.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10427288", "visit_id": "23841708", "time": "2179-11-29 19:37:00"} |
16591395-RR-31 | 248 | ## INDICATION:
with new effusions. Please assess for mass.
## CT OF THE CHEST:
There is no mediastinal hemorrhage, pneumomediastinum, or evidence of aortic
dissection. Atherosclerotic changes are seen along the aorta. Mildly
enlarged left lower paratracheal 11 mm lymph node (series 2, image 23) is
seen. There is no hilar or axillary lymphadenopathy.
There is a large left pleural effusion with large loculated component within
the major fissure and in the medial pleural space. There are associated left
basilar opacities, likely representing atelectasis, however obscured mass or
consolidation from infection cannot be excluded. The left lower lobe bronchus
is not well seen and may be compressed.
Only minimal right basilar atelectasis and minimal right pleural effusion.
There are no suspicious pulmonary nodules or masses visualized on this CT
scan, however lesions might be obscured by large effusion and atelectasis.
Partially visualized upper abdomen demonstrates a normal appearing spleen,
liver, and rigth adrenal gland. Mild thickening of the left adrenal gland
without nodularity. Large simple-appearing cysts are seen at both kidneys,
including a right parapelvic cyst.
## BONES:
There are no suspicious lytic or sclerotic bony lesions.
## IMPRESSION:
1. Large left effusion with large loculated major fissure and medial pleural
components.
2. Lingula and left basilar opacities are likely due atelectasis, however
obscured mass or consolidation due to infection cannot be excluded. Follow-up
imaging after resolution/drainage of effusion is recommended.
3. Left lower lobe bronchus not well visualized.
4. 11 mm left lower paratracheal lymph node.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16591395", "visit_id": "23578828", "time": "2157-03-02 19:20:00"} |
12384056-RR-53 | 223 | ## HISTORY:
with mental status change in a transplant with altered
mental status. Right wrist history CNP pneumonia. Please assess for source
of infection.
## FINDINGS:
There is been marked improvement in the interstitial opacities in
the lungs with mild residual or recurrent disease seen in the right lower
lobe. Bilateral pleural effusions have resolved. A small unchanged cyst is
seen in the left upper lobe. Right internal jugular catheter terminates in
the distal SVC.
The thyroid is normal and symmetric in appearance. Normal three vessel
branching aortic arch is seen with mild atherosclerotic calcification. The
heart appears normal with mitral and aortic valvular calcifications and
perhaps mild calcification of the left main coronary artery. Small
pericardial effusion is unchanged or minimally more prominent than the
previous examination. No pathologically enlarged axillary, supraclavicular,
mediastinal or hilar nodes are seen. The esophagus is normal in appearance.
The trachea and central airways are patent to the segmental level.
Although this study is not tailored for subdiaphragmatic evaluation imaged
upper abdomen reveals unchanged left adrenal lipoma. Rounded low-attenuation
structure in the pancreatic tail is likely invaginated fat. Calcification is
seen at the celiac and SMA origins.
## OSSEOUS STRUCTURES:
Degenerative changes are seen in the thoracic spine
without suspicious osseous lesion.
## IMPRESSION:
Marked improvement in interstitial opacities with mild residual
disease in the right lower lobe
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12384056", "visit_id": "21865204", "time": "2147-01-01 19:24:00"} |
14441502-RR-18 | 380 | ## INDICATION:
year old man with duodenal polyp/mass. ? carcinoid
## MR ENTEROGRAPHY:
The small bowel demonstrates normal motility on dynamic sequences. The
stomach is normal. Small bowel loops are normal in course, caliber, and fold
pattern. In the distal ileum, there is a sac-like segment of bowel that
measures approximately 4.9 x 9.4 cm (5:6). There is an additional short
segment blind-ending outpouching that communicates with the larger dilated
sac. The overall appearance has not significantly changed compared to the
prior CT of . There is no bowel wall thickening or
hyperenhancement. Colon is notable for sigmoid diverticulosis without
adjacent inflammatory changes to suggest diverticulitis. There is no fistula
or fluid collection.
MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:
The liver demonstrates normal signal intensity and morphology. No suspicious
focal liver lesions identified. There is no intra or extrahepatic biliary
dilatation. The gallbladder is normal. The spleen is not enlarged. The
pancreas demonstrates normal signal on T1 weighted images and enhances
homogeneously. The main pancreatic duct is normal in caliber. The adrenal
glands are within normal limits. Redemonstrated are simple and hemorrhagic
cysts in the lower pole of the right kidney without concerning features. The
kidneys enhance and excrete contrast symmetrically without concerning focal
lesions or hydronephrosis. Abdominal aorta is normal in caliber. Celiac
axis, SMA, and renal arteries are patent. Note is made of bilateral accessory
renal arteries. There is no mesenteric or retroperitoneal lymphadenopathy.
There is no free fluid.
MRI OF THE PELVIS WITH AND WITHOUT IV CONTRAST:
The bladder and terminal ureters are unremarkable. The prostate gland and
seminal vesicles are grossly normal. There is no pelvic lymphadenopathy or
free fluid.
## BONES AND SOFT TISSUES:
There is no bone marrow signal abnormality.
## IMPRESSION:
1. Known small submucosal lesion in the third portion of the duodenum seen on
prior endoscopic ultrasound is not clearly identified on MRI. If there remains
a high suspicion for neuroendocrine tumor such as carcinoid, an octreotide
scan could be peformed.
2. Sac-like outpouching of a short segment of proximal ileum with a short
blind-ending component extension is most compatible with postsurgical change,
likely a side-to-end anastomosis relating to reported prior hernia repair.
This is unchanged since the CT from .
3. Sigmoid diverticulosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14441502", "visit_id": "N/A", "time": "2154-03-16 07:13:00"} |
11453884-RR-34 | 193 | ## EXAMINATION:
RIGHT DIGITAL DIAGNOSTIC MAMMOGRAM WITH TOMOSYNTHESIS
INTERPRETED WITH CAD AND RIGHT BREAST ULTRASOUND
## INDICATION:
Callback from screening for architectural distortion in the
medial right breast on the CC view and a stable mass in the superior right
breast
## TISSUE DENSITY:
C- The breast tissue is heterogeneously dense which may
obscure detection of small masses.
There architectural distortion in the medial right breast did not persist on
additional imaging consistent with superimposed breast tissues. There is a
stable lobulated circumscribed mass in the 12 o'clock position of the right
breast measuring 5 mm. This is unchanged dating back to .
## BREAST ULTRASOUND:
Targeted ultrasound of the right breast in the area of the
previously described mass which is stable back to demonstrates a
lobulated cyst measuring 5 mm x 5 mm x 5 mm at 12 o'clock, 5 cm from the
nipple.
## IMPRESSION:
Architectural distortion did not persist on additional imaging consistent with
superimposed breast tissues.
Lobulated mass in the 12 o'clock position of the left breast stable back to
.
## RECOMMENDATION(S):
Age and risk appropriate screening.
## NOTIFICATION:
Findings reviewed with the patient at the completion of the
study.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11453884", "visit_id": "N/A", "time": "2195-06-09 10:32:00"} |
15509957-RR-32 | 85 | ## HISTORY:
Sudden onset of vertigo and vomiting.
## FINDINGS:
There is no evidence of acute intracranial hemorrhage, edema, mass effect, or
acute vascular territorial infarction. The ventricles and sulci are
prominent, consistent with age-related involutional changes. Periventricular
and subcortical white matter hypodensities are suggestive of chronic small
vessel ischemic disease. There is no fracture. Minimal mucosal thickening is
seen in the right maxillary sinus. Otherwise, the imaged paranasal sinuses,
mastoid air cells, and middle ear cavities are clear.
## IMPRESSION:
No acute intracranial process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15509957", "visit_id": "28761636", "time": "2184-06-22 19:33:00"} |
17508552-RR-11 | 218 | ## HISTORY:
male restrained passenger in with loss of
consciousness.
## STUDY:
CT of the torso with contrast; 130 cc of Omnipaque intravenous
contrast was administered without adverse reaction or complication. Images
were generated through the chest, abdomen and pelvis. Coronal and sagittal
reformatted images were also generated.
## CHEST:
The visualized portion of the thyroid appears unremarkable. There is
no axillary, hilar, or mediastinal lymphadenopathy. The aorta is of normal
caliber along its course without evidence of dissection. There is no evidence
of mediastinal hematoma. There is no pericardial or pleural effusion. The
lungs are clear of consolidation or contusion. There is no pneumothorax.
## ABDOMEN:
There is no perihepatic, perisplenic, or paracolic gutter fluid.
There is no free fluid or free air. The liver and spleen are intact. The
pancreas, kidneys, adrenal glands, small bowel, and large bowel appear normal.
The aorta is of normal caliber along its course and shows no evidence of
injury. There is no lymphadenopathy.
## PELVIS:
The bladder, prostate, and rectum appear unremarkable. There is no
free fluid or lymphadenopathy. Two areas of ill-defined hypodensity in the
left quadriceps likely represent small intramuscular hematomas.
## BONES:
There is no aggressive-appearing lytic or sclerotic lesion and no
fracture is present.
## IMPRESSION:
No evidence of intrathoracic or intra-abdominal injury, and no
evidence of fracture.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17508552", "visit_id": "26382485", "time": "2185-03-03 00:46:00"} |
18722881-RR-37 | 109 | ## EXAMINATION:
COMPLETE GU U.S. (BLADDER AND RENAL)
## INDICATION:
year old woman with hx hematuria // r/o stones, tumors etc
## FINDINGS:
Right kidney measures 11.2 cm and demonstrates no nephrolithiasis or
hydronephrosis. A 3.2 x 2.3 x 2.5 cm exophytic lower pole cyst is
demonstrated.
Left kidney measures 9.4 cm and demonstrates no nephrolithiasis or
hydronephrosis.
Visualized bladder measures 9.2 x 11.7 x 7.2 cm. Postvoid bladder measures 6.6
x 4.6 x 2.4 cm, 43 cc volume.
## IMPRESSION:
-No nephrolithiasis or hydronephrosis. 3.2 cm lower pole right renal cyst.
-43 cc postvoid residual bladder volume.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18722881", "visit_id": "N/A", "time": "2169-02-13 08:11:00"} |
11881615-RR-98 | 214 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## HISTORY:
with multiple myeloma on chemo p/w AMS // ?bleed,
other acute process
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.2 cm; CTDIvol = 49.6 mGy (Head) DLP =
903.1 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
## FINDINGS:
Study is degraded by motion. Within these confines:
There is no evidence of territorial infarction, intracranial hemorrhage,
edema, or mass. Small focal densities in the basal ganglia are likely
calcifications. Periventricular and subcortical white matter hypodensities,
nonspecific but probably reflect sequela of chronic microangiopathy.
Prominence of the ventricles and sulci may reflect age-related involutional
changes. Atherosclerotic vascular calcifications are noted.
No osseous abnormalities seen. The mastoid air cells, and middle ear cavities
are clear. The orbits are preserved. Minimal bilateral maxillary sinus and
ethmoid air cell mucosal thickening is present. Soft tissue densities are
noted within bilateral external auditory canals which may represent cerumen.
## IMPRESSION:
1. Study is degraded by motion.
2. Within limits of study, no acute intracranial abnormality, with no
definite evidence of acute intracranial hemorrhage. Please note MRI of the
brain is more sensitive for the detection of acute infarct.
3. Atrophy, probable small vessel ischemic changes, and atherosclerotic
vascular disease as described.
4. Minimal paranasal sinus disease , as described.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11881615", "visit_id": "N/A", "time": "2172-09-25 14:27:00"} |
10613235-RR-20 | 436 | ## PROCEDURE:
CT trachea without contrast with reconstructed images in both
inspiratory and expiratory dynamic phases.
## FINDINGS:
At end inspiration, the trachea and main bronchi are patent and
normal in appearance. No endotracheal or endobronchial secretions are
detected.
During dynamic expiration, there is moderate generalized narrowing of the
entire thoracic trachea due to both circumferential narrowing and anterior
bulging of the posterior tracheal wall. The right bronchial tree is severely
affected, more than the left.
For example, just superior to the aortic arch on , the cross-sectional
area of the trachea on inspiration 375 mm2 drops to 271 mm2 on the expiratory
dynamic phase of 5, 26. Tracheal narrowing is most prominent at its distal
portion just above the carina. At that level on 3, 32 the cross- sectional
area of the trachea, 450 mm2, drops to 118 mm2 on dynamic expiration on .
More marked narrowing, some to near occlusion, of the main bronchi, right
upper lobe bronchus, bronchus intermedius and lobar, segmental bronchi to the
middle lobe, lingula and lower lobes are noted with relative sparing of the
origin of the left upper lobe are seen.
The diameter of both right and left bronchial lumen is 1.2 cm decreasing to 3
mm respectively. The bronchus intermedius lumen from 1 cm; 3, 44 to 3.8mm; 5,
38.
The evaluation of the lungs is remarkable for two stable non-calcified less
than 2 mm nodules, in the left upper lobe 3, 36, and the right lower lobe on
3, 54. In addition, mild diffuse interstitial lung disease is present
characterized by subpleural distribution of irregular reticular opacities
affecting the lung bases to a greater degree. On expiration, moderate air
trapping is noted in both lungs.
No enlarged mediastinal or hilar lymph nodes are present. The heart size is
normal. There are coronary artery calcifications, severe right internal
carotid artery calcification and left subclavian artery calcification are
noted.
There is no pleural or pericardial effusion. Moderate-sized hiatal hernia is
present.
The bony structures demonstrate degenerative changes in the spine with no
suspicious lesions suspicious for malignancy or infection.
In the imaged portion of the upper abdomen on this limited examination a tiny
calcified granuloma is again seen within the liver.
## IMPRESSION:
1. Diffuse tracheobronchomalacia, moderate in severity in the trachea and
marked in severity in the bronchi, but stable when compared to the previous
examination.
2. Multifocal air trapping.
3. Stable mild diffuse interstitial lung disease.
4. Smaller than 3 mm non-calcified pulmonary nodules, stable for ten months.
Followup should be considered only if patient has higher than normal risk for
lung cancer.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10613235", "visit_id": "20500590", "time": "2128-05-07 11:18:00"} |
17132282-DS-4 | 753 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## HISTORY OF PRESENT ILLNESS:
Patient is a year old male who presents to as a
transfer from his for hypotension to the s systolic, fever
to 100.3, and mild headache. Patient has a history of Right
sided
SDH following fall in the setting of intoxication. Given his
symptoms and history of craniotomy for SDH, a head CT was
obtained which showed new acute vs subacute SDH on the right
side. Neurologically he is at his baseline since discharge.
Neurosurgery was consulted given the findings of the head CT. He
denies nausea, vomiting, dizziness, difficulty ambulating,
changes in hearing or speech. of note he is legally blind at
baseline
## PAST MEDICAL HISTORY:
Polysubstance abuse - ETOH/cocaine
Hep C
Afib
Schizophrenia
## HEENT:
Pupils: surgical EOMs grossly full
## MENTAL STATUS:
Awake and alert, agitated, requires redirecting
during exam
## ORIENTATION:
Oriented to person, place, and date.
## LANGUAGE:
Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.
## II:
Pupils surgical bilaterally. blind
## III, IV, VI:
Extraocular movements intact bilaterally without
nystagmus.
## V, VII:
Facial strength and sensation intact and symmetric.
## VIII:
Hearing intact to voice.
## XI:
Sternocleidomastoid and trapezius normal bilaterally.
## XII:
Tongue midline without fasciculations.
## MOTOR:
Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power throughout. No pronator drift
## SENSATION:
Intact to light touch
Exam on discharge:
Unchanged
## FINDINGS:
PA and lateral views of the chest are obtained. Lungs
are
hyperinflated without focal consolidation, effusion, or
pneumothorax.
Cardiomediastinal silhouette is normal. Bony structures are
intact. No free air below the right hemidiaphragm.
## IMPRESSION:
Hyperinflated lungs without acute intrathoracic
process.
## MPRESSION:
Acute re-bleed into the right cerebral subdural space
(at the site
Preliminary Reportof prior evacuation), with SDH thickness up to
9-mm. Minimal leftward shift of
Preliminary Reportnormally midline structures is unchanged.
## BRIEF HOSPITAL COURSE:
Mr. was admitted to the Neurosurgical service given a
report of fevers, hpotension and increasing headache.
A CT-head was ordered which revealed a an acute re-bleed into
the right cerebral subdural space (at the site of prior
evacuation) but no other significant changes and no increase in
midline shift (he already had known slight midline shift on
discharge last week).
He was closely monitored overnight. He remained afebrile and his
CXR and U/A did not reflect infectious etiologies.His blood
cultures are still pending.
He had a slight headache which he stated had not changed in
intensity since admission. His neurological exam was otherwise
not concerning.
He was deemed stable for discharge back to rehabilitation with
Neurosurgery follow-up as previously outlined on his previous
discharge.
## MEDICATIONS ON ADMISSION:
risperidone, albuterol, insulin,
fluphenazine, thiamine, folic acid, MVI, nicotine, keppra,
benztropine
## DISCHARGE MEDICATIONS:
1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain or fever.
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. risperidone 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
4. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig:
Puffs Inhalation Q4H (every 4 hours) as needed for wheezing.
5. insulin regular human 100 unit/mL Solution Sig: as directed
Injection as directed.
6. fluphenazine decanoate 25 mg/mL Solution Sig: One (1)
Injection Q 2 WEEKS ().
7. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
## 8. MULTIVITAMIN TABLET SIG:
One (1) Tablet PO DAILY (Daily).
9. folic acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
10. nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
11. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
12. benztropine 1 mg Tablet Sig: One (1) Tablet PO at bedtime.
## FACILITY:
Diagnosis:
acute on chronic subdural hematoma
## DISCHARGE INSTRUCTIONS:
You were admitted to the because of
headaches, low blood pressure and fevers.
You underwent a CT-scan of your head which revealed a slight
increase in the amount of blood in your head. However, there is
no evidence that this blood is causing problems at the moment
and the blood will reabsorb over time.
You should continue your rehabilitation and follow up with
Neurosurgery as previously outlined on your last discharge
paperwork.
Please note that we have NOT made changes to your medications.
You should continue to take your medications as outlined prior
to your admission to the hospital.
Please note the follow-up appointments listed below.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17132282", "visit_id": "29063065", "time": "2144-11-05 00:00:00"} |
11166070-RR-45 | 92 | ## HISTORY:
female with neck pain.
## FINDINGS:
C1-T1 are demonstrated on the lateral view. No prevertebral swelling is
identified. As demonstrated on radiographs dated , there is
straightening of cervical lordosis. No fracture or spondylolisthesis is
detected. Vertebral height appear preserved. There is mild narrowing of the
disc spaces between C5-C6 and C3-C4 with associated degenerative changes.
There are no focal lytic or sclerotic lesions identified.
## IMPRESSION:
Straightening of cervical lordosis, unchanged since prior examination dated in
.
Mild disc space and degenerative changes between C3-4 and C5-C6.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11166070", "visit_id": "N/A", "time": "2149-12-16 09:59:00"} |
15797182-RR-65 | 110 | ## EXAMINATION:
BILATERAL LOWER EXTREMITY ULTRASOUND
## INDICATION:
female with poor bilateral lower extremity
circulation.
## FINDINGS:
Grayscale, color, and spectral doppler imaging was obtained of the right and
left common femoral, femoral, and popliteal veins. Normal flow,
compressibility, augmentation, and waveforms are demonstrated. No intraluminal
thrombus is identified. Normal color flow and compressibility are demonstrated
in the posterior tibial and peroneal veins. There is normal respiratory
variation in both common femoral veins. The greater saphenous veins
demonstrate normal color flow, patency, and augmentation bilaterally. There is
no evidence of venous reflux. No cyst is seen.
## IMPRESSION:
No evidence of deep vein thrombosis or reflux in right or left lower
extremity.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15797182", "visit_id": "N/A", "time": "2192-11-14 09:58:00"} |
14838462-RR-21 | 306 | ## INDICATION:
male status post trauma. Please evaluate for injury.
## CT CHEST:
Heart, pericardium, and great vessels are normal. There is no
pleural or pericardial effusion. Endotracheal tube is in place, roughly 1.5
cm above the carina. Nasogastric tube extends into the gastric body. There
is no sign of mediastinal hematoma, or contusion. Slightly increased soft
tissue density in the anterior mediastinum most likely represents residual
thymic tissue. There is no pathologically enlarged lymphadenopathy within the
chest. Central airways are patent to the subsegmental level.
There are a few scattered ill-defined areas of slightly increased ground-glass
opacity, which most probably represent atelectatic lung, however, it is
difficult to exclude small early foci of pulmonary contusion. Small foci of
air in the anterior chest wall subcutaneous tissues most likely represent air
related to intravenous injections, as opposed to areas of laceration. There
is no pleural or pericardial effusion. There is no pneumothorax.
## CT ABDOMEN:
Liver, gallbladder, pancreas, spleen, and adrenal glands are
normal. Kidneys enhance and excrete contrast symmetrically. There is no
hydronephrosis. Abdominal aorta and its branches are normal in appearance.
Stomach and intra-abdominal loops of bowel are normal. There is no free air,
free fluid, or abnormal intra-abdominal lymphadenopathy.
## CT PELVIS:
Pelvic loops of large and small bowel, and genitourinary
structures are normal. Foley catheter balloon is in place within partially
decompressed bladder. There is no free pelvic fluid, or abnormal pelvic or
inguinal lymphadenopathy.
There is no osseous lesion suspicious for malignancy. Transversely oriented
linear lucency with well-corticated margins within the mid sternum is
compatible with unfused sternal ossification centers. No fractures seen.
## IMPRESSION:
1. No definite acute injury in the chest, abdomen, or pelvis.
2. Vague areas of increased ground-glass opacity scattered throughout the
lung may represent atelectasis, but early pulmonary contusion cannot be
excluded.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14838462", "visit_id": "25243951", "time": "2176-11-07 20:05:00"} |
16994213-RR-76 | 173 | ## INDICATION:
year old man with hand weakness, numbness. Patient with
vascular risk factors. Identical twin with diagnosis of MS. // Please
evaluate for white matter disease, vascular or otherwise.
## FINDINGS:
There is no significant interval change in the appearance of few scattered
foci of FLAIR hyperintensity predominantly in the subcortical and deep white
matter of both cerebral hemispheres of nonspecific nature. No focal
abnormalities are seen in the periventricular white matter, corpus callosum or
brain stem. There is no acute infarcts seen. There is chronic appearing
infarct or widening of the fissure visualized in the left cerebellum which is
unchanged. There is no evidence of a hippocampal or brain atrophy. No
abnormal signal seen in the hippocampal region. No acute infarcts are
identified.
## IMPRESSION:
No significant interval change since the previous MRI examination in scattered
white matter hyperintensities predominantly in the subcortical and deep white
matter without callosal, or brainstem FLAIR abnormalities. The
MRA appearances are not typical for demyelinating disease and may represent
mild small vessel disease but clinical correlation recommended.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16994213", "visit_id": "N/A", "time": "2138-06-23 16:58:00"} |
14271359-RR-3 | 216 | VEIN MAPPING FOR AV FISTULA.
The cephalic and basilic veins were mapped on both upper extremities. The
radial and brachial arteries were also examined.
On the right side, the brachial artery measures 3.3 mm. There was no calcium.
The radial artery is 2.3, contains a small calcification. The cephalic vein
is seen from the elbow to the shoulder region. This measures 3.5 mm in the
lower arm, 2.5 mm at the elbow, and 2.2-4.8 mm in the upper arm. The basilic
vein on the right side measures 2.5-2.8 mm in the lower arm, 2.7 at the elbow,
and 2.1-4.2 mm in the upper arm.
On the left side, the brachial artery measures 3.8 mm with no calcium. The
radial artery measures 2 mm, containing some calcification. The cephalic vein
is seen in the upper forearm measuring 2.6-3 mm, at the elbow, 5 mm, 3.8-4.9
mm in the upper arm. The basilic vein measures 2.9-4 mm in the forearm, 3.5
mm at the elbow, and 2.9-3.8 mm in the upper arm.
## IMPRESSION:
Measurements of the cephalic and basilic veins as indicated
above, as well as the radial and brachial arteries.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14271359", "visit_id": "N/A", "time": "2143-10-18 09:31:00"} |
15655764-DS-8 | 1,790 | ## MAJOR SURGICAL OR INVASIVE PROCEDURE:
ERCP with spincterotomy and stent placement
## HISTORY OF PRESENT ILLNESS:
male PMHx of s/p CCY , multiple ERCPs (Haverill) &
( ) for stone and biliary sludge removal presents
with 12 days of recurrent mid abdominal post-prandial pain,
reminiscent of prior biliary pain. It began after
eating a meal, producing sharp epigastric pain without radiation
but associated with nausea and diaphoresis, no vomiting. Since
then, it's occurred 3 more times similar each time, though less
intense than the first time, and always after eating. Pain
typically lasts about an hour prior to subsiding on its own.
Over this time he's eaten less because of the post-prandial
nature. The last time it occurred was last night 6pm
after dinner. This lasted about an hour and was followed by
several hours of rigors. He reports subjective fever and
headache off and on through out the week.
## AT ED:
Initial T 99.8, HR 92, BP 141/72, RR 18, SpO2 99%.
Repeat vitals four hours later T 98 HR 84. He has mild
transaminitis, mild Alk phos elevation, normal TBili. WBC was
normal without left shift, and HCT was 38.6 MCV 86. A RUQ U/S
wet read indicates CBC 3mm which dilates to 10mm without
obstruction lesion. Hemolyzed K+=6.5, repeat was 3.8.
## PAST MEDICAL HISTORY:
- s/p cholecystectomy
- s/p ERCP with stone and sludge removal
- s/p prostatectomy (prostate cancer
- s/p cataract
## FAMILY HISTORY:
Sister -
Mother -
Father - throat cancer
## GEN:
Well, in no distress
## HEENT:
Anicteric, OP clear, neck supple, L scleral hemorrhage
## LUNGS:
CTA bilat, good inspiratory effort
## ABD:
soft, NT, ND, no HSM, no rebound/guarding, no masses
## NEURO:
grossly normal, nl speech/cognition
## SKIN:
no rash, no jaundice
## MSK:
FROM throughout
.
Discharge Exam
AVSS
Abdomen Benign
## FINDINGS:
The liver has normal echogenicity and echotexture.
Note is made of an irregularly-shaped anechoic rounded structure
in the left lobe of the liver measuring 2.5 x 2.2 x 2.6 cm with
posterior acoustic enhancement, consistent with a simple cyst.
Pneumobilia, expected post ERCP, is noted. The main portal vein
is patent with expected hepatopetal flow. The common duct, as
it exits the liver, measures 3 mm, and then dilates to 10 mm
with a narrow zone of transition, likely related to post
cholecystectomy changes. Limited views of the right kidney and
IVC are unremarkable. There is no ascites.
## IMPRESSION:
Mild prominence of the CBD at the porta hepatis,
acceptable post cholecystectomy.
MRI Abdomen
## INDICATION:
Abdominal pain. Prior history of cholecystectomy.
## COMPARISON:
Ultrasound available from .
## TECHNIQUE:
T1- and T2-weighted multiplanar images of the
abdomen were
acquired within a 1.5 Tesla magnet, including 3D dynamic
sequences performed prior to, during, and following the
uneventful administration of 8 cc of Gadovist intravenous
contrast.
MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:
Included views of the lung bases are clear. There is no
pericardial or
pleural effusion. The heart size is normal. A 3.1 x 2.5 cm T2
hyperintense non-enhancing hepatic cyst and other subcentimeter
cysts or biliary hamartomas are present (4:14, 3:8, 9, 10). No
solid intrahepatic mass is detected. There is no intrahepatic
bile duct dilation.
Blooming artifacts along the left intrahepatic bile ducts denote
mild
pneumobilia (5:16, 18). There is a small focus of air within
the proximal CBD (5:20). Oral contrast refluxes into the CBD.
The right posterior intrahepatic bile duct drains into the left
main duct
(12:72). A 9-mm stone resides within the distal CBD (3:19,
12:76). No stones are detected in the remnant cystic duct,
which demonstrates a low attachment into the distal CBD (6:2).
The CBD measures up to 9 mm in diameter (3:18), within
post-cholecystectomy limits.
The spleen, stomach, adrenal glands, kidneys, pancreas, and
intra-abdominal loops of small and large bowel are normal.
There is no mesenteric or retroperitoneal lymphadenopathy, and
no ascites.
There are no bony lesions concerning for malignancy or
infection.
## IMPRESSION:
1. 9-mm stone within the distal CBD.
2. Post-cholecystectomy. The remnant cystic duct is free of
stones and
demonstrates low attachment to the distal CBD.
3. The right posterior intrahepatic duct drains into the left
main duct.
4. Mild pneumobilia.
5. Multiple hepatic cysts or biliary hamartomas.
CT Abdomen without contrast
## INDICATION:
ERCP yesterday, question of free air in the right
upper quadrant.
## TECHNIQUE:
MDCT images were obtained through the abdomen
without IV contrast
and with oral contrast. Coronal and sagittal reformations were
performed.
## FINDINGS:
The imaged lung bases are clear. The visualized
heart and
pericardium are unremarkable.
Lack of IV contrast limits evaluation of the intra-abdominal
organs. A CBD
stent has been placed. Patient is status post cholecystectomy.
There is
pneumobilia as expected in the left lobe. There is a moderate
amount of free
air throughout the retroperitoneum on the right. There is no
evidence of
leakage of oral contrast. A 3.0-cm ciliated hepatic foregut
cyst is seen in
the left lobe of the liver. A subcentimeter hypodensity in the
left lobe is
too small to characterize (2, 16). No other hepatic lesions are
identified.
No definite evidence of intrahepatic biliary duct dilatation.
The pancreas is
unremarkable. The spleen is normal. The adrenal glands are
normal. There is
a 3 mm non-obstructing stone in the lower pole of the left
kidney. No
hydronephrosis. The right kidney is unremarkable. Visualized
small and large
bowel are unremarkable.
Aorta is normal in caliber. There are mild aortic
calcifications.
## BONES:
No acute bony abnormalities identified.
## IMPRESSION:
1. Moderate amount of retroperitoneal free air on the right
likely from
duodenal perforation.
2. 3 mm non-obstructing stone in the lower pole of the left
kidney.
3. CBD stent is patent.
ERCP
## PROCEDURE:
The procedure, indications, preparation and potential
complications were explained to the patient, who indicated his
understanding and signed the corresponding consent forms. A
physical exam was performed. The patient was administered
moderate sedation. The patient was placed in the prone position
and an endoscope was introduced through the mouth and advanced
under direct visualization until the third part of the duodenum
was reached. Careful visualization was performed. The procedure
was not difficult. The quality of the preparation was good. The
patient tolerated the procedure well. There were no
complications.
## FINDINGS:
Esophagus: Limited exam of the esophagus was normal
## STOMACH:
Limited exam of the stomach was normal
## DUODENUM:
Limited exam of the duodenum was normal
## MAJOR PAPILLA:
Post sphincterotomy appearance of papilla that
has partially restenosed.
## CANNULATION:
Cannulation of the biliary duct was successful and
deep with a sphincterotome using a free-hand technique. Contrast
medium was injected resulting in complete opacification. The
procedure was not difficult.
Flouroscopic interpretation of Biliary Tree: At least two large
filling defects consistent with stones in the common bile duct.
The common bile duct was dlated to 13 mm. Given these fingings,
balloon sphincteroplasty was done using CRE balloon [ 12 and 13
mm].
## PROCEDURES:
The stones were removed using the extraction baloon.
Following the procedure, a linear air shadow within the right
upper quadrant was seen.
Because of concern for a small duodenal perforation, we elected
to put a 6cm by 10mm fully covered wallflex biliary stent to
seal any possible leak.
## IMPRESSION:
Limited exam of the esophagus, stomach and duodenum
normal.
Post sphincterotomy appearance of papilla that has partially
restenosed.
Cannulation of the biliary duct was successful and deep with a
sphincterotome using a free-hand technique. Contrast medium was
injected resulting in complete opacification. The procedure was
not difficult.
At least two large filling defects consistent with stones in
the common bile duct. The common bile duct was dlated to 13 mm.
Given these fingings, balloon sphincteroplasty was done using
CRE balloon [ 12 and 13 mm].
The stones were removed using the extraction baloon. Following
the procedure, a linear air shadow within the right upper
quadrant was seen.
Because of concern for a small duodenal perforation, we elected
to put a 6cm by 10mm fully covered wallflex biliary stent to
seal any possible leak.
## RECOMMENDATIONS:
Return to floor for ongoing care.
NPO.
IV fluids.
Continue IV antibiotics.
As the abdomen is currently soft and nontender, CT abdomen with
oral contrast tomorrow before starting PO.
If any increase in abdominal pain, urgent CT scan tonight and
surgical consult from pancreato-biliary surgery team.
Additional notes: The procedure was performed by Dr.
the GI fellow. FINAL DIAGNOSES are listed in the impression
section above. Estimated blood loss = zero. No specimens were
taken for pathology. I supervised the acquisition and
interpretation of the fluoroscopic images. The quality of the
fluoroscopic images was good.
## BRIEF HOSPITAL COURSE:
s/p CCY and prior ERCP for symptomatic biliary sludge
presented for ERCP.
## ACTIVE ISSUES:
# Choledocolithiasis s/p ERCP with duodenal perforation: Patient
was admitted with with abdominal pain, mild cholestatic LFT
picture, chills, headache without fever or leukocytosis. RUQ
U/S with possible CBD dilation. Pt underwent MRCP was positive
for a 9 mm stone in the distal CBD. Pt subsequently underwent
sphincteroplasty to correct narrowing and removal of stone via
balloon. However had duodenal perforation secondary to
procedure (see report above) with moderate amount of air
accumulating in retroperitoneal space on right side. This was
confirmed on CT scan. The patient was seen by surgery that
recommended conservative management. The patient was treated
with Cipro/Flagyl and transitioned to PO Cipro. The patient was
discharged on with an additional week of Cipro and
instructed not to take his aspirin. The patient will need to
return in weeks for stent removal. The patient was continued
on his home dose of Urosidiol 300mg BID on discharge.
.
## TRANSITIONAL ISSUES:
- Direct verbal signout provided to the patients PCP on
.
- The patient was instructed to take an additional week of
antibiotics
- Blood cultures were NGTD but pending on discharge
- The patient will need to return for stent pull in weeks
- The patient was instructed not take his aspirin for 1 week.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Aspirin 81 mg PO DAILY
2. Ursodiol 300 mg PO BID
3. Fish Oil (Omega 3) 1000 mg PO BID
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY
2. Fish Oil (Omega 3) 1000 mg PO BID
3. Ursodiol 300 mg PO BID
4. Ciprofloxacin HCl 500 mg PO Q12H
RX *ciprofloxacin 500 mg 1 tablet(s) by mouth twice a day Disp
#*14 Tablet Refills:*0
## DISCHARGE DIAGNOSIS:
Primary Diagnosis
- Choledocolithiasis
- Duodenal Perforation
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital for gallstones. You underwent
an ERCP that was complicated by a perforation of your small
bowel. You were watched clinically and your symptoms and labs
improved. You were discharged on antibiotics.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15655764", "visit_id": "20921780", "time": "2140-02-17 00:00:00"} |
16390424-RR-24 | 98 | ## HISTORY:
man with ADEM and worsened symptoms.
## FINDINGS:
The alignment is normal. The vertebral body heights and disc spaces are
normal. The bone marrow signal is unremarkable.
The craniocervical junction is normal. There is residual but improved patchy
abnormal signal throughout the cord without abnormal enhancement.
There is a small disc protrusion at C6-C7 without spinal canal or neural
foraminal narrowing. Otherwise, there are minimal uncovertebral osteophytes
without significant spinal canal or neural foraminal narrowing.
The posterior paraspinal soft tissues are unremarkable.
## IMPRESSION:
Residual but improved patchy abnormal signal throughout the cord without
abnormal enhancement.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16390424", "visit_id": "27973105", "time": "2141-01-12 05:39:00"} |
11390927-DS-18 | 963 | ## CHIEF COMPLAINT:
"my counselor wants me to go to inpatient"
## HISTORY OF PRESENT ILLNESS:
y/o homeless man with
polysubstance abuse presents to the ED after taking multiple
substances and stating he is suicidal. Of note, he is a poor
historian, gives a vague history, makes provocative statements,
becomes easily irritated and angry, and is often unable to
answer
directed questions without a lengthy conversation. He states he
has been having increasing thoughts of dying, with vague plans
such as walking across the street and being hit, or having a
massive heart attack. He states his depressive symptoms started
approximately 4 months ago after he was kicked out of his room
at
the (see below). He describes depression, anger, and poor
sleep. He did not give a specific reason for coming to the
hospital today but stated that he used approximately 11mg of
Xanax, 7mg of klonopin, o.3mg of clonidine, and 1800mg of
neurontin (prescribed as 800mg TID) today, due to his
depression.
He did not specifically state he took these in an overdose
attempt, though did discuss this with the ED attending. He
states
on numerous occasions that he wants to "go home to my father",
and when questioned further, he means he wants to die and be
with
God.
The patient appears to describes being arrested on numerous
occasions and having to go to court for warrants. The decided that his housing would no longer be
subsidized and for 4 months he has been homeless. He states he
has been banned from shelters and is currently living on the
street. He was living with some people several months ago for a
very short period of time. He left his extensive audiovisual
collection in this apt for storage. The patient claims these
people accused him of stealing their klonopins, and they sold
all
of his audiovisual equipment after the patient went to live with
another friend. He now states he wants to harm these people,
though denies any plan. He has not done anything thus far. He
becomes closed to the conversation at , stating nothing
is confidential and "I've read the DSM".
Pt denies any abnormal perceptions though admits to some
paranoia
and becomes paranoid around several themes during the interview
that lead him to feel threatened, irritable and angry.
Of note, patient has been seen 15 times by since
for psych/substance issues.
## HOSPITALIZATIONS:
Pt states detoxes, 20 psychiatric
admissions - last one at 2 months ago per pt. According
to BEST team, he was admitted to 5 days
ago for a similar presention. Recent history of multiple
admissions per BEST.
## MEDICATION TRIALS:
Zoloft, Valium, other meds pt could not
report
## SA/SIB:
Pt becomes guarded and does not answer these questions.
Head banging noted by BEST records when pt does not get what he
wants
Outpatient treaters: Denies. Pt appears to have contact with
, social worker from .
## PAST MEDICAL HISTORY:
Bradycardia, Syncope, prolonged QT (per BEST due to overuse of
benzodiazepines)
Hep C
Migraines
Neuropathy (pain issues)
## FAMILY HISTORY:
+mental illness and substance abuse
in parents.
## APPEARANCE & FACIAL EXPRESSION:
Caucasian man with shaved
head in hospital gown. Appears older than stated age. Often seen
to be picking a dry skin on his head.
## POSTURE:
Lying down, listening to IPOD
## BEHAVIOR:
Eye contact is piercing at times. No psychomotor
deficits
## SPEECH:
Regular rate, rythym, and volume
## MOOD:
"feeling depressed is a gross understatement for the
way I'm feeling"
## THOUGHT FORM:
tangential, perseverative, vague, overly
inclusive of details that are irrelevant
## THOUGHT CONTENT:
+paranoia towards physicians; numerous
references about interviewer not believing him etc...
## SUICIDALITY/HOMICIDALITY:
SI and HI, though pt will not
disclose thoughts of HI to interviewer since he does not believe
anything is confidential.
## ORIENTATION:
Fully x 3 (person, place, time (off one
day
## FUND OF KNOWLEDGE:
average...speaks about ,
financial crisis
## PROVERB INTERPRETATION:
The grass is greener on the
other side = "some people are not satisfied with their
situation,
but when they try to change it they are better off staying where
they were
## BRIEF HOSPITAL COURSE:
Pt was admitted to Deac 4 today, had been c/o L-sided chest
pain in ED, on unit began to c/o bilat calf pain. No SOB. ECG w/
peaked Tw, elevated D-dimer. CTA confirmed PE. BLE US pending.
Medicine will accept pt for anticoagulation w/ UFH gtt.
Psychiatry attending physician, , M.D., informed
of medical trigger and concurs with transfer of pt to Medicine
service.
## MEDICATIONS ON ADMISSION:
Neurontin 800mg TID
Klonopin 1mg QID
Methadone 14mg daily clinic)
## DISCHARGE MEDICATIONS:
1. Nicotine (Polacrilex) 2 mg Gum Sig: One (1) Gum Buccal Q1H
(every hour) as needed for craving.
2. Lorazepam 1 mg Tablet Sig: Two (2) Tablet PO Q1H (every hour)
as needed for CIWA>10.
3. Gabapentin 400 mg Capsule Sig: Two (2) Capsule PO TID (3
times a day).
4. Hydroxyzine HCl 25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Hydroxyzine HCl 25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) as needed for pruritus/anxiety/allergic rxn.
6. Methadone 10 mg/5 mL Solution Sig: Eleven (11) mg PO DAILY
(Daily).
7. Nicotine 7 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
8. Clonazepam 1 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
9. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Puffs Inhalation Q6H (every 6 hours) as needed for SOB.
10. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
## AXIS I:
Polysubstance abuse, r/o substance induced mood disorder
## AXIS III:
Hep C, neuropathy, migraines
## DISCHARGE CONDITION:
stable, transfer to medical floor
## DISCHARGE INSTRUCTIONS:
transfer to medical floor, per medical team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11390927", "visit_id": "29269869", "time": "2120-01-06 00:00:00"} |
16064864-RR-20 | 116 | ## EXAM:
Chest, single AP upright portable view.
## CLINICAL INFORMATION:
male with history of tachycardia.
## FINDINGS:
Single portable AP upright view of the chest was obtained. There
are relatively low lung volumes. Blunting of the left costophrenic angle and
to a lesser extent the right costophrenic angle may be due to small effusions.
Right base opacity is seen raising concern for consolidation. There is also a
patchy right mid lung opacity. Prominence of the hila may relate to fluid
overload. Cardiac silhouette is top normal to mildly enlarged. The aorta is
calcified and tortuous.
## IMPRESSION:
Patchy right mid lung and right base opacities, raising concern
for consolidation and infectious process in the appropriate clinical setting.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16064864", "visit_id": "25567096", "time": "2114-09-03 18:58:00"} |
18650356-RR-13 | 89 | ## INDICATION:
man with right facial swelling s/p assault.
## FINDINGS:
There is a soft tissue hematoma overlying the left frontal bone and
extending into the left periorbital and infraorbital soft tissues, as well as
over the anterior zygomatic arch. There is no fracture. There is no
intraorbital hematoma. The globes are intact. There are mucus retention cysts
in the maxillary sinuses and the left sphenoid sinus. Ostiomeatal units are
patent.
Concurrent head and cervical spine CTs are reported separately.
## IMPRESSION:
Left facial soft tissue hematoma. No fracture.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18650356", "visit_id": "24322696", "time": "2187-11-15 02:11:00"} |
16736889-RR-107 | 553 | ## INDICATION:
year old man with KS with past scan showing
peribronchovascular soft tissue thickening and interstitial septal nodularity.
Please evaluate. // year old man with KS with past scan showing
peribronchovascular soft tissue thickening and interstitial septal nodularity.
Please evaluate.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.0 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 5.9 s, 0.2 cm; CTDIvol = 95.5 mGy (Body) DLP =
19.1 mGy-cm.
3) Spiral Acquisition 6.4 s, 70.6 cm; CTDIvol = 5.9 mGy (Body) DLP = 410.6
mGy-cm.
4) Spiral Acquisition 2.9 s, 31.6 cm; CTDIvol = 5.3 mGy (Body) DLP = 163.8
mGy-cm.
Total DLP (Body) = 595 mGy-cm.
** Note: This radiation dose report was copied from CLIP (CT ABD AND
PELVIS WITH CONTRAST)
## NECK, THORACIC INLET, AXILLAE:
The visualized thyroid is normal.
Supraclavicular and axillary lymph nodes are not enlarged.
## MEDIASTINUM:
The pretracheal (05:24), and subcarinal (05:29) lymph nodes
appear decreased in size and less hypervascular compared to prior. Other
lymph nodes are not pathologic by CT size criteria. Soft tissue stranding and
infiltration within the mediastinal and hilar tissues are unchanged. The fat
plane between the esophagus and the aforementioned soft tissue infiltration of
the mediastinum is not well appreciated and this may represent diffuse
esophageal tumor infiltration. There is mild proximal esophageal dilation.
## HILA:
Hilar lymph nodes are not enlarged.
## HEART:
The heart is not enlarged and there is no coronary arterial
calcification. There is no pericardial effusion.
## VESSELS:
Vascular configuration is conventional. Aortic caliber is normal.
The main, right, and left pulmonary arteries are normal caliber.
## PULMONARY PARENCHYMA:
There has been interval resolution of masslike right
upper lobe consolidation. Right middle lobe nodule appear smaller, now
measuring 3 mm (6:137). Multiple subcentimeter nodules are unchanged (6:114,
116, 154, 169, 172).
## AIRWAYS:
Bilateral peribronchovascular soft tissue thickening and nodularity
in the lower lobes have significantly decreased compared to .
Bilateral lower lobe predominant bronchiectasis and wall thickening appear not
significantly changed. There is minimal right lower lobe atelectasis.
## PLEURA:
There has been significant decrease in nodular septal thickening
since . Pleural soft tissue density along the right heart
border likely is residual tumor. High density thickening of the pleura, left
greater than right and involving the costal and mediastinal pleural for
consistent with history of pleurodesis. There has been interval decrease in
trace left nonhemorrhagic pleural effusion. Consolidative appearance of the
left lower lobe may be due to atelectasis secondary to pleural restriction or
residual tumor. No pleural effusion seen on the right.
## CHEST WALL AND BONES:
There is no worrisome lytic or sclerotic lesion.
Multilevel degenerative changes are mild.
## UPPER ABDOMEN:
Please see separately submitted Abdomen and Pelvis CT report
for subdiaphragmatic findings.
## IMPRESSION:
1. Interval improvement of bilateral lower lobe peribronchovascular soft
tissue thickening from known Kaposi sarcoma.
2. Residual medial pleural tumor in the right hemithorax.
3. Loss of fat plane between the mediastinal soft tissue infiltration and the
esophageal wall, concerning for diffuse esophageal tumor infiltration.
Please see separately submitted Abdomen and Pelvis CT report for
subdiaphragmatic findings.
## NOTIFICATION:
The impression and recommendation above was entered by Dr.
on at 17:28 into the Department of Radiology critical
communications system for direct communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16736889", "visit_id": "N/A", "time": "2142-03-26 11:54:00"} |
14923534-RR-30 | 211 | ## INDICATION:
year old woman with nausea and worsening vomiting. Evaluate for
intrabdominal pathology
## CT OF THE ABDOMEN:
The bases of the lungs are clear. The visualized heart and
pericardium are unremarkable.
The liver is fatty, but enhances homogeneously without focal lesions or
intrahepatic biliary duct dilatation. Patient is s/p cholecystectomy. The
portal vein is patent. The pancreas, spleen and adrenal glands are
unremarkable. The kidneys do not show solid or cystic lesions and present
symmetric nephrograms and excretion of contrast. No pelvicaliceal dilatation
or perinephric abnormalities are present.
The stomach, duodenum and small bowel are within normal limits without
evidence of wall thickening or obstruction. Apendix has been surgically
removed. The colon is within normal limits. The intra-abdominal vasculature is
unremarkable. There is no retroperitoneal or mesenteric lymph node
enlargement by CT size criteria. No ascites, free air or abdominal wall
hernias are noted.
## PELVIC CT:
The urinary bladder and terminal ureters are normal. The uterus and
adnexae are unremarkable. No pelvic wall or inguinal lymph node enlargement is
seen. There is no pelvic free fluid.
## OSSEOUS STRUCTURES:
No blastic or lytic lesion suspicious for malignancy are
present.
Coronal and sagittal images were reviewed confirming the axial findings.
## IMPRESSION:
Fatty liver. Otherwise normal abdomen and pelvis CT.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14923534", "visit_id": "21493185", "time": "2138-12-04 13:23:00"} |
15958365-RR-33 | 493 | ## HISTORY:
female with FAP status post subtotal colectomy. Patient
with prior ileal and anal anastomosis, though now with temporary end-ileostomy
due to frequent watery stools. Patient now with fever, nausea, and increasing
abdominal pain.
## CT ABDOMEN WITH INTRAVENOUS CONTRAST:
There is minimal atelectasis at the
left lung base. No consolidation or pleural effusion identified. The imaged
cardiac apex is within normal limits.
There is a tiny focus of air along the liver dome (2:11), likely secondary to
recent exploratory laparotomy and ileostomy formation on . The
liver demonstrates homogeneous parenchymal enhancement without suspicious
focal lesion. The hepatic veins and portal venous system are grossly patent.
No intra- or extra-hepatic biliary ductal dilatation is identified.
Cholecystectomy clips are seen within the right upper quadrant. The spleen,
pancreas, and adrenal glands are normal. There is symmetric enhancement and
excretion from both kidneys without suspicious focal lesion or hydronephrosis.
There is a subcentimeter hypodensity within the upper pole of the right kidney
that likely represents a simple cyst (2:22). The abdominal aorta and its
branch vessels are non-aneurysmal and grossly patent, though demonstrate mild
atherosclerotic calcifications.
## GI:
Oral contrast passes freely through the stomach and loops of small bowel
and exits through the ileostomy. There are no signs of small-bowel
obstruction or inflammation. The patient's prior J-pouch is dilated and fluid
filled. However, the degree of dilatation is unchanged compared to prior
examination from . Persistent fluid may be secondary to ongoing
mucosal secretion. However, in the right paracolic gutter is a thin oblong
fluid collection measuring 3.5 x 3.8 x 8.9 cm (301B:19, 300B:20, 300B:22).
This has an enhancing rim. No other fluid collection or free fluid is
evident.
## CT PELVIS WITH INTRAVENOUS CONTRAST:
There is an enlarged uterus with areas
of hypoattenuation suggestive of multiple fibroids. No obvious adnexal mass
lesion is identified. The bladder is decompressed and has air within it
anteriorly, likely secondary to instrumentation, correlate clinically (2:64).
No pelvic free fluid is evident.
## BONES AND SOFT TISSUES:
A left breast implant is noted. There is mild pectus
excavatum deformity. No bone destructive lesion or acute fracture is
identified. There is irregularity of the superior endplate of the L2
vertebral body, likely degenerative as it is unchanged from prior examination
from .
## IMPRESSION:
1. 3.8 x 3.9 x 9 cm right paracolic gutter fluid collection concerning for
abscess.
2. Normal appearance of the small bowel without evidence of obstruction or
inflammation. No extraluminal leak of contrast.
3. Persistently dilated J-pouch, though unchanged in morphology compared to
prior examination.
4. Left lower lobe atelectasis. No pneumonia or pleural effusion.
5. Tiny focus of free air adjacent to the liver dome, likely related to
recent postoperative state from ex lap on .
6. Air within the bladder likely secondary to instrumentation, correlate
clinically.
The communicated the above results to Dr. at 8:30
p.m. in person on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15958365", "visit_id": "25698102", "time": "2155-07-14 18:03:00"} |
15223781-RR-137 | 86 | ## EXAMINATION:
HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) RIGHT
## INDICATION:
year old woman with YR PO F/U- RIGHT HIP// PO F/U- RIGHT
HIP
## PELVIS:
Enthesopathic changes of the left greater trochanter. Mild left hip
osteoarthritis. Fusion hardware of the lower lumbar spine is again seen.
Mild degenerative changes of the lower lumbar spine.
## RIGHT HIP:
Status post total-hip arthroplasty. Alignment is unchanged. No
evidence of hardware complication. No fractures.
## IMPRESSION:
Status post right hip Total arthroplasty without evidence of complication.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15223781", "visit_id": "N/A", "time": "2161-04-09 13:16:00"} |
15656684-RR-14 | 136 | ## INDICATION:
man with right hand pain, no specific injury.
## FINDINGS:
There is bone marrow edema involving the base of the second metacarpal, but no
distinct fracture line is identified. The remainder of the bone marrow is
within normal limits.
The flexor and extensor tendons in the imaged field of view are normal in
morphology and signal intensity. The muscles are normal and symmetric. There
is no mass or fluid collection.
## IMPRESSION:
Nonspecific edema at the base of the second metacarpal. The differential
diagnosis for this finding is extensive, but the patient reports a history
of trauma associated with this. In this setting, a bone contusion would be
most likely. A non-displaced fracture at the base of the second metacarpal is
considered less likely, but cannot be entirely excluded. Clinical correlation
is therefore requested.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15656684", "visit_id": "N/A", "time": "2188-11-01 16:27:00"} |
16529283-RR-22 | 136 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
yo woman with hodgkins, undergoing chemotherapy. Has 10 day
h/o cold symptoms and cough. Evaluate for pneumonia// yo woman with
hodgkins, undergoing chemotherapy. Has 10 day h/o cold symptoms and cough.
Evaluate for pneumonia
## FINDINGS:
PA and lateral views of the chest provided.
Compared to prior chest radiograph from , there is interval
resolution of bilateral pleural effusions. No evidence of pneumothorax. No
focal consolidations. A right-sided chest port is again seen with distal tip
terminating in the cavoatrial junction, unchanged. Lungs appear
hyperinflated.
## IMPRESSION:
No evidence of pneumonia or other acute cardiopulmonary process.
Interval resolution of bilateral pleural effusions.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 9:54 am, 5 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16529283", "visit_id": "N/A", "time": "2124-04-27 08:59:00"} |
14153350-RR-70 | 90 | ## EXAMINATION:
CT C-SPINE W/O CONTRAST
## INDICATION:
with midline c spine and T spine ttp, s/p MVC// r/o fx or
dislocation
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 5.4 s, 21.1 cm; CTDIvol = 36.9 mGy (Body) DLP = 779.0
mGy-cm.
Total DLP (Body) = 779 mGy-cm.
## FINDINGS:
Alignment is normal. No fractures are identified.There is no significant
canal or foraminal narrowing.There is no prevertebral edema.
The thyroid and included lung apices are unremarkable.
## IMPRESSION:
No cervical spine fracture or malalignment.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14153350", "visit_id": "N/A", "time": "2132-05-05 21:12:00"} |
12378122-RR-23 | 103 | ## CHEST:
Frontal and lateral views
## HISTORY:
with breast CA, lumbar spine stenosis p/w
diarrhea and lle pain, recent weight loss // rule out pulmonary edema,
consolidation
## FINDINGS:
Opacity at the right cardiophrenic angle may be due to prominent fat pad, but
underlying consolidation is not excluded in the appropriate clinical setting.
No prior radiograph is available for comparison. No pleural effusion or
pneumothorax is seen. The cardiac and mediastinal silhouettes are
unremarkable.
## IMPRESSION:
Opacity at the right cardiophrenic angle may be due to prominent fat pads, but
underlying consolidation is not excluded in the appropriate clinical setting ;
CT is more sensitive.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12378122", "visit_id": "N/A", "time": "2118-04-14 19:26:00"} |
12669505-RR-6 | 179 | ## EXAMINATION:
CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST Q116 CT HEADSINUS
## HISTORY:
with orbital edema, s/p assault with punch to
both eyes/face// r/o orbital fracture
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 1.6 s, 12.7 cm; CTDIvol = 24.7 mGy (Head) DLP = 312.4
mGy-cm.
Total DLP (Head) = 312 mGy-cm.
## FINDINGS:
No acute orbital fracture is seen. There is bilateral preseptal and left
greater than right infraorbital soft tissue swelling. Partially imaged
maxillary sinuses demonstrate mild mucosal thickening bilaterally and likely
mucous retention cysts in the left maxillary sinus. Mild mucosal thickening
in the left frontal sinus and minimal mucosal thickening in the ethmoid air
cells bilaterally. The right ostiomeatal unit is patent. Difficult to
discern whether the left ostiomeatal unit is patent or slightly occluded.
The partially imaged bilateral mastoid air cells are clear.
The globes, extraocular muscles, optic nerves, and retrobulbar fat appear
normal.
## IMPRESSION:
1. No evidence of orbital fracture. Bilateral preseptal and left greater than
right infraorbital soft tissue swelling without acute orbital fracture. No
retrobulbar hematoma.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12669505", "visit_id": "N/A", "time": "2125-06-12 16:56:00"} |
15285988-RR-78 | 117 | ## EXAMINATION:
LEFT DIGITAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD
## INDICATION:
year old woman with left breast microcalcifications
## TISSUE DENSITY:
B- There are scattered areas of fibroglandular density.
Within the outer and slightly upper left breast at posterior depth is a 3-4 mm
group of coarse heterogeneous calcifications. There is no mass or area of
unexplained architectural distortions. Vascular calcifications are noted.
## IMPRESSION:
Indeterminate calcifications in the left upper outer posterior breast for
which stereotactic breast biopsy is recommended.
## RECOMMENDATION(S):
Left breast stereotactic biopsy.
## NOTIFICATION:
Findings and recommendation were reviewed with the patient who
agrees with the plan. She was given information to schedule her follow-up.
## BI-RADS:
4B Suspicious - moderate suspicion for
malignancy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15285988", "visit_id": "N/A", "time": "2147-02-09 10:01:00"} |
15129509-RR-86 | 123 | ## INDICATION:
History: with multiple complaints// PNA?xray tib/fib: fx?
## FINDINGS:
No acute fracture or dislocation. Chronic ununited fracture of the mid
patella is re-demonstrated with distraction of fracture components by
approximately 9 mm. Severe tricompartmental degenerative changes with joint
space narrowing, subchondral sclerosis, and osteophyte formation are noted
involving all 3 compartments of the knee. Multiple loose bodies are seen
within the posterior aspect of the knee. No significant joint effusion.
Osseous structures are diffusely demineralized. No concerning lytic or
sclerotic osseous abnormality. Imaged left ankle is unremarkable. There is
diffuse soft tissue swelling with mild vascular calcifications throughout the
leg. No soft tissue gas.
## IMPRESSION:
No acute fracture or dislocation. Chronic ununited patellar fracture. Severe
tricompartmental degenerative changes.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15129509", "visit_id": "27875306", "time": "2196-02-17 20:23:00"} |
14643893-RR-12 | 100 | ## INDICATION:
woman with vertigo and unsteady gait, evaluate for
stroke.
## FINDINGS:
There is no evidence of acute intracranial hemorrhage, acute major
vascular territory infarction, shift of normally midline structures, discrete
masses or mass effect. The ventricles and sulci are prominent consistent with
age-related involutional changes. Periventricular and subcortical white
matter changes likely represent sequelae of chronic small vessel ischemic
disease, however, chronicity and stability are not well defined. Bilateral
paranasal sinuses are clear.
## IMPRESSION:
1. No acute intracranial process.
2. Periventricular and subcortical white matter low-attenuating regions
likely represent sequelae of chronic small vessel ischemic disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14643893", "visit_id": "22573319", "time": "2176-10-01 21:11:00"} |
17989630-DS-20 | 774 | ## HISTORY OF PRESENT ILLNESS:
is a year old female with disease that
was diagnosed after multiple episodes of left sided
paresthesias. She presents for elective surgical treatment.
## PAST MEDICAL HISTORY:
She had rhinoplasty in , breast augmentation procedure .
## FAMILY HISTORY:
Was not significant for moyamoya disease, she
reported that one of her aunt had ischemic strokes in the past.
## UPON DISCHARGE:
==============
Alert and oriented to person, place and time. PERRL, EOMI, No
pronator drift and MAE .
Incision is edematous; clean, dry and intact.
## PERTINENT RESULTS:
Please see OMR for relevant findings.
## BRIEF HOSPITAL COURSE:
is a year old female with disease who
presents for elective surgical treatment.
On , she underwent elective right sided
encephaloduroarteriosynangiosis. The procedure was
uncomplicated. For further procedure details, please see
separately dictated operative report by Dr. . She was
extubated in the operating room and transported to the PACU for
recovery. Once stable, she was transferred to the for close
neurological monitoring. The patient was discharged to home on
.
## MEDICATIONS ON ADMISSION:
ASA 81mg, lorazepam 0.5mg prn
## DISCHARGE MEDICATIONS:
1. Acetaminophen 325-650 mg PO Q6H:PRN fever or pain
Do not exceed 4 G in any form in 24 hours.
2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation
3. Docusate Sodium 100 mg PO BID
4. OxyCODONE (Immediate Release) mg PO Q4H:PRN pain
RX *oxycodone 5 mg tablet(s) by mouth every six (6) hours
Disp #*20 Tablet Refills:*0
5. Senna 17.2 mg PO QHS
6. Aspirin 81 mg PO DAILY
## DISCHARGE INSTRUCTIONS:
Surgery
You underwent a surgery with burr holes to treat your
.
Please keep your sutures along your incision dry until they
are removed.
It is best to keep your incision open to air but it is ok to
cover it when outside.
Call your surgeon if there are any signs of infection like
redness, fever, or drainage.
Activity
We recommend that you avoid heavy lifting, running, climbing,
or other strenuous exercise until your follow-up appointment.
You make take leisurely walks and slowly increase your
activity at your own pace once you are symptom free at rest.
try to do too much all at once.
No driving while taking any narcotic or sedating medication.
If you experienced a seizure while admitted, you are NOT
allowed to drive by law.
No contact sports until cleared by your neurosurgeon. You
should avoid contact sports for 6 months.
Medications
***Please do NOT take any blood thinning medication
(Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon.
You should continue to take your Aspirin 81mg.
You may use Acetaminophen (Tylenol) for minor discomfort if
you are not otherwise restricted from taking this medication.
## WHAT YOU EXPERIENCE:
Feeling more tired, restlessness, irritability, and mood
swings are also common.
You may also experience some post-operative swelling around
your face and eyes. This is normal after surgery and most
noticeable on the second and third day of surgery. You apply
ice or a cool or warm washcloth to your eyes to help with the
swelling. The swelling will be its worse in the morning after
laying flat from sleeping but decrease when up.
You may experience soreness with chewing. This is normal from
the surgery and will improve with time. Softer foods may be
easier during this time.
Constipation is common. Be sure to drink plenty of fluids and
eat a high-fiber diet. If you are taking narcotics (prescription
pain medications), try an over-the-counter stool softener.
## HEADACHES:
Most headaches are not dangerous but you should call your
doctor if the headache gets worse, develop arm or leg weakness,
increased sleepiness, and/or have nausea or vomiting with a
headache.
Mild pain medications may be helpful with these headaches but
avoid taking pain medications on a daily basis unless prescribed
by your doctor.
There are other things that can be done to help with your
headaches: avoid caffeine, get enough sleep, daily exercise,
relaxation/ meditation, massage, acupuncture, heat or ice packs.
When to Call Your Doctor at for:
Severe pain, swelling, redness or drainage from the incision
site.
Fever greater than 101.5 degrees Fahrenheit
Nausea and/or vomiting
Extreme sleepiness and not being able to stay awake
Severe headaches not relieved by pain relievers
Seizures
Any new problems with your vision or ability to speak
Weakness or changes in sensation in your face, arms, or leg
Call and go to the nearest Emergency Room if you experience
any of the following:
Sudden numbness or weakness in the face, arm, or leg
Sudden confusion or trouble speaking or understanding
Sudden trouble walking, dizziness, or loss of balance or
coordination
Sudden severe headaches with no known reason
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17989630", "visit_id": "21487897", "time": "2127-09-01 00:00:00"} |
11247339-RR-7 | 88 | ## FINDINGS:
There is a live in breech presentation. The placenta is
anterior without evidence of previa. There is a normal amount of amniotic
fluid. No fetal morphologic abnormalities are detected. Views of the head,
face, heart, outflow tracts, stomach, kidneys, cord insertion site, bladder,
spine, and extremities are normal. The uterus and right ovary are normal.
The left ovary is not identified.
The following biometric data were obtained:
## EFW:
288 grams.
Compared to the prior exam, there has been appropriate interval growth.
## IMPRESSION:
Normal fetal survey.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11247339", "visit_id": "N/A", "time": "2142-01-11 07:43:00"} |
17715147-DS-21 | 2,720 | ## CHIEF COMPLAINT:
female with past medical history notable for
congestive heart failure, CAD s/p DES to in , history of
CVA, type 2 diabetes, osteoporosis, vitamin D deficiency, and RA
who presented from with symptoms and MRI
findings consistent with cauda equina syndrome, now s/p T12-S1
laminectomy, doing well.
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Posterior Lumbar decompression T12- S1 via T12, L1, L2 ,L3,L4
L5 and S1 laminectomy medial facetectomy and foraminotomy,
performed under general anesthesia on with Dr.
.
## HISTORY OF PRESENT ILLNESS:
female with past medical history notable for
congestive heart failure, CAD s/p DES to in , history of
CVA, type 2 diabetes, osteoporosis, vitamin D deficiency, and RA
who presents from as transfer for severe back
pain and for neurosurgery evaluation. Patient initially
presented to on after a mechanical fall
at
home. Patient reports that she was walking with her walker
alone
without supervision and overstretched and ended up falling on
it.
Unclear if she lost consciousness but denied any presyncopal
symptoms. She was evaluated at in this setting and was
cleared to return home. However the patient represented due to
worsening lower back pain and further imaging was performed
including an MRI of the L-spine. MRI of the patient's L spine
was notable for severe spinal canal stenosis between L1 and S1
as
well as possible tethering of the cauda equina and impingement
of
certain exiting nerve roots. Given these findings, the patient
was transferred to for neurosurgery/spine assessment.
Prior to transfer, patient received 10 mg of IV Decadron.
On arrival to the floor, patient confirmed above history. Denies
fecal incontinence but did note urinary retention which lead to
her to having a foley placed at .
Patient was taken to OR with Ortho for T12-S1 laminectomy.
Per Ortho, procedure went longer than expected with greater than
anticipated EBL, procedure as expected otherwise. Admitted to
Medicine for general post-operative care. Patient doing well
post-operatively, healing on trajectory.
## PAST MEDICAL HISTORY:
CHF
CAD s/p in
CVA
Diabetes, Type 2
GERD
HTN
HLD
RA
Vitamin D deficiency
Osteoporosis
## PHYSICAL EXAM:
ADMISSION PHYSICAL EXAM
=======================
## HEENT:
AT/NC, anicteric sclera, MMM
## NECK:
supple, no LAD, no elevated JVP although difficult to
assess
## CV:
RRR, S1/S2, no murmurs, gallops, or rubs
## PULM:
CTAB, no wheezes, rales, rhonchi, breathing comfortably
without use of accessory muscles
## GI:
abdomen soft but distended, obese, nontender in all
quadrants, no rebound/guarding
## EXTREMITIES:
no cyanosis or clubbing, trace or extremity pitting
edema
## PULSES:
2+ radial pulses bilaterally
## NEURO:
Alert, moving all 4 extremities with purpose, symmetric
lower extremity strength bilaterally, intact sensation
bilaterally in lower extremities but mildly diminished distally
from mid shin on, 2+ patellar tendon reflex, face symmetric
## DERM:
warm and well perfused, no excoriations or lesions, no
rashes
## GENERAL:
NAD, oriented to person only
nl resp effort
RRR
## SENSORY:
UE
C5 C6 C7 C8 T1
(lat arm) (thumb) (mid fing) (sm finger) (med arm)
R SILT SILT SILT SILT SILT
L SILT SILT SILT SILT SILT
T2-L1 (Trunk)
SILT
L2 L3 L4 L5 S1 S2
(Groin) (Knee) (Med Calf) (Grt Toe) (Sm Toe) (Post Thigh)
R SILT SILT SILT SILT SILT SILT
L SILT SILT SILT SILT SILT SILT
## NO BEATS
PERIANAL SENSATION:
Normal
Rectal totne: Absent. Stool palpated in rectum
DISCHARGE PHYSICAL EXAM
=======================
## HEENT:
AT/NC, anicteric sclera, MMM
## NECK:
supple, no LAD, no elevated JVP although difficult to
assess
## CV:
RRR, S1/S2, no murmurs, gallops, or rubs
## PULM:
CTAB, no wheezes, rales, rhonchi, breathing comfortably
without use of accessory muscles
## GI:
abdomen soft but distended, obese, nontender in all
quadrants, no rebound/guarding
## EXTREMITIES:
no cyanosis or clubbing, trace or extremity
pitting.
## PULSES:
2+ radial pulses bilaterally
## NEURO:
Alert, moving all 4 extremities with purpose, lower
extremity strength bilaterally, improved from pre-op exam.
Diminished TA and function on the R. Intact sensation
bilaterally in lower extremities but mildly diminished distally
from mid shin on, face symmetric.
## DERM:
warm and well perfused. Eccymosis noted to chin, R sided
chest, no abrasions or open aspects. Surgical incision to
midline back, no clinical signs of infection.
## ORTHO SPINE DISCHARGE PHYSICAL EXAM:
NAD, A&Ox4
nl resp effort
RRR
dressing c/d/I
## SENSORY:
L2 L3 L4 L5 S1 S2
(Groin) (Knee) (Med Calf) (Grt Toe) (Sm Toe) (Post Thigh)
R SILT SILT SILT SILT SILT SILT
L SILT SILT SILT SILT SILT SILT
## INDICATION:
year old woman with compression fracture s/p
fall with left hip pain// eval for fracture
## IMPRESSION:
There is demineralization. No acute fractures or dislocations
are seen;
however, there is poor evaluation of the sacrum and lower lumbar
spine.
Fracture deformities of the right superior and inferior pubic
rami and pubic symphysis bilateral are again seen.There are
extensive vascular
calcifications. There are moderate degenerative changes of both
hip joints.
## INDICATION:
female presenting for T12-S1
decompression and
laminectomy
## TECHNIQUE:
Single lateral view of the lumbar spine
## FINDINGS:
2 intraoperative images were acquired without a radiologist
present.
Images show surgical probes overlying the superficial soft
tissues at the
level of L3-L5. There is 2.0 cm of anterolisthesis of L5 on S1.
There is a moderate compression deformity of L2 and mild
compression deformity of T12. Multilevel disc height loss with
osteophytosis is moderate at several levels.
## IMPRESSION:
Intraoperative images were obtained during T12-S1 decompression
and
laminectomy. Please refer to the operative note for details of
the procedure.
=
=
=
=
=
=
=
=
=
=
================================================================
## ADMISSION LABS:
06:11AM BLOOD WBC-5.7 RBC-3.64* Hgb-11.2 Hct-33.0*
MCV-91 MCH-30.8 MCHC-33.9 RDW-11.9 RDWSD-39.6 Plt
06:11AM BLOOD PTT-31.1
06:11AM BLOOD Glucose-319* UreaN-38* Creat-1.2* Na-128*
K-5.9* Cl-88* HCO3-25 AnGap-15
06:11AM BLOOD ALT-13 AST-19 LD(LDH)-235 AlkPhos-107*
TotBili-0.4
06:11AM BLOOD Albumin-4.0 Calcium-9.2 Phos-4.2 Mg-2.1
05:39PM BLOOD VitB12-537
05:39PM BLOOD TSH-1.2
06:11AM BLOOD 25VitD-36
03:58PM BLOOD freeCa-1.05*
IMAGING:
Imaging:
CT Torso
No solid organ injury visualized. Possible small fracture
involving anterior superior endplate of L2. Distended urinary
bladder. Left adnexal cystic density which has increased in
size,
consider pelvic ultrasound. Healing right rib fractures.
CT Head/C-spine
No acute intracranial process. No acute fracture dislocation of
the cervical spine.
X-ray humerus
No acute fracture identified.
X-ray knee
Soft tissue swelling anterior to the left patella. Extensive
chondrocalcinosis in medial and lateral joint compartments of
left knee. Mild left knee osteoarthritis.
Pelvic ultrasound
Persistent atrophic echogenic uterus consistent with extensive
calcifications. Nonvisualization of bilateral ovaries.
Interval
marked decrease in size of left adnexal hypoechoic lesion
probably cystic or tubular. No abnormal pelvic fluid collection
is seen.
MRI L-spine
Severe anterior wedge compression deformity of L2 vertebral
body.
Degree of height loss appears not significantly changed dating
back to CT from , however, there is associated bony edema
within the vertebral body and newly apparent oblique fracture
through the anterior superior endplate suggesting possible acute
on chronic injury. No bony retropulsion.
Advanced multilevel degenerative disc disease and facet
arthropathy in the lumbar spine as detailed level by level most
notably at the following levels:
-At T1-L1, moderate bilateral neural foraminal stenosis with
contact of the exiting T12 nerve roots, moderate to marked
spinal
canal stenosis with mass-effect on distal cord and cauda equina
-At L1-L2, moderate spinal canal stenosis with mass-effect and
tethering of the cauda equina nerve roots, moderate bilateral
neuroforaminal stenosis with contact of the exiting L1 nerve
roots
-At L4-L5, moderate spinal stenosis with tethering of the cauda
equina nerve roots, mild to moderate right neural foraminal
stenosis with possible contact the exited right L4 nerve root,
effacement of the lateral recesses with mass-effect on the
descending nerve roots
-At L5-S1, could spinal canal stenosis with mass-effect on cauda
equina nerve roots, mild to moderate bilateral neuroforaminal
stenosis with possible contact the exiting L5 nerve roots,
effacement of the lateral recesses with mass-effect on the
ascending nerve
Partially visualized left adnexal septated cystic lesion
measuring at least 4.9 cm in maximum dimension as noted on
recent
prior CT. Recommend pelvic ultrasound for further evaluation.
## BRIEF HOSPITAL COURSE:
PATIENT SUMMARY
===============
female with past medical history notable for
congestive heart failure, CAD s/p DES to in , history of
CVA, type 2 diabetes, osteoporosis, vitamin D deficiency, and RA
who presented from as transfer for severe back
pain with abnormalities seen on MRI L-spine at OSH consistent
with cauda equina syndrome, now s/p T12-S1 laminectomy with
ortho .
TRANSITIONAL ISSUES
===================
[] Patient will need void trial in rehab, foley left in place at
discharge
[] Ortho spine follow up in 2 weeks
[] held at discharge given post-operative blood loss,
ensure that patient does not require this (per our records, last
stent in
[] Repeat CBC on , discharge Hgb was 9.9
[] Consider urology referral if patient fails void trial at
rehab, given that she has had history of urinary retention in
the past
[] Lisinopril held at discharge given hyperkalemia, consider
re-starting as outpatient given CAD
[] Held ferrous sulfate at discharge given constipating nature,
re-start once patient is completed with opioids
[] Ensure good bowel regimen and titrate to bowel movement
[] Continue to monitor blood glucose and uptitrate insulin
regimen
[] Titrate pain regimen to pain control for patient to work with
NEW medications
- amLODIPine 5 mg PO/NG DAILY
- Bisacodyl 10 mg PR QHS
- Docusate Sodium 100 mg PO BID
- Fleet Enema (Mineral Oil) 1 Enema PR ONCE
- HYDROmorphone (Dilaudid) 4 mg PO Q3H:PRN Pain - Severe
HELD medications
- Clopidogrel 75 mg PO DAILY
- Ferrous Sulfate 325 mg PO DAILY
- Lisinopril 2.5 mg PO DAILY
CHANGED medications
- Insulin Glargine and sliding scale are half of prior home dose
Glargine 20 Units Bedtime
Humalog 6 Units Breakfast
Humalog 6 Units Lunch
Humalog 7 Units Dinner
- Polyethylene Glycol 17 g PO/NG BID (uptitrated)
- Senna 17.2 mg PO/NG BID (uptitrated)
ACUTE ISSUES ADDRESSED
======================
#Cauda equina compression
#Compression Fracture at L2, Acute on Chronic
#Severe Spinal Stenosis
Underwent T12-S1 Laminectomy, healing on trajectory. Following
Spine recommendations: activity as tolerated, no
lifting/twisting/bending, no bracing needed. Was successfully
able to have normal bowel movement post-op day 1. Neuro
examinations improved daily, with some continued R LLE weakness
(TA and , and continued bilateral neuropathy present at
baseline. Patient also failed void trial, and was discharged to
rehab facility with foley in place.
- Will require orthopedic spine follow up and after care.
- Will require follow up with PCP if she fails void trial
again/continues to have urinary symptoms.
# Acute blood loss anemia
Surgical, given EBL 1.5 L. Transfused total of 4 u pRBC and 2 u
FFP post-operatively. CBC and vitals remained stable during the
remainder of the asdmission. Minimal output was noted to
surgical drain, which was d/c'ed .
#Urinary retention
- Failed void trial post-operatively, foley was replaced. Per
pt history, appears she had some degree of urinary retention at
baseline.
#Mechanical Fall
Patient initially presented to approximately 3
days ago after falling over her walker while in her house.
Patient was seen by physical therapy, who recommended discharge
to rehab facility.
#Hyperkalemia
Noted to have hyperkalemia with potassium of 5.5 at .
EKG unremarkable per discharge summary. Of note, patient was
newly started on lisinopril while admitted at for
better blood pressure management. Whole blood potassium was 4.8
while admitted, no further management was needed. Lisinopril
held at discharge.
CHRONIC ISSUES
==============
#Diabetes, type II - discharged on lower insulin regimen,
continue to titrate as needed for blood sugars
#CHF - Lasix 40mg daily was held post-operatively, re-started
#H/o CABG, CAD s/p DES to in , H/o CVA
-Continued aspirin 81 mg
-Held want to reassess at PCP follow up.
#HTN
-Lisinopril 2.5 held due to hyperkalemia. Amlodipine 5 started.
#HLD
-Continued home statin
#RA
-Held hydroxychloroquine 200 mg daily, re-started at discharge
#GERD
-Continued home pantoprazole 40 mg daily
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Vitamin D 1000 UNIT PO DAILY
2. Hydroxychloroquine Sulfate 200 mg PO DAILY
3. Senna 17.2 mg PO QHS:PRN Constipation - First Line
4. Aspirin 81 mg PO DAILY
5. Ferrous Sulfate 325 mg PO DAILY
6. Loratadine 10 mg PO DAILY
7. Multivitamins 1 TAB PO DAILY
8. Pregabalin 100 mg PO TID
9. Pantoprazole 40 mg PO Q24H
10. Furosemide 40 mg PO DAILY
11. Atorvastatin 20 mg PO QPM
12. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing
13. Magnesium Oxide 400 mg PO DAILY
14. Glargine 40 Units Bedtime
Humalog 12 Units Breakfast
Humalog 12 Units Lunch
Humalog 14 Units Dinner
15. TraMADol 25 mg PO Q6H:PRN Pain - Moderate
16. Clopidogrel 75 mg PO DAILY
17. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO TID:PRN GERD
symptoms
18. Polyethylene Glycol 17 g PO DAILY:PRN Constipation
19. Lidocaine 5% Patch 1 PTCH TD Q12H:PRN Pain
20. Lisinopril 2.5 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO TID:PRN Pain - Mild Duration: 5
Days
RX *acetaminophen [Acetaminophen Extra Strength] 500 mg 2
tablet(s) by mouth three times a day Disp #*18 Tablet Refills:*0
2. amLODIPine 5 mg PO DAILY
3. Bisacodyl 10 mg PR QHS
4. Docusate Sodium 100 mg PO BID
5. Fleet Enema (Mineral Oil) 1 Enema PR ONCE Duration: 1 Dose
6. HYDROmorphone (Dilaudid) 4 mg PO Q3H:PRN Pain - Severe
7. Glargine 20 Units Bedtime
Humalog 6 Units Breakfast
Humalog 6 Units Lunch
Humalog 7 Units Dinner
8. Polyethylene Glycol 17 g PO BID
9. Senna 17.2 mg PO BID
10. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing
11. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO TID:PRN
GERD symptoms
12. Aspirin 81 mg PO DAILY
13. Atorvastatin 20 mg PO QPM
14. Furosemide 40 mg PO DAILY
15. Hydroxychloroquine Sulfate 200 mg PO DAILY
16. Lidocaine 5% Patch 1 PTCH TD Q12H:PRN Pain
17. Loratadine 10 mg PO DAILY
18. Multivitamins 1 TAB PO DAILY
19. Pantoprazole 40 mg PO Q24H
20. Pregabalin 100 mg PO TID
21. TraMADol 25 mg PO Q6H:PRN Pain - Moderate
22. Vitamin D 1000 UNIT PO DAILY
23. HELD- Clopidogrel 75 mg PO DAILY This medication was held.
Do not restart Clopidogrel until your doctor tells you to.
24. HELD- Ferrous Sulfate 325 mg PO DAILY This medication was
held. Do not restart Ferrous Sulfate until your doctor tells you
to.
25. HELD- Lisinopril 2.5 mg PO DAILY This medication was held.
Do not restart Lisinopril until your doctor tells you to.
26. HELD- Magnesium Oxide 400 mg PO DAILY This medication was
held. Do not restart Magnesium Oxide until your doctor tells you
to
## DISCHARGE DIAGNOSIS:
Cauda equina syndrome, now s/p T12-S1 Laminectomy on
## ACTIVITY STATUS:
Out of Bed with assistance to chair or
wheelchair.
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
It was a pleasure caring for you at .
WHY WAS I IN THE HOSPITAL?
You had compression in your spinal cord from fractures and
stenosis in your spine, partially a result from your recent
fall. The compression was concerning for cauda equina syndrome,
which if untreated could lead to neural complications including
paralysis.
WHAT HAPPENED TO ME IN THE HOSPITAL?
- You had surgery with the Orthopedic Spine time, and underwent
a T12-S1 Laminectomy, and were treated for post-operative care
afterwards. You had a drain placed near your surgical incision
which was removed by the Spine team.
- You developed an acute blood loss anemia, due to blood loss
during surgery. You were given transfusions, and your labs
stably improved.
- You worked with physical therapy to be able to safely get out
of bed.
WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL?
- Follow up with your Orthopedic Spine apppointments for wound
care for your incision, and for repeat XRays and orthopedic
aftercare.
- Follow up with your primary care provider, particularly for
your diabetes management and for follow up regarding your blood
loss anemia
- Monitor your symptoms closely, and call your doctor if you
develop any new or worsening symptoms
We wish you the best!
Sincerely,
Your Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17715147", "visit_id": "24056488", "time": "2155-04-12 00:00:00"} |
12896960-RR-13 | 207 | ## INDICATION:
male with remote history of lymphoma admitted for
septic shock after prostate biopsy and questionable seizure, which has been
exonerated, but found to have asymmetric intention tremor (L>R), dysmetria,
nystagmus, and gait instability.// Evaluate for cerebellar pathology including
stroke, tumor, among others.
## FINDINGS:
Study is mildly degraded by motion. Left parietal focal area of increase
susceptibility is noted (see 06: 15). There is no definite associated T2 or
FLAIR hyperintensity. Adjacent probable developmental venous anomaly is noted
(see 9: 85-89).
There is no evidence of masses, mass effect, midline shift or infarction.
There is prominence of the ventricles and sulci suggestive of involutional
changes. Left parietal calvarium probable arachnoid granulation is noted (see
4:9 on current study and 602:50 on prior noncontrast head CT). There is no
abnormal enhancement after contrast administration. Nonspecific bilateral
mastoid fluid is present. Bilateral ethmoid air cell, frontal sinus and
maxillary sinus mucosal thickening is present.
## IMPRESSION:
1. Study is mildly degraded by motion.
2. No acute intracranial abnormality, with no definite evidence of acute
infarct.
3. Left parietal probable cavernous malformation with adjacent developmental
venous anomaly.
4. No definite evidence of enhancing intracranial mass.
5. Paranasal sinus disease and nonspecific mastoid fluid, as described.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12896960", "visit_id": "27866798", "time": "2184-05-24 20:38:00"} |
15905060-RR-8 | 409 | ## INDICATION:
Followup of pancreatic cancer after CyberKnife treatment.
## CHEST:
The thyroid is unremarkable. There is no supraclavicular or axillary
lymphadenopathy. There is no mediastinal or hilar lymphadenopathy. The heart
and great vessels are unremarkable. There is no pericardial effusion. The
lungs are clear without nodules, masses, focal consolidations, or pleural
effusions.
## ABDOMEN:
The liver is of normal shape and contour. Again seen is a hypodense
lesion in segment IV which measures 5 mm (2, 51). This is stable from prior
exam. There are two new hypodense lesions, one in the periphery of the right
lobe that measures 6 mm (2, 48) and one in the central left lobe that measures
12 x 11 mm (2, 52). Given that these are new, they are concerning for
metastatic disease. The patient is status post cholecystectomy. There is
pneumobilia secondary to the patient's stent. This is stable from the prior
exam. There is no definite biliary dilation. The spleen is unremarkable.
There are varices around the spleen and stomach. Again seen is the
ill-defined mass involving the head and body of the pancreas with associated
duct dilation and distal atrophy. Four metallic seeds have been placed since
the prior scan. The ill-defined mass surrounds the confluence of the splenic
vein and superior mesenteric vein. These are markedly attenuated, as seen in
the prior exam, but there is flow seen within the portal vein, splenic vein
and distal SMV. There is no definite clot. Again seen are multiple lymph
nodes around the pancreatic head and adjacent to the biliary stent. These are
also unchanged. There is a new soft tissue nodule seen within the anterior
abdominal cavity, which measures 20 x 13 mm (2:74). This is worrisome for
metastatic disease. This was not seen in the prior exam. There are small
lymph nodes seen within the mesentery.
The kidneys and adrenals are unremarkable. The kidneys enhance and excrete
contrast appropriately. The large bowel is unremarkable without mass,
stricture, or wall edema.
## OSSEOUS STRUCTURES:
There are mild degenerative changes of the spine with
small anterior osteophytes. There are no concerning lytic or sclerotic
lesions.
## IMPRESSION:
1. Stable appearance of the ill-defined pancreatic mass and surrounding lymph
nodes.
2. Two new lesions within the liver are concerning for metastatic disease.
3. Soft tissue nodule within the anterior abdominal cavity is concerning for
metastatic disease.
4. Interval placement of fiducial metallic seeds.
5. Stable appearance of a biliary stent.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15905060", "visit_id": "N/A", "time": "2167-02-05 11:54:00"} |
18632166-RR-48 | 96 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## INDICATION:
with newly diagnosed clot in IJ, history of breast cancer,
would like to assess for metaststic disease prior to anticoagulation
## FINDINGS:
There is no evidence of acute large territorial infarction, hemorrhage, edema,
or mass. The ventricles and sulci are normal in size and configuration.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
## IMPRESSION:
No evidence of intracranial metastatic disease. No acute intracranial
abnormality detected. Of note, MRI is more sensitive for the detection of
metastases.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18632166", "visit_id": "23816611", "time": "2145-04-26 21:26:00"} |
14124085-RR-60 | 109 | ## EXAM:
MRI brain and MRA head.
## CLINICAL INFORMATION:
Patient with vertigo and pulmonary embolism now with
right-sided weakness.
## BRAIN MRI:
The ventricles and extra-axial spaces are normal in size without midline
shift, mass effect, or hydrocephalus. No focal signal abnormalities are seen.
No acute infarcts are noted. Following gadolinium, no evidence of abnormal
parenchymal, vascular or meningeal enhancement seen. A prominent CSF space in
the anterior left temporal lobe indicates a small incidental arachnoid cyst.
## IMPRESSION:
No acute infarct or enhancing brain lesions.
## MRA HEAD:
Head MRA demonstrates normal flow signal in the arteries of anterior and
posterior circulation.
## IMPRESSION:
Normal MRA of the head.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14124085", "visit_id": "24342114", "time": "2175-08-12 20:54:00"} |
15051145-DS-13 | 1,771 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
right knee and groin/hip pain
## CC:
Right hip pain and knee pain
## HPI:
year old male, , with metastatic thyroid
cancer to right iliac, receiving radiation therapy, presents one
day after discharge with severe pain in right groin/knee.
He was discharged yesterday with plan to complete palliative
radiation to large metastatic burden in pelvis. He states he
went home yesterday and was ambulating with crutches without
difficulty.
Today, patient was seen in radiation oncology to receive 4 of 5
planned treatments to the right iliac crest. Patient was in
severe pain upon arrival to the department, with pain in right
groin/knee. The pain made his legs buckle and he fell to the
ground. There was no strike to head or neck. No loss of
consciousness. Patient was seen by Dr. decision
was made to send to ED for further evaluation/films. He was
given 10 Oxycodone po at 9:55 a.m. in the department.
In the ED, initial vitals were
pain T 99 HR 79 BP 159/80 RR 20 98% RA.
Pain now worse in hip and knee. Pelvis and extremity
radiographs obtained, recevied morphine 15 mg IV, and admitted
for further evaluation.
Upon arrival to the floor, patient was comfortable lying in bed,
but then developed severe pain in right groin when sitting
up/standing. He confirmed the above history with the aid of the
interpreter over the phone. He has no fevers, chills, cough,
abdominal pain, dysuria, diarrhea, or other infectious symptoms.
He is not depressed or anxious, and states he has good social
support at home. He denies weakness/numbness/tingling in arms
or legs.
## ROS:
(+) Per HPI
(-) Denies night sweats, recent weight loss or gain. Denies
blurry vision, diplopia, loss of vision, photophobia. Denies
headache, sinus tenderness, rhinorrhea or congestion. Denies
chest pain or tightness, palpitations, lower extremity edema.
Denies shortness of breath, or wheezes. Denies nausea, vomiting,
diarrhea, constipation, abdominal pain, melena, hematemesis,
hematochezia. Denies stool or urine incontinence. Denies
arthralgias or myalgias. Denies rashes or skin breakdown. All
other systems negative.
## PAST ONCOLOGIC HISTORY:
Metastatic papillary thyroid carcinoma
- The margin was involved by cancer, and the tumor extended
focally into the soft tissues. Following surgery,
the patient underwent radiation therapy to the right iliac wing.
He received a total of 5000 cGy over 25 fractions.
- A PET/CT scan on showed significant progression of
disease with new lesions in the L4 pedicle/superior facet, left
iliac bone, and left lateral mass of C1 vertebral body. Though
this was asymptomatic, we electively choose to radiate the C1
vertebral body and he completed radiation therapy on .
He then received treatment with 150 mCi of radioactive (131-I)
iodine therapy on after rhTSH stimulation.
- A PET scan on showed mixed changes with
multiple bony lesions being worse than prior. He underwent
treatment with 150 mCi of I-131 on . He was
treated again with radioactive iodine on .
- planned treatment with sorafenib in , yet to begin given
ongoing pain from metastases to pelvis
## PAST MEDICAL HISTORY:
History of R eye surgery after trauma in .
Past history of surgery on sinuses in .
## FAMILY HISTORY:
Mother - bronchitis, denies family history of malignancy
## GENERAL:
NAD when in bed, uncomfortable with sitting/standing
## HEENT:
AT/NC, EOMI, PERRLA, anicteric sclera, pink conjunctiva,
patent nares, MMM, good dentition, nontender supple neck, no LAD
## CARDIAC:
RRR, S1/S2, no murmurs, gallops, or rubs
## LUNG:
CTAB, no wheezes, rales, rhonchi, breathing comfortably
without use of accessory muscles
## ABD:
nondistended, +BS, nontender in all quadrants, no
rebound/guarding, no hepatosplenomegaly
## EXT:
moving all extremities, no cyanosis, clubbing or edema, no
obvious deformities, no right knee tenderness or effusion
## PULSES:
2+ DP and pulses bilaterally
## NEURO:
CN II-XII intact, strength in , no
sensory deficits, remainder of exam limited by pain
## SKIN:
warm and well perfused, no excoriations or lesions, no
rashes
Discharge exam
## GEN:
Alert, oriented to name, place and situation. no acute
signs of distress.
## HEENT:
NCAT, Pupils equal and reactive, sclerae non-icteric,
MMM.
## SUPPLE
LYMPH NODES:
No cervical, supraclavicular or axillary LAD.
## CV:
S1S2, reg rate and rhythm, no murmurs, rubs or gallops.
## RESP:
Good air movement bilaterally, no rales, rhonchi or
wheezing.
## ABD:
Soft, non-tender, non-distended, no hepatosplenomegaly
## EXTR:
No lower leg edema
## NEURO:
muscle strength in quads, hamstring and
dorsal/plantar flexion at ankle on the right, intact throughout
otherwise, no urinary or fecal incontinence
## FINDINGS:
Single AP view of the pelvis demonstrates a large lytic
metastasis in the
right iliac bone, and a smaller lesion near the left anterior
superior iliac
spine, similar in appearance since the prior study. No
radiolucent fracture
line is identified. No pubic symphysis or SI joint diastasis
seen. Femoral
acetabular joint space narrowing and subchondral sclerosis
bilaterally.
2 views of the right hip demonstrate no fracture or dislocation.
As noted
above, degenerative changes of the right hip joint.
2 views of the right femur demonstrate no fracture, dislocation,
joint
effusion, or soft tissue abnormality.
## IMPRESSION:
Large bilateral iliac bone metastasis with no fracture of the
pelvis, right
hip, or right femur.
HIP UNILAT MIN 2 VIEWS RIGHTStudy Date of 12:37
## FINDINGS:
Single AP view of the pelvis demonstrates a large lytic
metastasis in the
right iliac bone, and a smaller lesion near the left anterior
superior iliac
spine, similar in appearance since the prior study. No
radiolucent fracture
line is identified. No pubic symphysis or SI joint diastasis
seen. Femoral
acetabular joint space narrowing and subchondral sclerosis
bilaterally.
2 views of the right hip demonstrate no fracture or dislocation.
As noted
above, degenerative changes of the right hip joint.
2 views of the right femur demonstrate no fracture, dislocation,
joint
effusion, or soft tissue abnormality.
## IMPRESSION:
Large bilateral iliac bone metastasis with no fracture of the
pelvis, right
hip, or right femur.
PELVIS (AP ONLY)Study Date of 12:37
## FINDINGS:
Single AP view of the pelvis demonstrates a large lytic
metastasis in the
right iliac bone, and a smaller lesion near the left anterior
superior iliac
spine, similar in appearance since the prior study. No
radiolucent fracture
line is identified. No pubic symphysis or SI joint diastasis
seen. Femoral
acetabular joint space narrowing and subchondral sclerosis
bilaterally.
2 views of the right hip demonstrate no fracture or dislocation.
As noted
above, degenerative changes of the right hip joint.
2 views of the right femur demonstrate no fracture, dislocation,
joint
effusion, or soft tissue abnormality.
## IMPRESSION:
Large bilateral iliac bone metastasis with no fracture of the
pelvis, right
hip, or right femur.
KNEE (AP, LAT & OBLIQUE) RIGHTStudy Date of 3:37
## FINDINGS:
There is no fracture or dislocation. There are no
focal osseous
lesions. The joint spaces are maintained without significant
atherosclerotic
disease. There is a small amount of spurring along the anterior
superior
patella. No joint effusion is identified.
## IMPRESSION:
No evidence of an acute fracture or focal osseous
lesion.
## BRIEF HOSPITAL COURSE:
with metastatic papillary thyroid cancer presenting with
worsening right hip pain in setting of known slight progression
of lytic lesions throughout pelvis, with no pathologic fracture
and no signs or symptoms of infection (specifically
osteomyelitis).
# Right hip pain: Known lytic metastases without evidence of
pathologic fracture on imaging. The right knee pain may be
referred from the hip. Has minimal pain at rest, but
uncomfortable with ambulation/standing, though this has improved
with pain meds. He does not seem to know how to take his long
acting and short acting pain meds, and his readmission may
relate to not taking MSContin at home. We have tried to
reinforce this several times and have asked his roommate to
help. Explained that he should take MSContin regardless of
whether he has pain. His MSContin dose was increased to 60mg
BID. He completed his 5 fractions of palliative radiation
therapy, which will hopefully help with pain control as well. He
will continue oxycodone q4h prn, as well as aggressive
bowel regimen: colace, miralax standing, senna, bisacodyl, MOM
prn. He was seen by physical therapy and deemed okay to go home
with walker.
# Fever/Leukocytosis: had one low grade fever with leukocytosis,
which subsequently resolved without antibiotics. Likely
secondary to tumor burden. infectious workup unremarkable
## # HYPOTHYROIDISM:
S/p thyroidectomy. He is on supplemental
synthroid dosing, TSH mildly elevated, free T4 therapeutic.
continue same Synthroid dose 175 mcg daily
# Metastatic papillary thyroid cancer: Plan is to start
sorafenib, which has been delayed due to pain crises from
metastatic disease. He should start this upon returning home.
## # HYPOCALCEMIA:
Resolved. vit D level 41. Cont home calcium/vit
D dose.
- Vitamin D 800 u tid
- Calcium 3000 mg tid
- calcitriol 0.25 mcg bid
# Dispo:
[x] Discharge documentation reviewed, pt is stable for
discharge.
[x] Time spent on discharge activity was greater than 30min.
[ ] Time spent on discharge activity was less than 30min.
, MD, pager
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Calcitriol 0.25 mcg PO BID
2. Levothyroxine Sodium 175 mcg PO 5X/WEEK ( )
3. Levothyroxine Sodium 350 mcg PO 2X/WEEK ( )
4. Acetaminophen 1000 mg PO Q8H
5. calcium carbonate-vitamin D3 600 mg(1,500mg) -400 unit oral
TID
6. Morphine SR (MS 30 mg PO Q12H
7. Docusate Sodium 100 mg PO BID
8. OxycoDONE (Immediate Release) mg PO Q4H:PRN pain
9. Senna 8.6 mg PO BID
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO Q8H
2. Calcitriol 0.25 mcg PO BID
3. Docusate Sodium 100 mg PO BID
4. Levothyroxine Sodium 175 mcg PO 5X/WEEK ( )
5. Levothyroxine Sodium 350 mcg PO EVERY M, T, W, TH, F
6. Morphine SR (MS 60 mg PO Q12H
RX *morphine 60 mg 1 tablet extended release(s) by mouth every
twelve (12) hours Disp #*60 Tablet Refills:*0
7. OxycoDONE (Immediate Release) mg PO Q4H:PRN pain
8. Senna 8.6 mg PO BID
9. calcium carbonate-vitamin D3 600 mg(1,500mg) -400 unit oral
TID
10. Polyethylene Glycol 17 g PO DAILY
RX *polyethylene glycol 3350 [Miralax] 17 gram 1 packet by mouth
daily Disp #*30 Packet Refills:*0
11. Bisacodyl 10 mg PO/PR DAILY:PRN constipation
RX *bisacodyl 5 mg 1 tablet,delayed release ( ) by mouth
daily Disp #*30 Tablet Refills:*0
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
You were admitted to for leg pain. You underwent
extensive imaging, and there were no evidence of fracture. We
felt that your pain was related with the cancer. We increased
your pain medication. You were also evaluated by the physical
therapist and are okay to go home.
You can go home now, and please follow with your oncologist for
treatment.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15051145", "visit_id": "25731772", "time": "2150-05-15 00:00:00"} |
13556226-DS-13 | 1,131 | ## ALLERGIES:
Oxacillin / Penicillins / Iodine-Iodine Containing
## ATTENDING:
Complaint:
chest and jaw pain
## HISTORY OF PRESENT ILLNESS:
Mr. is a yo M w/ PMH of significant cardiac disease
with CABG s/p 5 vessel CABG and multiple stents who presented to
the ED with worsening jaw/chest pain. Pt reports over the past 6
mo he has had occaional jaw pain that comes on with exertion,
that has increased in frequency and intensity over the past 2
weeks. On the day of presentation, pt reports walking yards
he had the pain in his jaw as well as his chest. nonradiating,
no diaphroesis, some anxiety feeling and shortness of breath,
and went to the ED as this is his anginal pain and it has been
getting worse.
In the ED, initial vitals were 97.2 57 151/81 20 95% 3L. He was
seen by the cardiology attending who felt that he did not
require the heparin gtt given his current antiplatlet regimen
and he was admitted for cardiac catheterization.
On arrival to the floor patient reported feeling well. He did
report a repeat episode of chest pain while he was in the
bathroom and his oxygen had fallen off and that this resolved
with replacing his oxygen prior to this provider .
## PAST MEDICAL HISTORY:
Hypertension
Hypercholesterolemia
Ulcerative colitis
CAD s/p CABG complicated by sternal dehiscence, wound infection
resulting in flap closure and sternectomy.
s/p mult caths, most recent shows:
## FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Patent LIMA to the LAD with stable moderate distal
anastomotic
lesion.
3. Occluded SVG to the RCA.
4. 80% ISRS of the SVG to the OM.
5. Diffusely diseased SVG to the diagonal.
6. Successful PTCA of the SVG to the OM.
7. Unsuccessful PCI of the totally occluded SVG to the RCA.
.
## FAMILY HISTORY:
(+) CAD Father and uncle died at age from
an MI, another uncle died of an MI at age . One son died of
brain cancer.
## GENERAL:
Well appearing, younger than stated age appearing male
in NAD sitting up in chair comfortably
## HEENT:
PEERLA, wearing glasses, JVP not evident at 90deg
## CHEST:
large mediastinal scar without sternal plate in place and
visible pulsation of the heart through the skin. No evidence of
erythema
## CV:
RRR, no appreciable MRG
## LUNGS:
dry crackles midway up posterior with good air movement
## ABDOMEN:
Soft, nontender, colostomy in place
## EXT:
dry skin, no peripheral edema, 2+ DP pulses bilaterally
## GENERAL:
Well appearing, younger than stated age appearing male
in NAD sitting up in chair comfortably
## HEENT:
PEERLA, wearing glasses, JVP not evident at 90deg
## CHEST:
large mediastinal scar without sternal plate in place and
visible pulsation of the heart through the skin. No evidence of
erythema
## CV:
RRR, no appreciable MRG
## LUNGS:
dry crackles midway up posterior with good air movement
## ABDOMEN:
Soft, nontender, colostomy in place
## EXT:
dry skin, no peripheral edema, 2+ DP pulses bilaterally.
femoral access site is clean, without bruit or hematoma
## RCA:
100% proximal with right to right collaterals to the PDA
and PL
## SVG-DIAGONAL:
Subtotal to small to medium diagonal branch that
fills with competitive flow from the LIMA. This vessel is
unchanged from prior study in
## SVG-OMB1 AND OMB2:
Subtotally occluded within the in stent
restenosis - it was a large vessel and fed a large distribution
of the OMB1 and OMB2
## LIMA-LAD:
Patent to the LAD with prominent collaterals to the
RCA and diagonal branch.
Interventional details
The patient presented with rest pain and is s/p CABG with sterna
dehiscence.
Bivaluridin was used for anticoagulation to achieve and ACT >
300
secs
Using an AL1 guiding catheter, the SVG to the OMB was crossed
with a 0.014 BMW wire and dilated with a 2.0 mm balloon. A
0.014
Filterwire was then used to cross the lesion and the stents were
dilated with a 3.0 mm x 10 mm Cutting balloon. A 3.5 mm x 12 mm
Resolute stent was deployed in the mid SVG. The proximal SVG
was
stented with a 3.0 mm x 3 mm Resolute stent and a 3.5 mm x 12 mm
Resolute. The entire stent was post dilated with a 3.25 mm x 12
mm balloon. This resulted in no residual stenosis and TIMI 3
flow
into the distal vessel.
Assessment & Recommendations
1.Three vessel coronary artery disease
2.Subtotal in-stent restenosis of the SVG to OMB1 and OMB2
3.Aspirin and clopidogrel
## BRIEF HOSPITAL COURSE:
yo M w/ PMH of CAD s/p CABG x5, and DES in who presents
with jaw pain with exertion and now with increasing frequency
concerning for unstable angina
# Unstable angina- Patient presented with non-exertional chest
and jaw pain while off of baseline home oxygen. Cardiac showed 3
vessel disease and in-stent stenosis. PCI and three stents were
deployed for revascularization. Patient was chest pain free
prior to discharge. Patient will have repeat echocardiograph as
an outpatient.
#Hypertension- Well controlled, continued home medications
#Ulcerative colitis- not on chronic immunsuppressants s/p
colectomy with colostomy. Stool output was monitored throughout
admission.
#Restrictive lung disease-Respiratory status was stable on
baseline home requirements of 3L
#OSA- continued CPAP
## TRANSITIONAL ISSUES:
- Will have followup echocardiograph as an outpatient
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Acetaminophen w/Codeine TAB PO Q6H:PRN pain
2. Fish Oil (Omega 3) 1000 mg PO BID
3. econazole 1 % Topical BID
4. ClonazePAM 0.5 mg PO QHS
5. Metoprolol Tartrate 25 mg PO BID
6. Simvastatin 80 mg PO DAILY
7. Multivitamins 1 TAB PO DAILY
8. Isosorbide Dinitrate 10 mg PO BID
9. Nitroglycerin SL 0.3 mg SL PRN chest pain
10. Clopidogrel 75 mg PO DAILY
11. Aspirin 325 mg PO DAILY
12. FoLIC Acid 2 mg PO DAILY
13. Vitamin D 400 UNIT PO DAILY
## DISCHARGE MEDICATIONS:
1. Aspirin 325 mg PO DAILY
2. ClonazePAM 0.5 mg PO QHS
3. Clopidogrel 75 mg PO DAILY
4. FoLIC Acid 2 mg PO DAILY
5. Isosorbide Dinitrate 10 mg PO BID
6. Metoprolol Tartrate 25 mg PO BID
7. Multivitamins 1 TAB PO DAILY
8. Nitroglycerin SL 0.3 mg SL PRN chest pain
9. Vitamin D 400 UNIT PO DAILY
10. Acetaminophen w/Codeine TAB PO Q6H:PRN pain
11. econazole 1 % Topical BID
12. Fish Oil (Omega 3) 1000 mg PO BID
13. Simvastatin 80 mg PO DAILY
## DISCHARGE INSTRUCTIONS:
Hello Mr. ,
It was a pleasure taking care of you at the
. You came because of chest and jaw
pain. Catherization showed a blockage in one of your coronary
artery grafts, and you received three stents. Now you are ready
to go home. Please continue to take your home medications and
follow up with your doctors
Instructions:
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13556226", "visit_id": "20328819", "time": "2166-09-16 00:00:00"} |
11769227-RR-3 | 154 | ## INDICATION:
female with genetic abnormality, atraumatic
progressive right leg pain.
There are no prior examinations for comparison.
PELVIS, AP; BILATERAL HIPS, AP AND FROGLEG VIEWS:
There is an acute right
mid-cervical femoral fracture, with superomedial displacement and 1.5-cm
superior overriding of the distal fracture fragment. The left hip is normal.
The iliac bones have a flared appearance. There is mild sclerosis involving
the left sacroiliac joint. The acetabulae are shallow, with mild anterior and
lateral uncovering of the femoral heads, which retain a normal rounded
appearance.
Moderate amount of retained fecal material is noted in the ascending colon.
T-shaped IUD device is present in the pelvis.
## RIGHT FEMUR, AP AND LATERAL:
No distal femoral fractures are noted. There is
no knee joint effusion.
## IMPRESSION:
1. Acute mid-cervical right femoral fracture, with mild superomedial
displacement and overriding of distal fragment.
2. Skeletal dysplasia, consistent with known genetic abnormality.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11769227", "visit_id": "29364968", "time": "2121-10-03 17:50:00"} |
13800049-RR-23 | 152 | ## INDICATION:
year old man with anticardiolipin antibody, lupus
anticoagulant syndrome admitted with multiple joint pain, rashes,
concerned for glomerulonephritis.// Kidney biopsy (native) for etiology of
glomerulonephritis.
## OPERATORS:
Dr. and Dr. , provided sonographic guidance
for biopsy that was performed by the Nephrology team. Dr.
radiologist, was present and supervising throughout the guidance and reviewed
and agrees with the trainee's findings
## FINDINGS:
This procedure was performed by the Nephrology team; please see Nephrology
procedure note for further details.
Real-time ultrasound guidance for percutaneous renal biopsy was provided by
radiologist. The lower pole of the left kidney was targeted and 3 biopsy
passes performed.
## SEDATION:
Moderate sedation was provided by administering divided doses of
Fentanyl and Versed throughout the total intra-service time of 10 minutes
during which the patient's hemodynamic parameters were continuously monitored
by an independent, trained radiology nurse.
## IMPRESSION:
Ultrasound guidance for percutaneous left native kidney biopsy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13800049", "visit_id": "20532192", "time": "2134-12-19 10:43:00"} |
12050491-DS-20 | 698 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## HISTORY OF PRESENT ILLNESS:
The patient underwent left hemithyroidectomy . She was
discharged to home on the day of surgery. Since surgery, the
patient has been doing well except that she has noticed a
somewhat weak voice with some loss of the register. She has not
felt any hoarseness, however.
On today's postop visit, she offered no complaints other than
the moderate weakness of her voice as described above. The neck
incision was healing well without signs of infection or other
complications. Her voice sounded clear and seemed to be of good
projection.
Pathologic report revealed a 3.8-cm papillary thyroid carcinoma
of the follicular variant. It was unifocal and there was no
evidence of extrathyroidal extension or lymph node metastases.
The pathologic report and its implications were discussed with
the patient. She will now be scheduled for a completion
thyroidectomy. After the completion thyroidectomy, we will
subsequently also arrange for a consultation in endocrinology to
discuss the potential need of radioiodine.
## PAST MEDICAL HISTORY:
breast cancer - ER+, PR+. HER-2+, invasive grade1, s/p
herceptin/taxol, now almost complete with radiation, and on
herceptin
Papillary thyroid cancer
## FAMILY HISTORY:
non-contributory, no family h/o breast cancer or thyroid disease
## PHYSICAL EXAM:
On discharge:
afebrile, AVSS
## HEENT:
Neck soft, flat, steristrips and gauze dressing in place.
No hematoma. Voice strong but slightly raspy. neg Chvostek's
sign
## RESP:
breathing comfortably on room air
## BRIEF HOSPITAL COURSE:
The patient tolerated the procedure without intra-operative
complications. Please refer to the operative note for full
operative detail. The patient was extubated in the OR and
transferred to the PACU and admitted to the floor overnight.
Her pain was well controlled on oral pain medications. Her diet
was slowly advanced on POD 0 she was tolerating a regular diet
prior to discharge. Exam upon d/c was unremarkable. POD 1
calcium level was 7.9, however remained asymptomatic and denied
any signs of hypocalcemia. She was started on calcium and
vitamin D supplement along with her thyroid hormone replacement.
The remainder of her hospital course was relatively
unremarkable, and pt was discharged in stable condition,
ambulating and voiding independently, and with adequate pain
control. Pt was given explicit instructions to follow-up in
clinic with Dr. PCP/endocrinologist. Pt was given
detailed discharge instruction outlining wound care, activity,
diet, follow up and the appropriate medication scripts.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list may be inaccurate and requires
futher investigation.
1. Dexamethasone 4 mg PO DAILY:PRN mouth ulcers
2. lactobacillus acidophilus oral unknown
3. Fish Oil (Omega 3) Dose is Unknown PO DAILY
4. anastrozole 1 mg oral daily
5. lysine unknown oral unknown
6. Multivitamins 1 TAB PO DAILY
7. flaxseed oil unknown oral daily
8. Calcitrate-Vitamin D (calcium citrate-vitamin D3) unknown
oral daily
## DISCHARGE MEDICATIONS:
1. Acetaminophen 325-650 mg PO Q6H:PRN pain
2. Ibuprofen 600 mg PO Q8H:PRN pain
RX *ibuprofen 600 mg 1 tablet(s) by mouth every eight (8) hours
Disp #*30 Tablet Refills:*0
3. Levothyroxine Sodium 112 mcg PO DAILY
RX *levothyroxine 112 mcg 1 tablet(s) by mouth once a day Disp
#*30 Tablet Refills:*12
4. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain
Do not drive or drink alcohol while taking this medication
RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours
Disp #*20 Tablet Refills:*0
5. anastrozole 1 mg oral daily
6. Dexamethasone 4 mg PO DAILY:PRN mouth ulcers
7. Fish Oil (Omega 3) 1000 mg PO DAILY
you may resume pre-op dosage
8. flaxseed oil 0 mg ORAL DAILY
You may resume your pre-op regimen
9. lactobacillus acidophilus 0 tab ORAL DAILY
You may resume your pre-op regimen
10. lysine 0 mg ORAL Frequency is Unknown
You may resume your pre-op regimen
11. Multivitamins 1 TAB PO DAILY
12. Calcitriol 0.25 mcg PO BID
RX *calcitriol 0.25 mcg 1 capsule(s) by mouth twice a day Disp
#*60 Capsule Refills:*0
13. Calcitrate-Vitamin D (calcium citrate-vitamin D3) 0 200 ORAL
DAILY
14. Calcium Carbonate 1500 mg PO TID
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12050491", "visit_id": "23155471", "time": "2144-10-19 00:00:00"} |
17134675-RR-64 | 217 | ## EXAMINATION:
EMERG BILAT LOWER EXT VEINS
## INDICATION:
year old woman on Coumadin, wheelchair bound // DVT
## FINDINGS:
Of note, this study is technically limited.
## RIGHT LEG:
There is normal compressibility, flow, and augmentation of the
right common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
## LEFT LEG:
The left common femoral vein shows partial noncompressibility with
internal color flow suggesting partially occlusive thrombus. Of note, the
left common femoral vein in real-time was thought to compress however these
images do not show complete compression of the left common femoral vein. The
superficial femoral vein is not visualized, which is new from . The left
popliteal vein shows normal compressibility and color flow. The calf veins
are not well seen.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa ( ) cyst.
## IMPRESSION:
Technically limited study.
The left common femoral vein shows incomplete compression suggesting DVT. The
left SFV is not visualized and the left calf veins are not visualized. This
examination is suboptimal and should be repeated for further evaluation. If
findings remain equivocal, further evaluation with CT venogram or MRI venogram
can be performed.
## NOTIFICATION:
These findings were discussed with Dr. telephone at
20:41 on by Dr. .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17134675", "visit_id": "27044480", "time": "2191-12-25 13:33:00"} |
16850712-RR-33 | 295 | ## EXAMINATION:
INJ/ASP MAJOR JT W/FLUORO
## INDICATION:
year old man with arthritis of right foot // inject cortisone
and lidocaine into and TMT joint of right foot
## PROCEDURE:
The risks, benefits, and alternatives were explained to the
patient and written informed consent obtained.
A pre-procedure timeout confirmed three patient identifiers.
Under fluoroscopic guidance, an appropriate spot was marked. The area was
prepared and draped in standard sterile fashion.
1 cc 1% Lidocaine was used to achieve local anesthesia. Under intermittent
fluoroscopic guidance, a 25-gauge needle was advanced into the first
tarsometatarsal joint and appropriate position was confirmed by the injection
of a small amount of water soluble contrast. A mixture of 0.5 cc of 0.25%
Bupivacaine and 0.5 cc of Kenalog (20 mg) was injected, dispersing the
contrast. Subsequently, Under intermittent fluoroscopic guidance, a 25-gauge
needle was advanced into the second tarsometatarsal joint and appropriate
position was confirmed by the injection of a small amount of water soluble
contrast. A mixture of 0.5 cc of 0.25% Bupivacaine and 0.5 cc of Kenalog (20
mg) was injected, dispersing the contrast.
The needle was removed, hemostasis achieved, and a sterile bandage applied.
The patient experienced improvement in symptoms immediately following the
procedure.
The patient tolerated the procedure well and left the department in stable
condition. There were no immediate complications or complaints.
## FINDINGS:
Mild degenerative changes of the TMT joints. No fracture or dislocation.
Successful intraarticular injection.
## IMPRESSION:
1. Imaging Findings - Mild TMT joint degenerative changes.
2. Procedure - Technically successful therapeutic injection into the first
and second TMT joints.
I Dr. personally supervised the Resident/Fellow
during the key components of the above procedure and I have reviewed and agree
with the Resident/Fellow findings/dictation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16850712", "visit_id": "N/A", "time": "2197-11-09 15:39:00"} |
15433386-DS-12 | 986 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## HISTORY OF PRESENT ILLNESS:
yo homeless man with h/o diverticulosis, HTN, etoh abuse
(sober , last drink , hepatitis C who presents with
5 days of painless rectal bleeding, similar to prior episodes of
diverticular bleeding. Patient has had BRBPR with each bowel
movement, filling the bowl. He otherwise denies any abdominal
pain, rectal pain, n/v, fever, CP, SOB, lightheadedness, or
syncope. He presented to his PCP yesterday, where he was found
to have a drop in HCT from 46 ->33, and was subsequently
transferred to the ED for further work-up and management
of his symptoms.
In the ED, initial vital signs were: 98.2, 85, 127/77, 18, 99%
RA.
Admission labs were notable for Hgb/Hct of 10.4/30.9 (versus
11.4/33.4 on , 15.2/45.9 , unremarkable Chem7 with
the exception of BUN/Cr of , and normal coagulation panel.
He received 1L of IV normal saline. Gastroenterology was
consulted, felt that this was a slow diverticular bleed,
suggested prep overnight w 1L moviprep q4h till clear for
colonoscopy in the AM, no CTA unless significant increase in
bleed. Vital signs prior to transfer were as follows: 74,
133/81, 16, 100% RA.
On arrival to the floor, he was stable, and denied any
dizziness, abdominal pain, or SOB. He had 3 BM since midnight
and had not noted any gross blood in stool. He was slightly
irritable, but had no complaints.
## PAST MEDICAL HISTORY:
Hep C
Polysubstance misuse (alcohol, tobacco)
GERD
Gout
Hypertension
Temporomandibular joint syndrome
Seasonal allergies
Migraine syndrome
Depression/PTSD
Chronic low back pain
## FAMILY HISTORY:
Mother, living, with hypertension. Father, deceased, with
prostate cancer. Brother, deceased, with HIV/AIDS, diabetes
mellitus, glaucoma, hypertension, and psychiatric illness.
Sister, alive, with diabetes mellitus
## CARDIAC:
RRR, S1/S2, no murmurs, gallops, or rubs
## LUNG:
CTAB, no wheezes, rales, rhonchi, breathing comfortably
without use of accessory muscles
## ABDOMEN:
nondistended, +BS, nontender in all quadrants
## EXTREMITIES:
moving all extremities well, no cyanosis, clubbing
or edema
## PULSES:
2+ DP pulses bilaterally
## SKIN:
warm and well perfused
DISCHARGE PHYSICAL EXAM
Vitals- 98.0F, 105/61, 60, 18, 99%RA I&O MN NPO/BRP
General- Alert, oriented, no acute distress
HEENT- Sclerae anicteric, MMM, oropharynx clear
Neck- supple, JVP not elevated, no LAD
Lungs- Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV- Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen- soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU- no foley
Ext- warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro- CNs2-12 intact, motor function grossly normal
## IMPRESSION:
Small hiatal hernia
Normal mucosa in the whole stomach
Normal mucosa in the whole duodenum
Otherwise normal EGD to third part of the duodenum
- COLONOSCOPY
## IMPRESSION:
Diverticulosis of the sigmoid colon, descending
colon, transverse colon and ascending colon. This is the likely
source for hematochezia.
Normal mucosa in the whole colon
Otherwise normal colonoscopy to cecum
## BRIEF HOSPITAL COURSE:
homeless man, with h/o diverticulosis, HTN, alcohol abuse
(sober since , and untreated Hepatitis C presenting with 5
days of painless hematochezia, in the setting of asymptomatic
anemia.
## #HEMATOCHEZIA:
Patient's symptoms were thought to be likely due
to lower GI bleeding secondary to diverticulosis, given his
prior history. His admission labs were notable for anemia with
hematocrit to 30.9 (baseline 46). He received IL of normal
saline and was type & crossed for 2 units but did not require
any transfusions during this hospitalization. He underwent an
endoscopy on which was remarkable only for a small
hiatal hernia with normal mucosa, as well as a colonoscopy on
which showed multiple, non-bleeding diverticuli
throughout the sigmoid, descending, transverse and ascending
colon. We think his current symptoms were related to recent
bleed (though resolved) from one or more of these diverticuli.
He remained asymptomatic and hemodynamically stable throughout
his hospital course. He had no further hematochezia, with stable
hematocrit, and was subsequently discharged on with
plans to follow up with his PCP.
## #HTN:
BPs stable. We held his home amlodipine given bleed, with
instructions to restart at discharge.
TRANSITIONAL ISSUES
===================
#Please take all your medications as prescribed
#Please drink plenty of fluids and eat foods rich in fiber
#Please follow up with your PCP as scheduled
#Code status: Full code
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Amlodipine 10 mg PO DAILY
2. Cyanocobalamin 250 mcg PO DAILY
3. FoLIC Acid 1 mg PO DAILY
4. Ferrous Sulfate 325 mg PO DAILY
5. Multivitamins 1 TAB PO DAILY
6. Vitamin D 1000 UNIT PO DAILY
## DISCHARGE MEDICATIONS:
1. Amlodipine 10 mg PO DAILY
2. Cyanocobalamin 250 mcg PO DAILY
3. Ferrous Sulfate 325 mg PO DAILY
4. FoLIC Acid 1 mg PO DAILY
5. Multivitamins 1 TAB PO DAILY
6. Vitamin D 1000 UNIT PO DAILY
## DISCHARGE DIAGNOSIS:
1. Lower GI bleed secondary to diverticulosis
## DISCHARGE INSTRUCTIONS:
Dear Mr ,
It was a pleasure taking care of you at the
. You were admitted on with
symptoms of painless bleeding from your rectum. We checked your
blood which showed you had anemia (your blood counts were low).
We gave you some fluids, and did an endoscopy which did not show
any source of upper gastrointestinal bleed, and a colonoscopy
which showed several diverticuloses (outpouchings) throughout
your entire lower gastrointestinal segment. We think one or more
of these outpouchings bled giving your symptoms. There was no
active bleed during your hospitalization, your anemia was stable
on daily lab testing, and you were able to tolerate a regular
diet at discharge.
Please take all of your medications as prescribed. Please drink
plenty of fluids and eat foods rich in fiber to prevent
recurrence of your symptoms. Please follow up with your PCP at
the appointment listed below.
Thank you for choosing the . We wish you the very best.
Your Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15433386", "visit_id": "20984556", "time": "2120-12-27 00:00:00"} |
16666816-RR-19 | 184 | ## EXAMINATION:
ABDOMEN US (COMPLETE STUDY)
## INDICATION:
year old woman presents with change in stool color to
pale/white, ? biliary obstruction. No h/o liver disease/gall stones.// Biliary
obstruction
## LIVER:
The hepatic parenchyma appears within normal limits. The contour of
the liver is smooth. There is no focal liver mass. The main portal vein is
patent with hepatopetal flow. There is no ascites.
## BILE DUCTS:
There is no intrahepatic biliary dilation.
## GALLBLADDER:
There is no evidence of stones or gallbladder wall thickening.
## PANCREAS:
The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
## KIDNEYS:
Normal cortical echogenicity and corticomedullary differentiation is
seen bilaterally. There is no evidence of masses, stones, or hydronephrosis
in the kidneys.
Right kidney: 11.7 cm
Left kidney: 10.9 cm
## RETROPERITONEUM:
There is severe atherosclerotic calcification in the
abdominal aorta. The visualized portions of the IVC are within normal limits.
## IMPRESSION:
Severe atherosclerotic calcification in the abdominal aorta. Otherwise normal
abdominal ultrasound with no evidence of cholelithiasis or biliary
obstruction.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16666816", "visit_id": "N/A", "time": "2124-09-04 10:33:00"} |
15047315-RR-30 | 120 | CT HEAD WITHOUT CONTRAST
## INDICATION:
male status post right MCA stroke, now with mental
status change. Evaluate for interval change in edema, hemorrhage.
## FINDINGS:
The known right frontotemporal cortical infarct is again noted.
There is less associated cytotoxic edema, with decreased shift of the normally
midline structures compared to prior. The cortical margins of the large
territorial infarct have become relatively hyperdense in a thick gyriform
pattern, which can be seen with early "mineralization" of cortical laminar
necrosis. There is no new hemorrhage or infarct. Postoperative changes
involving the right frontal sinus are again noted.
## IMPRESSION:
No new hemorrhage or infarct. Interval decrease in edema and
mass effect of the large right MCA territorial infarction, with possible early
mineralization.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15047315", "visit_id": "27064983", "time": "2187-11-25 06:30:00"} |
11606087-RR-29 | 73 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## INDICATION:
year old woman with s/p fall with head strike// r/o any abnl
## FINDINGS:
There is no evidence of acute large territorial infarction, hemorrhage, edema,
or large mass. The ventricles and sulci are normal in size and configuration.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable.
## IMPRESSION:
No acute intracranial abnormality.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11606087", "visit_id": "N/A", "time": "2155-06-14 16:18:00"} |
15359493-RR-20 | 126 | ## HISTORY:
male found on ground with contusion of the eye.
## STUDY:
CT of the cervical spine without contrast; coronal and sagittal
reformatted images were also generated.
## FINDINGS:
There is no fracture or malalignment. The prevertebral soft
tissues are of normal thickness. A calcification along the anterior
longitudinal ligament of the C5-C6 level is noted. Small disc bulges of C5-C6
and C6-C7 are noted. Mild degenerative changes are seen, primarily in the
form of small anterior osteophytes. The facet joints are appropriately
aligned with one another. The occipitoatlantic and atlantoaxial articulations
are symmetric. The dens is intact. The visualized portions of the lung
apices appear unremarkable.
## IMPRESSION:
No fracture or malalignment with normal prevertebral soft
tissues; mild degenerative changes as described above.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15359493", "visit_id": "N/A", "time": "2164-07-14 23:01:00"} |
18252831-RR-16 | 255 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## INDICATION:
woman with right upper quadrant pain evaluate for
cholecystitis.
## LIVER:
The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. There is no focal liver mass. The main portal vein is patent
with hepatopetal flow. There is trace perihepatic ascites. There is an
isoechogenic area measuring approximately 3.6 x 1.5 cm adjacent to the left
lobe of the liver that may represent blood clot (image 24).
## BILE DUCTS:
There is no intrahepatic biliary dilation.
## GALLBLADDER:
The gallbladder is not dilated A 3 mm echogenic focus at the
gallbladder fundus is noted, representing a small polyp or adherent stone. A
tiny dependent stone is also seen.
## PANCREAS:
Imaged portion of the pancreas appears within normal limits, without
masses or pancreatic ductal dilation, with portions of the pancreatic tail
obscured by overlying bowel gas.
## SPLEEN:
The spleen measures 10.1 cm.
## IMPRESSION:
1. No evidence of acute cholecystitis. Tiny gallstone. Small polyp versus
adherent stone at the gallbladder fundus.
2. Trace perihepatic ascites.
3. Echogenic structure located between the left lobe of the liver and right
kidney, measuring approximate 3.6 x 1.5 cm, while this may represent blood
clot, a followup ultrasound is recommended to exclude a soft tissue lesion.
## RECOMMENDATION(S):
Followup abdominal ultrasound to re-evaluate echogenic
nodule adjacent to the left lobe of the liver.
## NOTIFICATION:
The findings were discussed by Dr. with
Dr. on the at 11:41 , 20 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18252831", "visit_id": "N/A", "time": "2113-04-21 18:08:00"} |
12160571-RR-26 | 550 | ## EXAMINATION:
MRI of the Abdomen
## INDICATION:
year old man with s/p RFA to multiple lesions on
with Dr. // evaluate interval change s/p RFA.
## LOWER THORAX:
The lung bases are clear. No pleural or pericardial effusion.
## LIVER:
There are diffuse reticular markings hyperintense on the T2 weighted
images which demonstrate progressive peripheral enhancement in keeping with
known history of cirrhosis. Patient is status post radiofrequency ablation of
the previously seen hepatocellular carcinomas in segments 4a, 6 and 8 ( ).
In segment 4a, the radiofrequency ablation cavity measures approximately 25 x
31 mm. There is intrinsic high signal on the T1 weighted images in keeping
with coagulation necrosis. There is no central enhancement to suggest
recurrent or residual disease.
In segment 8, the ablation cavity measures approximately and 21 x 30 mm.
There is intrinsic high T1 signal and no enhancement or washout to suggest
recurrent or residual disease.
In segment 6, the ablation cavity measures 25 x 36 mm and appears similar to
the other ablation cavity. There is no central enhancement to suggest
recurrent or residual disease.
In segment 2, there is a 7 x 13 mm focus demonstrating arterial enhancement
which normalizes on the portal venous and delayed phase images. There is no
T2 correlate. This finding likely represents a transient hepatic intensity
difference and appears slightly larger compared to the previous exam
(1101:25). In segment 6, there is another similar-appearing lesion measuring
10 x 14 mm which is also unchanged compared to the previous exam (1001:73).
Adjacent to the IVC in segment 8, there is a stable 5 x 11 mm focus of
arterial enhancement which appears to communicate with the portal vein and is
consistent with an intrahepatic varix. There is a small amount of perihepatic
free fluid.
## BILIARY:
No intra- or extra-hepatic duct dilatation. The common bile duct is
within normal limits. The gallbladder is contracted and there are multiple
small calculi.
## PANCREAS:
The pancreatic parenchyma maintains normal bulk, intrinsic
hyperintense T1 signal and enhancement pattern. No focal lesion or ductal
abnormality is seen.
## SPLEEN:
There is borderline splenomegaly measuring up to 13 cm. No focal
lesions identified.
## ADRENAL GLANDS:
Normal in size and signal characteristics. No focal lesions.
## KIDNEYS:
The kidneys are normal in size and signal characteristics. The
corticomedullary differentiation is well-maintained with normal excretion of
contrast on the delayed phase images. There are no concerning solid or cystic
lesions. Multiple bilateral cortical cysts measuring up to 6 mm are again
noted. No hydronephrosis or hydroureter.
## GASTROINTESTINAL TRACT:
The GI tract is of normal caliber throughout.
## LYMPH NODES:
No significant mesenteric, retroperitoneal or porta hepatis
lymphadenopathy by size criteria.
## VASCULATURE:
There is a replaced left hepatic artery arising from the left
gastric artery. The portal and hepatic veins are patent. The visualized
abdominal aorta and proximal mesenteric vessels appear patent without any
significant areas of narrowing or dilatation. No esophageal varices are
identified.
## OSSEOUS AND SOFT TISSUE STRUCTURES:
The bone marrow demonstrates normal signal
characteristics. No concerning osseous lesions.
## IMPRESSION:
1. The radiofrequency ablation cavities in segments 4A, 6, and 8 no longer
demonstrate arterial enhancement to suggest recurrent or residual disease.
2. There are no hepatic lesions meeting OPTN criteria for HCC.
3. Morphologic features of cirrhosis with portal hypertension characterized
by ascites and splenomegaly.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12160571", "visit_id": "N/A", "time": "2133-11-28 13:53:00"} |
19104262-DS-16 | 807 | ## HISTORY OF PRESENT ILLNESS:
G4P2 @ presents with constipation, cramping, and
leaking fluid. She has not had a bowel movement for over a week
now. Today, she went to the bathroom around noon, and after
straining for an hour, she had a large hard stool and a gush of
clear fluid. No leaking since that time. Has had some abdominal
cramping that was constant after she had her BM, but now is
feeling some contractions. She has a mild frontal headache. No
visual changes. Has had a nonproductive cough for days. Has
had unchanged SOB for the past month. Denies any chest pain.
Denies any vaginal bleeding or abnormal discharge. Denies
dysuria. Feeling normal fetal movement.
She reports that her blood sugars were a little high over the
weekend in the 200s, but were normal yesterday with fasting in
the and postprandials in the 110s. However, last night her
glucometer ran out of batteries and she couldn't find her
charger
so she has not been able to check her blood sugar today. She has
only had a cup of juice to drink today because she feels so full
from the constipation. She did take some insulin at 2pm to cover
the juice. Denies any nausea or emesis. Is feeling hungry now.
## *) DATING:
:
*) Labs: O+/Ab-/RPRNR/RI/HbsAg-/HIV-/GBS
*) Routine:
- Genetics: LR ERA and Panorama
- U/S: nl full fetal survey
*) Issues
- Poorly controlled T1DM, last A1C 8.7% ( ), had ophtho
consult during previous admission. Nl fetal echo. Last EFW 1262g
(34%) on
- Lagging FL diagnosed on U/S, shortened long bones, LR
NIPT
## PGYNHX:
Denies abnormal Pap, fibroids, Gyn surgery, STIs
## PSH:
I&D of thigh abscesses and
## MEDS:
NPH , humalog sliding scale (pt does not know the
sliding scale without her sheet), PNV, colace, PNV
## PHYSICAL EXAM:
On day of discharge:
AFVSS
NAD
RRR
CTAB
## PERTINENT RESULTS:
04:30PM BLOOD WBC-11.0 RBC-3.85* Hgb-11.6* Hct-33.8*
MCV-88 MCH-30.1 MCHC-34.2 RDW-12.9 Plt
04:30PM BLOOD Neuts-76.4* Monos-2.5 Eos-0.6
Baso-0.2
08:05AM BLOOD Glucose-173* UreaN-6 Creat-0.5 Na-136
K-3.8 Cl-105 HCO3-20* AnGap-15
07:43PM BLOOD Glucose-63* UreaN-7 Creat-0.5 Na-140
K-3.9 Cl-109* HCO3-22 AnGap-13
04:30PM BLOOD Glucose-292* UreaN-8 Creat-0.6 Na-135
K-4.1 Cl-102 HCO3-18* AnGap-19
08:05AM BLOOD Calcium-8.6 Phos-3.3 Mg-1.8
07:43PM BLOOD Calcium-8.5 Phos-2.3* Mg-2.0
04:30PM BLOOD Calcium-8.9 Phos-2.3* Mg-1.9
04:39PM BLOOD %HbA1c-8.1* eAG-186*
04:40PM BLOOD pO2-247* pCO2-29* pH-7.41
calTCO2-19* Base XS-- G4P2 with T1DM admitted to labor and delivery with poor
glucose control in DKA. She was rescusitated and given insulin
with improvement in her lab values and FSBG. She had reassuring
fetal testing throughout. Once stabilized from a maternal
perspective she was transfered to the antepartum unit for close
monitoring of her blood glucose, optimization of her insulin
regimen and daily NSTs for fetal wellbeing.
For her T1DM, she was followed by endocrinology. She
received extensive counseling regarding diabetes, rationale for
control longterm and in pregnancy, poor pregnancy outcomes
including fetal demise with poor control and nutrition. Her
regimen was progressively optimized throughout her admission,
with good control by discharge.
For her constipation she received a bowel regimen with good
effect.
On HD#4 she was felt to safe for discharge with close follow up
scheduled.
## DISCHARGE MEDICATIONS:
1. Docusate Sodium 100 mg PO BID:PRN Constipation
RX *docusate sodium 100 mg 1 tablet(s) by mouth times per
day Disp #*60 Tablet Refills:*6
2. NPH 8 Units Breakfast
NPH 12 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
3. Prenatal Vitamins 1 TAB PO DAILY
4. Polyethylene Glycol 17 g PO DAILY:PRN constipation
RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 17 grams by
mouth daily Refills:*6
## DISCHARGE DIAGNOSIS:
diabetic ketoacidosis
Type 1 Diabetes
Pregnancy
Constipation
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
You were admitted to the high risk pregnancy service at
for diabetic ketoacidosis (DKA). You were treated for DKA and
your insulin regimen was modified to try to improve your glucose
control. We feel that your blood sugars are now under better
control and that it is safe for you to be discharged. It is very
important that you continue to regularly check your fingersticks
at home and try to eat meals at the same time each day. It is
also important to try to keep your medical appointments. We will
now be combining your diabetes and prenatal appointments
together so that you will have fewer visits.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19104262", "visit_id": "28092921", "time": "2117-06-16 00:00:00"} |
17438961-RR-20 | 101 | ## CLINICAL INDICATION:
Evaluate if left thyroid mass is amenable to biopsy.
## THYROID ULTRASOUND:
The right lobe measures 5.1 x 1.5 x 1.9 cm. It contains
several heterogeneous subcentimeter hypoechoic masses in the mid and upper
pole. A right mid pole thyroid nodule measuring 1.5 x 1.9 cm is noted. The
entire left lobe contains an ill-definied mass with heterogenous echoes and
some internal vascularity. The left thyroid measures 5.8 x 3.4 x 4.8 cm.
## IMPRESSION:
Bilateral thyroid masses. A large mass involving the entire left
lobe is amenable to biopsy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17438961", "visit_id": "N/A", "time": "2182-06-10 10:17:00"} |
15094587-RR-19 | 85 | ## INDICATION:
s/p FEVAR and L fem endart w/L flank pain// L renal US
for ?renal artery thrombosis
## FINDINGS:
The right kidney measures 10.1 cm. The left kidney measures 9.2 cm. There is a
1.6 x 1.3 cm interpolar left simple renal cyst. There is no hydronephrosis or
stones bilaterally. Normal cortical echogenicity and corticomedullary
differentiation are seen bilaterally.
The bladder is moderately well distended and normal in appearance.
## IMPRESSION:
No sonographic evidence of left renal artery thrombosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15094587", "visit_id": "29597259", "time": "2113-01-31 02:34:00"} |
17075739-RR-21 | 106 | ## INDICATION:
Is ET tube in place? Any sign of infection?
## FINDINGS:
NG tube and ET tube have been removed. There is a minimal
improvement of lung opacification mainly for reduction of the bilateral
pleural effusion more evident on the left base. Persistent atelectasis of
right lower, right middle and left lower lobes. There is no pneumothorax.
Cardiomediastinal silhouette is unchanged and still mildly enlarged; moderate
aortosclerosis.
## IMPRESSION:
All the monitoring devices have been removed. The bibasilar
atelectasis with pleural effusion is minimally improved, mainly for reduced
pleural effusion especially on the left base. Persistent bibasilar
atelectasis with large atelectasis of the right middle lobe.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17075739", "visit_id": "21966244", "time": "2199-02-10 03:58:00"} |
14095193-RR-99 | 137 | ## INDICATION:
year old woman with thyroid nodules. Please reevaluate nodule
size.
## THE RIGHT LOBE MEASURES:
(transverse) 2.2 x (anterior-posterior) 1.4 x
(craniocaudal) 5.5 cm.
The left lobe measures: (transverse) 2.0 x (anterior-posterior) 1.7 x
(craniocaudal) 4.9 cm.
Isthmus anterior-posterior diameter is 0.3 cm.
Thyroid parenchyma is homogenous and has normal vascularity. In the midpole of
the right lobe is a 1.2 x 0.9 x 1.6 cm hypoechoic nodule with cystic spaces
(previously 1.6 x 1.0 x 2.0 cm). In the mid to inferior pole of the left lobe
is a confluence of 4 isoechoic nodules with cystic spaces the largest of which
measures 1.5 cm, which is identical in appearance to prior examination.
## IMPRESSION:
Stable bilateral thyroid nodules.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14095193", "visit_id": "N/A", "time": "2145-09-14 13:56:00"} |
10636786-RR-6 | 186 | ## INDICATION:
female with fever and leukocytosis and history of
hepatitis C.
## ABDOMINAL ULTRASOUND:
The gallbladder is unremarkable without stones or wall
edema. Within the right lobe of the liver there is a 0.9 x 0.8 x 0.8 cm
hyperechoic lesion likely representing a hemangioma. An area of heterogeneity
adjacent to the gallbladder fossa likely represents focal fatty sparing. There
is no intra- or extra-hepatic biliary dilatation. The portal vein is patent
with appropriate hepatopetal flow. A 2.5 x 1.4 x 1.8 cm lymph node is seen
within the porta hepatis. The right kidney measures 10.9 cm. The left kidney
measures 10.7 cm. There are no stones or hydronephrosis bilaterally. The
pancreas and spleen are unremarkable. The visualized portions of the aorta
are of normal caliber throughout.
## IMPRESSION:
1. Enlarged lymph node within the porta hepatis.
2. Hyperechoic lesion in the right lobe of the liver likely represents a
hemangioma. This as well as an area of heterogenicity adjacent to the
gallbladder fossa should be further evaluated with dedicated abdominal MRI.
Findings were conveyed to on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10636786", "visit_id": "N/A", "time": "2126-02-01 09:54:00"} |
17122832-RR-3 | 92 | ## FINDINGS:
Supine portable AP view of the chest was provided. Layering
bilateral pleural effusions likely account for the lower lung opacities seen.
There is also likely a component of compressive atelectasis. These findings
are better assessed on the outside hospital CT and appear grossly stable. The
mid and upper lungs appear well aerated. The overall heart size appears
grossly within normal limits. Bony structures are intact.
## IMPRESSION:
Layering bilateral pleural effusions with lower lung atelectasis.
Findings were more clearly assessed on the outside hospital CT performed on
the same date.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17122832", "visit_id": "24582122", "time": "2187-12-10 18:19:00"} |
19060383-RR-127 | 184 | ## HISTORY:
male status post liver transplant with history of
anastomotic biliary strictures. Patient status post biliary stenting three
months ago.
## FINDINGS:
14 fluoroscopic spot images from ERCP are submitted for review. The
initial scout image shows multiple biliary stents in the right upper quadrant.
Subsequent images show removal of the stents and cannulation of the distal
common bile duct. The intra- and extra-hepatic biliary tree is opacified with
contrast material and again visualized is narrowing in the mid common bile
duct consistent with known stricture. There is proximal dilatation of the
common hepatic duct and the central intrahepatic ducts with a few irregular
filling defects seen. Per ERCP note, the filling defects were related to
stent debris. A balloon sweep was performed to remove debris from the duct.
Despite the persistent stricture, the decision was made not to put in any new
stents given the free flow of bile visualized during the procedure.
## IMPRESSION:
Mid common bile duct narrowing consistent with anastomotic
stricture. Removal of prior biliary stent and balloon sweep to remove debris.
Please see ERCP note for further details.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19060383", "visit_id": "N/A", "time": "2120-10-05 23:16:00"} |
11017406-RR-20 | 83 | ## HISTORY:
disease with retching of unclear cause.
## FINDINGS:
There is minimal premature spillage into the oropharynx but no evidence of
aspiration or penetration. There is also minimal swallow delay. Barium passes
through the oropharynx with no evidence of obstruction. A barium pill was
adminstered which proceeded to the region of the stomach.
## IMPRESSION:
Minimal premature spillage and swallow delay with no evidence of aspiration or
penetration. Please refer to the speech and swallow note from the same day
for further details.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11017406", "visit_id": "N/A", "time": "2140-08-12 13:43:00"} |
15003296-RR-68 | 111 | ## INDICATION:
year old woman with postmenopausal bleed; has IUD in place for
years. Evaluate for uterine abnormality.
## FINDINGS:
The uterus is anteverted and measures 8.9 x 4.1 x 5.5 cm. The endometrium is
heterogenous and measures 5 mm. Portions of the endometrium are not well
evaluated due to a Lippes loop IUD within the canal. There may be minor
breakthrough of the myometrium by the device. No fibroids are noted.
The ovaries are not visualized. There is no free fluid.
## IMPRESSION:
Lippes loop IUD within the uterine cavity obscures portions of the
endometrium. The tip of the IUD appears to minimally extend into the fundal
myometrium.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15003296", "visit_id": "N/A", "time": "2130-05-21 14:10:00"} |
11506070-RR-16 | 116 | ## INDICATION:
AMA and diabetes complicating pregnancy.
## FINDINGS:
Transabdominal imaging shows a live in cephalic
presentation. The placenta is posterior without evidence of previa. Amniotic
fluid volume is increased with the AFI measuring 26 cm. There is an anterior
fibroid measuring approximately 6 cm unchanged compared to the prior exam.
A biophysical profile was performed with two points each being awarded for
breathing, movement, tone and fluid for a normal score. Duplex Doppler of
the umbilical artery demonstrates a normal S/D ratio of 2.0.
No biometry was performed on today's exam.
## IMPRESSION:
Live in cephalic presentation. Polyhydramnios is
present with the AFI measuring 26 cm. There is a 6 cm anterior fibroid.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11506070", "visit_id": "N/A", "time": "2169-01-10 14:55:00"} |
18487217-RR-20 | 87 | ## INDICATION:
year old man with pleural effusion s/p chest tube// eval for
remaining pleural effusion
## FINDINGS:
Left-sided chest tube in the left lung base, unchanged in position.
Small left pleural effusion is unchanged.
Improvement of bilateral pulmonary edema, with now nearly clear lungs.
Lung volumes have improved.
No pneumothorax.
Stable mild cardiomegaly with unremarkable mediastinal silhouette.
## IMPRESSION:
There has been interval improvement of bilateral pulmonary edema and lung
expansion.
Small left pleural effusion is unchanged and chest tube remains in the same
position.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18487217", "visit_id": "24504787", "time": "2150-12-03 09:54:00"} |
19665761-RR-21 | 546 | ## INDICATION:
woman with metastatic colon cancer.
Treatment response.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 19.5 s, 0.2 cm; CTDIvol = 331.7 mGy (Body) DLP =
66.3 mGy-cm.
3) Spiral Acquisition 10.0 s, 64.9 cm; CTDIvol = 10.2 mGy (Body) DLP =
654.5 mGy-cm.
4) Spiral Acquisition 5.2 s, 33.9 cm; CTDIvol = 9.9 mGy (Body) DLP = 329.8
mGy-cm.
Total DLP (Body) = 1,053 mGy-cm.
** Note: This radiation dose report was copied from CLIP (CT ABD AND
PELVIS WITH CONTRAST)
## FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL:
The included thyroid is with no
incidental findings.
There is no supraclavicular or axillary lymphadenopathy.
Excluding the breasts which must be evaluated by mammography the chest wall is
with no focal soft tissue abnormalities to suggest malignancy.
## UPPER ABDOMEN:
Nodule number of hypodense metastasis of varying sizes involve
the liver, better evaluated on CT of the abdomen and pelvis reported on the
same day.
## MEDIASTINUM:
There is no mediastinal, hilar or any other intrathoracic
lymphadenopathy.
Lower paraesophageal upper abdomen 0.8 cm lymph node is unchanged.
The esophagus is collapsed and unremarkable.
## HEART AND PERICARDIUM:
Heart and major vessels within normal size.
There are no appreciable atherosclerotic calcifications of the coronaries or
thoracic aorta.
Variant-double SVC.
Right Port-A-Cath terminates in the junction of brachiocephalic and SVC.
Large number of collaterals in the right upper extremity.
Contrast was injected through the right arm, not through the port-A-cath thus
its patency cannot be evaluated.
There is a linear hypodensity extending from the tip of the port with contrast
surrounding it, better evaluated on coronal reconstruction, 07:25 and is
suspicious for clot.
## PLEURA:
Mild biapical pleural parenchymal fibrosis in unchanged.
There is no pleural effusion.
## LUNG:
Airways are patent to subsegmental level.
Right hemidiaphragm is elevated, 4.5 cm higher than left, with adjacent
subsegmental passive atelectasis.
Left upper lobe subpleural 0.4 cm nodule is larger by virtue of mm in
comparison to (5:130).
Remaining bilateral micro nodules are unchanged for example right upper lobe
05:58, 75, right lower lobe image 155.
Left lower lobe 0.4 mm nodule is stable (05: 180).
There are no new lung masses, no lung opacifications.
## CHEST CAGE:
There is new T6 vertebral sclerotic lesion, with no pathologic
fracture and there is no evidence of spinal cord compression. The adjacent
right ribs are also involved. New sclerotic lesion in the sternum.
## IMPRESSION:
-Linear hypodensity extending from the tip of the port in a patent SVC,
suspicious for clot.
-New sclerotic metastasis to the sternum, T6 vertebra and adjacent right 6 and
7 ribs. No pathologic fracture.
-Left upper lobe subpleural 0.4 cm nodule is larger by virtue of mm in
comparison to , remaining pre-existing nodules are unchanged.
-There is no new mediastinal lymphadenopathy and lower paraesophageal sub cm
lymph node is unchanged.
-Please refer to the same day CT of the abdomen and pelvis report.
## NOTIFICATION:
The impression and recommendation above was entered by Dr.
on at 16:40 into the Department of Radiology critical
communications system for direct communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19665761", "visit_id": "N/A", "time": "2114-09-25 12:04:00"} |
15801927-RR-10 | 210 | ## EXAMINATION:
Mechanical thrombectomy for large vessel occlusion stroke PE
The following vessels were imaged during the intervention
Right femoral artery
Left internal carotid artery
In addition, before the intervention a noncontrast head CT was obtained
## INDICATION:
female without significant past medical history that
presented to an outside hospital with a left MCA syndrome and hyperdense MCA
in head CT. CTA revealed a proximal M1 occlusion. stroke scale was 22.
Patient received IV tPA and was transferred to our hospital for consideration
of mechanical thrombectomy for large vessel occlusion.
## OPERATORS:
Dr. Dr. physician performed the
procedure. Dr. supervised the trainee during the key
components of the procedure and has reviewed and agrees with the trainee's
findings.
The following devices were used during the intervention
-Trevo 4mm x 30mm
-FlowGate
-Aristotle wire
-CAT6 catheter
## FINDINGS:
Head CT without contrast does not reveal intracranial hemorrhage.
Right femoral artery has good runoff without stenosis or significant
tortuosity.
Left internal carotid artery has complete occlusion in the proximal M1 segment
of the left middle cerebral artery consistent with a TICI 0. After mechanical
thrombectomy, the recanalization is TICI 3.
## IMPRESSION:
Complete revascularization of left middle cerebral artery
## RECOMMENDATION(S):
Transfer the patient to neuro ICU under stroke neurology
and perform head CT
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15801927", "visit_id": "22369565", "time": "2131-07-21 21:09:00"} |
17014241-RR-23 | 358 | ## NO PO CONTRAST; HISTORY:
with h/o anal fistula and
gangrene presents with swollen, erythematous and draining perineal areaNO PO
contrast// Please evaluate for rectal fistula
## SINGLE PHASE SPLIT BOLUS CONTRAST:
MDCT axial images were acquired
through the pelvis following intravenous contrast administration with split
bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 4.4 s, 34.6 cm; CTDIvol = 27.1 mGy (Body) DLP = 938.2
mGy-cm.
Total DLP (Body) = 938 mGy-cm.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is
free fluid in the pelvis. Visualized colon and small bowel are within normal
limits with normal wall enhancement and thickness.
There is intramural fat within the rectum, consistent with history of chronic
inflammatory changes. perirectal abscess or fistula is demonstrated. There
is a linear soft tissue tract in the left ischioanal fossa, at the site of the
previous perianal fistulous tract seen on prior MR. is significant
soft tissue stranding. definitive perianal abscess or new fistulous tract.
## REPRODUCTIVE ORGANS:
The prostate and seminal vesicles are normal.
## LYMPH NODES:
There is retroperitoneal or mesenteric lymphadenopathy. There
is pelvic or inguinal lymphadenopathy.
## VASCULAR:
Moderate atherosclerotic disease is noted. abdominal aortic
aneurysm.
## BONES:
There is evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
There is subtle stranding seen within the perineum near the base
of the scrotum (series 2, image 60). Known perineal abscess seen on same-day
ultrasound was not imaged on the current exam. There is a small umbilical
hernia containing fat.
## IMPRESSION:
1. Subtle stranding seen within the perineum near the base of the scrotum.
Perineal abscess seen on same-day ultrasound was not imaged on the current
exam.
2. Soft tissue tract in the left ischioanal fossa at the site of prior
perianal fistulous tract seen on prior MR. definitive perianal or
perirectal abscess or new perianal fistula. Consider MRI for improved
assessment of perianal fistulous disease.
3. Intramural fat within the rectum, likely reflective of chronic inflammatory
changes.
## RECOMMENDATION(S):
MRI of the pelvis for further assessment of perianal
fistulous disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17014241", "visit_id": "N/A", "time": "2145-04-03 13:39:00"} |
13789582-RR-39 | 493 | ## EXAMINATION:
CTA ABD AND PELVIS
## INDICATION:
year old woman with GI bleed, appears lower GI source. //
?source of abdominal bleeding
## ABDOMEN AND PELVIS CTA:
Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 4.8 s, 52.5 cm; CTDIvol = 4.2 mGy (Body) DLP = 217.9
mGy-cm.
2) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 9.1 mGy (Body) DLP = 4.6
mGy-cm.
3) Spiral Acquisition 6.5 s, 50.8 cm; CTDIvol = 13.9 mGy (Body) DLP = 704.1
mGy-cm.
4) Spiral Acquisition 6.5 s, 50.8 cm; CTDIvol = 13.9 mGy (Body) DLP = 705.1
mGy-cm.
Total DLP (Body) = 1,632 mGy-cm.
## VASCULAR:
There is no abdominal aortic aneurysm. There is minimal calcium burden in the
abdominal aorta and great abdominal arteries. There is apparent mild stenosis
of the celiac artery, which may be related to patient positioning.
## LOWER CHEST:
Minimal atelectasis is noted in the lung bases. Trace bibasilar
pleural effusions right greater than left with overlying compressive
atelectasis.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder demonstrates a small amount
of layering high density material consistent with sludge. There are no stones
within the gallbladder lumen or gallbladder wall thickening. Trace
perihepatic fluid is unchanged.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
A left percutaneous nephrostomy tube with its distal tip in the left
renal pelvis is unchanged. Otherwise come The kidneys are of normal and
symmetric size with normal nephrogram. There is no evidence of stones, focal
renal lesions, or hydronephrosis. There are no urothelial lesions in the
kidneys or ureters. There is no perinephric abnormality.
## GASTROINTESTINAL:
Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. Colon and rectum are within normal limits.
Appendix contains air, has normal caliber without evidence of fat stranding.
There is no evidence of mesenteric lymphadenopathy.
## RETROPERITONEUM:
There is no evidence of retroperitoneal lymphadenopathy.
## PELVIS:
A Foley catheter is identified within the urinary bladder. There is
no evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in
the pelvis.
## REPRODUCTIVE ORGANS:
The visualized reproductive organs are unremarkable.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
1. No contrast extravasation to suggest intra-abdominal bleed.
2. Small bilateral pleural effusions with small volume intraperitoneal
ascites.
3. No significant change in left percutaneous nephrostomy tube. No
hydronephrosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13789582", "visit_id": "28781192", "time": "2167-11-27 14:05:00"} |
17031372-RR-34 | 185 | ## INDICATION:
male with recent posterior fossa mass resection, now
being treated for pulmonary embolism on heparin. Evaluate for intracranial
hemorrhage.
## FINDINGS:
Patient is status post suboccipital craniectomy and partial
resection of a left cerebellar mass. Post-surgical changes continue to evolve
including decrease in the amount of small air locules in the posterior neck.
Residual hyperdensity along the posterior aspect of the surgical bed has
decreased in size compared to and may represent calcification
within a resolving hematoma, though a small amount of residual mass cannot be
excluded. Right frontal hypodensity and overlying right frontal craniotomy are
related to patient's previous ventriculostomy and are unchanged.
There is no acute intracranial hemorrhage, shift of normally midline
structures, or evidence of acute major vascular territorial infarction. Slight
prominence of ventricles and sulci consistent with age-related atrophy is
unchanged. The imaged portions of the paranasal sinuses and mastoid air cells
remain well aerated.
## IMPRESSION:
1. No acute intracranial hemorrhage.
2. Postoperative change in the cerebellum with likely resolving hematoma in
the surgical bed. Continued attention is recommended on followup imaging to
exclude residual tumor.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17031372", "visit_id": "25246940", "time": "2119-09-30 13:21:00"} |
17579206-RR-17 | 353 | ## EXAMINATION:
MR CERVICAL SPINE W/O CONTRAST MR SPINE
## HISTORY:
with no significant PMH s/p fall 3 days ago with new
significant bilateral radiculopathy in C8 distribution.IV contrast to be
given at radiologist discretion as clinically needed// Rule out vertebral
fracture or other spinal pathology i/s/o significant bilateral radiculopathy.
Please make sure you get down to T1 Rule out vertebral fracture or other
spinal pathology i/s/o significant bilateral radiculopathy
## FINDINGS:
Alignment is normal. Vertebral body signal intensity is normal. There is
loss of signal of the intervertebral discs on the T2 weighted images
throughout the cervical spine due to degenerative disease. The spinal cord
appears normal in caliber and configuration.
Imaging from C1 through C3 demonstrates no spinal canal or neural foraminal
compromise.
At C3-4, there is a minimal bulge of the disc that slightly encroaches on the
spinal canal but does not contact the spinal cord. There is mild left neural
foraminal narrowing.
At C4-5, a a bulge of the intervertebral disc encroaches on the spinal canal
and slightly flattens the anterior surface of the spinal cord. The neural
foramina appear normal.
At C5-6, there is a disc bulge and midline protrusion that encroach on the
spinal cord and indented in the midline. Uncovertebral and facet osteophytes
produce severe bilateral neural foraminal narrowing.
At C6-7 there is a small annular fissure just to the right of midline. This
is associated with a tiny protrusion of the disc that touches the anterior
surface of the spinal cord without deforming it. The neural foramina appear
normal.
At C7-T1 there is a tiny midline annular fissure associated with a small
midline disc protrusion that does not contact the spinal cord. The neural
foramina appear normal.
Included images of the upper thoracic spine demonstrate no spinal canal or
neural foraminal narrowing. There is no evidence of spinal canal or neural
foraminal narrowing. There is no evidence of infection or neoplasm.
## IMPRESSION:
Multilevel degenerative disc disease with midline protrusions at C5-6, C6-7
and C7-T1.
Bilateral neural foraminal narrowing at C5-6.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17579206", "visit_id": "N/A", "time": "2140-04-14 01:06:00"} |
14546043-DS-10 | 1,479 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## CHIEF COMPLAINT:
R hemiparesis, dysarthria, aphasia
## HISTORY OF PRESENT ILLNESS:
man with no known PMH presents as an OSH transfer with
multiple episodes of right hemiparesis, dysarthria, aphasia the
day of presentation. The patient is a fairly poor historian;
history is per him and the notes from . These episodes
began at 11am while he was driving (works as a ). He
had acute onset right hemiparesis ("the right side was dead").
It lasted 20 minutes and reportedly then resolved; he had
another episode perhaps 10 minutes later, similar to the first,
also lasting another 20 minutes. His boss called EMS and he was
brought to . Notes from there say he had right facial
droop, dysarthria, and right grip weakness per EMS. The ED exam
reports a dense right hemiparesis and aphasia. He was sent to
CT, which was normal, and when he returned his symptoms had
resolved. He had several other episodes during his time in the
ED there. He had a normal carotid ultrasound and EKG, and an
ECHO that was normal apart from a small ASD. He was given ASA
325mg and PHT 500mg, and transferred to .
## PAST MEDICAL HISTORY:
Pt is unwilling to provide a PMH.
## FAMILY HISTORY:
cancer in a mother and sister, stroke in a sister ago,
when she was in her , unknown cause, 1 child is healthy.
## GENL:
NAD, lying in bed
## HEENT:
NCAT, MMM, OP clear
## CV:
RRR, nl S1, S2, no m/r/g
## WARM AND DRY
NEUROLOGIC EXAMINATION:
MENTAL STATUS:
Awake and alert, minimally cooperative with
history and exam, odd affect. Oriented to person, place, and
date. Attentive, says backwards. Speech is fluent with
normal
comprehension and repetition; naming intact. Very mild
dysarthria. Reading intact. Registers , recalls in 5
minutes. No right-left confusion. No evidence of apraxia or
neglect.
## CRANIAL NERVES:
Fundoscopic examination reveals sharp disc
margins. Pupils equally round and reactive to light. No RAPD.
Visual fields are full to confrontation. Extraocular movements
intact bilaterally without nystagmus. Sensation intact V1-V3.
Right UMN facial palsy. Hearing intact to finger rub
bilaterally.
Palate elevation symmetric. Sternocleidomastoid and trapezius
full strength bilaterally. Tongue midline, movements intact.
## MOTOR:
Normal bulk and tone bilaterally. No observed myoclonus,
asterixis, or tremor. No pronator drift.
Del Tri Bi WE FE FF IP H Q DF PF TE
R
L
## SENSATION:
Intact to light touch, pinprick, vibration, position
sense, and cold sensation throughout. No extinction to DSS.
## REFLEXES:
1+ and symmetric throughout. Toes downgoing
bilaterally.
## COORDINATION:
finger-nose-finger, finger-to-nose, fine finger
movements, and RAM normal.
## GAIT:
Narrow based, steady. Able to tandem, though difficulty at
first (pt says one leg much shorter than other).
Romberg negative.
## ADMISSION LABS:
(per outside report)
142 108 14
-----
< 89
4.5 26 1.23
Ca , TP 7.2, Alb 4.3, TB 0.7, AST 19, ALT 19, AP 102
Imaging from OSH:
per report, negative CT, CTA, nl carotid u/s, nl ECHO except
small ASD
## FINDINGS:
There are no previous studies available for direct
comparison.
The patient has healed fractures of the right tibial and fibular
shafts. There are no metallic densities in the soft tissues. The
patient does have a prominent shard of bone extending
posteriorly best seen on the lateral view at the level of
fracture site. No new fractures are seen. There are degenerative
changes seen of the right knee joint with spurring of the medial
and lateral compartments.
## IMPRESSION:
1. No retained metallic densities in the right lower extremity
to prevent the patient from having an MRI.
2. Healed fracture deformities of the right tibial and fibular
shafts.
MRI/MRA NECK W/O CONTRAST 7:00
## FINDINGS:
The diffusion images demonstrate a region of slow
diffusion in the genu and posterior limb of the left internal
capsule. This is faintly visible on the FLAIR images, suggesting
a subacute infarction. The gradient echo images demonstrate a
small area of hypointensity that may reflect a small amount of
hemorrhage within this infarction. Images of the remainder of
the brain appear normal. The MRA of the brain demonstrates
atheromatous disease in the left carotid siphon with dilatation,
but no evidence of stenosis or occlusion. The MRA of the neck is
heavily degraded by motion artifact, but there is no evidence of
common or internal carotid stenosis or occlusion. If further
detail of the neck arteries is required, a repeat gadolinium
MRA, or a CTA of the neck may be helpful.
## CONCLUSION:
Subacute infarction of the genu and posterior limb
of the left internal capsule with a small amount of hemorrhage.
No evidence of arterial stenosis or occlusion.
Lower Extremity Doppler Ultrasound- negative for DVT
(bilaterally).
## BRIEF HOSPITAL COURSE:
Mr. is a year old right handed man with no known PMH who
presented with multiple episodes today of right hemiparesis,
dysarthria, and
reportedly aphasia. He was tranferred from an outside hospital
for further evaluation.
1) Left posterior limb of the internal capsule infarct-
On admission exam, he had a slight right upper motor neuron
facial palsy. He had a normal CT, CTA, carotid u/s at the OSH,
and ECHO showing ASD.
He was noted to have aphasia per outside records, but after
obtaining further history this seemed unlikely. His urine was
positive for cocaine metabolites, which in the setting of likely
untreated hypertension and possible hyperlipidemia are risk
factors for stroke. The patient intially refused any further
evaluation for his stoke- there were multiple discussions with
him regarding his refusal of a knee x-ray needed for his MRI
clearance (ED attending, ED resident, and neuro resident). He
was able to understand and repeat back to me that he was
refusing the x-ray, thus could not get the MRI, and thus is at
risk of having recurrent stroke, with possible paralysis or
aphasia for life, or even death.
The patient eventually complied with recommendations for
evaluation with MRI revealing sub-acute posterior limb of the
internal capsule infarction. This is likely a small vessel
ischemic stroke from cocaine induced vasospasm and likely
chronic hypertension and hypercholesterolemia. He was started on
Aspirin 325mg daily and atorvastatin 20mg daily. He was
instructed to discontinue any further use of cocaine for risk of
permanent disability or death. ECHO report was obtained from
revealing secundum type ASD.
were ordered to rule out occult DVT as possible etiology for
stroke given his employment as a , which were
negative. Lipid profile revealed hypertriglyceridemia, which was
likely related to a non fasting sample. Hgb A1C was 5.8.
After extensive discussion with the patient regarding risk of
permanent disability or death from an incomplete stroke
evaluation, he wished to sign out from the hospital Against
Medical Advice. He eventually agreed to further work up for the
etiology of his stroke. Given noramal A1c and lipid profile that
was difficult to interpret in context of poor sampling was
likely cocaine use.
He was provided with prescriptions for 1 month supply of aspirin
and atorvastatin. He will need to establish a primary care
physician for continued treatment with these medications given
need for interval FLP, LFT's, and CK to continue safe longterm
treatment. He was strongly encouraged to follow up with the
stroke neurology center.
## DISCHARGE MEDICATIONS:
1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): Establish a primary care doctor for refills on this
medication. .
Disp:*30 Tablet(s)* Refills:*0*
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*3*
3. Losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
## DISCHARGE DIAGNOSIS:
Left thalamocapsular infarction likely small vessel secondary to
cocaine use.
## DISCHARGE CONDITION:
Discharge exam: Stable. No further neurologic deficits.
## DISCHARGE INSTRUCTIONS:
You were admitted for right arm and leg weakness with difficulty
speaking. You were found to have had a stroke. This was likely
related to cocaine use, high blood pressure and high
cholesterol.
It is essential that you never use cocaine again. You could have
another, much more severe and disabling stroke, or die from the
stroke.
It is essential that you take all medications as prescribed to
modify your risk factors for having another stroke.
It will be important to establish a primary care physician for
monitoring of the new medications you were started on:
1) Atorvastatin for high cholesterol- taking this medication
while using cocaine can put you at risk for serious
complications. Discontinue immediately if you experience severe
muscle pain or weakness.
2) Aspirin to prevent blood clots.
3) Losartan to control your blood pressure.
Seek a primary care physician to prescribe refills on these
medications.
Seek immediate medical attention through your doctor or call
if you experience any difficulty speaking, weakness, numbness,
tingling, chest pain, shortness of breath or any other
concerning symptoms.
Your leg ultrasounds were negative for blood clots.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14546043", "visit_id": "29434422", "time": "2124-04-13 00:00:00"} |
11804756-RR-12 | 113 | ## EXAMINATION:
CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST
## INDICATION:
year old woman with etoh sp fall// ro fx
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 2.4 s, 19.1 cm; CTDIvol = 26.8 mGy (Head) DLP = 512.0
mGy-cm.
Total DLP (Head) = 512 mGy-cm.
## FINDINGS:
There is no facial bone fracture. Pterygoid plates are intact. There is no
mandibular fracture and the temporomandibular joints are anatomically aligned.
The orbits are intact. The globes and extra-ocular muscles are unremarkable.
There is no orbital hematoma.
Included paranasal sinuses are clear. There is a thick subgaleal hematoma
over the left forehead.
## IMPRESSION:
1. No acute fracture.
2. Additional findings described above
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11804756", "visit_id": "N/A", "time": "2141-08-15 23:19:00"} |
13599966-RR-31 | 139 | ## HISTORY:
male with visual field cut. Evaluation for intracranial
hemorrhage.
## FINDINGS:
There is no evidence of intracranial hemorrhage, major vascular territorial
infarction, shift of the normally midline structures, mass effect or edema.
The ventricles and sulci are prominent, due to age related atrophy.
Periventricular white matter hypodensities likely reflect the sequelae of
chronic small vessel ischemic disease. Basal ganglia calcifications are
noted. The basal cisterns appear patent. The gray-white matter
differentiation is preserved. No fractures are identified. The cranial and
facial soft tissues are unremarkable. Polypoid mucosal thickening in the left
maxillary sinus and minimal mucosal thickening in the right maxillary sinus is
noted. Otherwise the paranasal sinuses, mastoid air cells and middle ear
cavities are clear.
## IMPRESSION:
No acute intracranial process. MRI is more sensitive for the detection of
small areas of ischemia and infarction.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13599966", "visit_id": "N/A", "time": "2141-06-30 08:56:00"} |
10997090-RR-69 | 188 | ## INDICATION:
man with head strike, on Coumadin.
## FINDINGS:
No acute fracture is detected in the cervical spine. The
atlanto-axial and atlanto-occipital articulations are intact. Extensive
degenerative changes of the cervical spine are again noted, worse at C3-C4 and
C4-C5 levels. There is mild spinal canal narrowing at these levels.
Extensive anterior osteophyte formation is noted in the cervical spine from C3
to C7 levels. Mild grade 1 anterolisthesis of C5 on C6 is unchanged since the
prior study. Multilevel spinal canal and neural foraminal narrowing is noted,
is most severe at C3-C4 level. There is severe neural foraminal narrowing of
the left C3-C4 neural foramina from bony facet hypertrophic changes.
Biapical pleural scarring is again noted. Previously seen 1-cm right thyroid
nodule is not visualized in the current study. However, a subtle 6-mm
hypoattenuating nodule is seen within the upper pole of the right thyroid lobe
(3:55).
## IMPRESSION:
Extensive degenerative changes of the cervical spine without
evidence of acute cervical spine fracture. Right thyroid nodule. If
clinically indicated, a thyroid ultrasound can be performed for further
assessment.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10997090", "visit_id": "N/A", "time": "2126-04-17 19:20:00"} |
13375874-RR-18 | 145 | ## CLINICAL INFORMATION:
male with history of multiple myeloma and
Paget's disease status post unwitnessed fall.
## FINDINGS:
There is no evidence of intracranial hemorrhage. There is no mass
effect or midline shift. The ventricles and sulci are prominent but
consistent with patient's age. Gray-white differentiation is preserved.
Incidental note is made of calcifications along the falx. The visualized
orbits are unremarkable, and other visualized soft tissues are normal in
appearance. The left mastoid air cells are minimally opacified which may be
inflammatory, the right mastoid air cells are clear. There is moderate
mucosal thickening of the right maxillary sinus, the left maxillary sinus is
clear. The visualized sphenoid, ethmoid and frontal sinuses are clear. There
is no evidence of osseous injury.
## IMPRESSION:
1. No evidence of acute intracranial process.
2. Minimal opacification of left mastoid air cells is likely
post-inflammatory.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13375874", "visit_id": "21426307", "time": "2158-12-27 10:01:00"} |
13130904-RR-212 | 106 | ## EXAMINATION:
SHOULDER VIEWS NON TRAUMA LEFT
## INDICATION:
year old woman with atraumatic left shoulder x 1 month.//
Evaluate bony abnormalities, DJD
## FINDINGS:
There are severe degenerative changes at the glenohumeral joint with a
bone-on-bone appearance and prominent umbrella osteophytes. No fracture or
dislocation seen. Small round calcific densities projecting anterior to the
humeral head on the axillary view may reflect loose bodies in the subacromial
subdeltoid bursa. There are mild degenerative changes at the
acromioclavicular joint. Visualized portions of the left lung are grossly
unchanged.
## IMPRESSION:
Severe degenerative changes at the glenohumeral joint, similar in appearance
when compared to the prior study.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13130904", "visit_id": "N/A", "time": "2159-04-20 13:33:00"} |
15812912-DS-12 | 1,401 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
sternal debride, replate, pec flaps
Sternal debridement and VAC dressing
prior:
CABG x6 on
## HISTORY OF PRESENT ILLNESS:
female s/p CABG x 6 on by Dr. . Since discharge,
she has been experiencing sternal drainage which has increased
in
amount over the last several weeks. While at rehab, sternal
incision was only treated with dry sterile dressing which needed
to be changed several times per day. Initially started on
Doxycycline. Wound cultures were taken which eventually grew out
Proteus mirabilis. Antibiotic was eventually switched to
Ciprofloxacin. She denies fevers, chills, night sweats,
anorexia.
Overall she feels tired but in general feels well. She has no
malaise.
## PAST MEDICAL HISTORY:
CAD
NSTEMI
Hypertension
GERD
Left lower extremity lymphedema
Uterine cancer
## PAST SURGICAL HISTORY:
Hysterectomy
Total right hip replacement
History of cholecystectomy, 1980s
## FAMILY HISTORY:
No family history of CAD
## PHYSICAL EXAM:
Vital Signs sheet entries for :
## GENERAL:
Elderly female in wheelchair, non-toxic
## NECK:
Supple [x] Full ROM [x]
## CHEST:
Lungs clear but decreased at both bases
## HEART:
RRR [x] Irregular [] no murmur or rub
## ABD:
Soft [x] non-distended [x] non-tender [x] bowel sounds +
## EXTREMITIES:
Warm [x], well-perfused [x]
Edema + bilaterally
## NEURO:
Grossly intact
Right leg EVH incision - superficial scab o/w CDI
Sternal incision: Lower had obvious dehiscence with visible
suture material of skin and subcutaneous tissue. Drainage was
serosanginous and did not appear purulent. No surrounding
erythema. Sternum was stable without click. Incision was
extremely friable and obvious signs of tunneling superiorly.
*** Wound was opened to approximately 15cm long and extensive
debridement was performed bedside. Patient tolerated procedure
well. The sternal plating system became visible. Wound now
measure approximately 15 x 4 x 4 cm - packed with DSD ***
## RESPIRATORY:
CTA [x] No resp distress [x]
## GI/ABDOMEN:
Bowel sounds present [x] Soft [x] ND [x] NT [x]
## EXTREMITIES:
Right Upper extremity Warm [x] Edema tr
Left Upper extremity Warm [x] Edema
Right Lower extremity Warm [x] Edema tr
Left Lower extremity Warm [x] Edema chronic lymphedema
## SKIN/WOUNDS:
RLE Clean, dry, intact [x]
## STERNAL:
prevena in place
2 JPs intact
## ANAEROBIC CULTURE (PRELIMINARY):
NO GROWTH.
ACID FAST SMEAR (Final :
NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
## FUNGAL CULTURE (PRELIMINARY):
NO FUNGUS ISOLATED.
POTASSIUM HYDROXIDE PREPARATION (Final :
NO FUNGAL ELEMENTS SEEN.
3:45 pm SWAB STERNAL WOUND.
GRAM STAIN (Final :
1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR
LEUKOCYTES.
NO MICROORGANISMS SEEN.
WOUND CULTURE (Final :
PROTEUS MIRABILIS. SPARSE GROWTH.
MEROPENEM AND Cefepime test result performed by
Microscan.
MEROPENEM MIC <=1 MCG/ML. Cefepime MIC <=2 MCG/ML.
## SENSITIVITIES:
MIC expressed in
MCG/ML
PROTEUS MIRABILIS
|
AMPICILLIN
-----
=>32 R
AMPICILLIN/SULBACTAM-- =>32 R
CEFAZOLIN
-----
16 R
CEFEPIME
-----
S
CEFTAZIDIME
-----
<=1 S
CEFTRIAXONE
-----
<=1 S
CIPROFLOXACIN
-----
<=0.25 S
GENTAMICIN
-----
<=1 S
MEROPENEM
-----
S
PIPERACILLIN/TAZO
-----
<=4 S
TOBRAMYCIN
-----
<=1 S
TRIMETHOPRIM/SULFA
-----
2 S
ACID FAST SMEAR (Final :
NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
## ACID FAST CULTURE (PRELIMINARY):
A swab is not the optimal specimen for recovery of
mycobacteria or
filamentous fungi. A negative result should be
interpreted with
caution. Whenever possible tissue biopsy or aspirated
fluid should
be submitted.
## FUNGAL CULTURE (PRELIMINARY):
NO FUNGUS ISOLATED.
A swab is not the optimal specimen for recovery of
mycobacteria or
filamentous fungi. A negative result should be
interpreted with
caution. Whenever possible tissue biopsy or aspirated
fluid should
be submitted.
POTASSIUM HYDROXIDE PREPARATION (Final :
Test cancelled by laboratory.
PATIENT CREDITED.
Inappropriate specimen collection (swab) for Fungal Smear
( ).
## BRIEF HOSPITAL COURSE:
year old woman with a PMH of NSTEMI s/p 6vCABG on
admitted with sternal wound infection with exposed hardware s/p
debridement with removal of lower 3 sternal plates on .
Cultures have grown Proteus mirabilis and she has improved
clinically on cefepime 2g q8. She underwent flap closure on
with negative sternal and periosteal cultures negative.
Plan for discharge to rehab with ID OPAT follow up in 2 weeks,
anticipate ~6 week course of therapy pending clinical progress.
Essential Dates for OPAT therapy:
debridement with removal of lower 3 sternal plates
flap closure, placement of Prevena
Plan for Transition to Oral Therapy: Potentially (as not all
hardware removed)
Have susceptibilities been obtained? Yes
Is the use of rifampin planned? (Yes/No & Date started) No
## PER PLASTIC SURGERY:
- Continue prevena incisional vac x2 weeks (end
- Bra on at all times
- No Arm abduction past 45 degrees
- Abx per ID, currently on cefepime
- Hold anticoagulation as long as possible
By the time of HD# 10 she was cleared for discharge to Life Care
rehabilitation in . All follow up appointments advised.
## MEDICATIONS ON ADMISSION:
AMIODARONE - amiodarone 200 mg tablet. tablet(s) by mouth daily
-
(Prescribed by Other Provider)
ATORVASTATIN - atorvastatin 80 mg tablet. tablet(s) by mouth
daily - (Prescribed by Other Provider)
HYDROCHLOROTHIAZIDE - hydrochlorothiazide 25 mg tablet.
tablet(s)
by mouth daily - (Prescribed by Other Provider)
LANSOPRAZOLE - lansoprazole 30 mg delayed release,disintegrating
tablet. tablet(s) by mouth daily - (Prescribed by Other
Provider)
LIDOCAINE - lidocaine 5 % topical patch. daily as directed -
(Prescribed by Other Provider)
METOPROLOL TARTRATE - metoprolol tartrate 25 mg tablet.
tablet(s)
by mouth 3 times daily - (Prescribed by Other Provider)
RIVAROXABAN [XARELTO] - Xarelto 20 mg tablet. tablet(s) by mouth
daily w/ dinner - (Prescribed by Other Provider)
Medications - OTC
ASPIRIN [ADULT ASPIRIN REGIMEN] - Adult Aspirin Regimen 81 mg
tablet,delayed release. tablet(s) by mouth daily - (Prescribed
by Other Provider)
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild/Fever
2. Amiodarone 200 mg PO DAILY
3. CefePIME 2 g IV Q8H
weeks of treatment -starting - projected end date
4. DiphenhydrAMINE 25 mg PO Q8H:PRN itching
5. Docusate Sodium 100 mg PO BID
6. Furosemide 20 mg PO BID
until lower extremity edema resolved and at pre-op weight
7. Heparin 5000 UNIT SC BID
8. Lidocaine 5% Patch 1 PTCH TD QAM pain
9. Lidocaine 5% Patch 1 PTCH TD QAM under rigth breast
10. Multivitamins 1 TAB PO DAILY
11. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Second
Line
12. Potassium Chloride 20 mEq PO BID
13. Sarna Lotion 1 Appl TP QID:PRN itch
14. Senna 17.2 mg PO QHS:PRN Constipation - First Line
15. Sodium Chloride 0.9% Flush mL IV DAILY and PRN, line
flush
16. Sodium Chloride 0.9% Flush mL IV Q8H and PRN, line
flush
17. Sodium Chloride Nasal SPRY NU QID
18. TraMADol 50 mg PO Q4H:PRN Pain - Moderate
Reason for PRN duplicate override: Alternating agents for
similar severity
RX *tramadol [Ultram] 50 mg tablet(s) by mouth every 4
hours Disp #*20 Tablet Refills:*0
19. Aspirin 81 mg PO DAILY
20. Atorvastatin 40 mg PO QPM
21. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY
22. Metoprolol Tartrate 12.5 mg PO TID
23.Outpatient Lab Work
## WEEKLY:
CBC with differential, BUN, Cr plus ESR/CRP
*PLEASE OBTAIN WEEKLY CRP for patients with bone/joint
infections
and endocarditis or endovascular infections
## DISCHARGE DIAGNOSIS:
s/p CABG c/b sternal dehiscence
sternal debride, replate, pec flaps
Sternal debridement and VAC dressing
## DISCHARGE CONDITION:
Alert and oriented x3 non-focal
Ambulating with assist due to deconditioning
Incisional pain managed with oral analgesics- prefers Tylenol
and Lidoderm patches for pain control.
## INCISIONS:
Sternal - prevena in place and 2 JP's
and Edema bilaterally
## DISCHARGE INSTRUCTIONS:
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns
## FEMALES:
Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns . Answering service will contact on call
person during off hours**
PREVENA
· The Prevena Wound dressing should be left on until you
have your follow up visit with the plastic surgeon- through
.
· You may shower, however, please avoid getting the
dressing and suction canister soiled or saturated.
· You will be sent to rehab with a shower bag to hold the
suction canister while bathing.
· If you notice any redness, swelling or drainage, please
contact your surgeon's office at .
Empty the JP drains every 8 hours and record output and bring
log with you to your follow up appointment.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15812912", "visit_id": "28859671", "time": "2119-06-19 00:00:00"} |
15397770-DS-9 | 2,211 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
bloating and pelvic mass
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
, ureterolysis, mass ressection
, hematoma evacuation
## HISTORY OF PRESENT ILLNESS:
Ms. is a y/o G4P2 who is referred to gyn onc for
evaluation of her complex pelvic mass.
She reports experiencing abdominal bloating with decreased
appetite over the past 6 weeks. Reports "feeling like giving
birth" and reports significant pressure associated with fatigue.
Has noticed increasing size of abdomen. Was sent for imaging and
was noted to have 17cm complex pelvic mass and significant
ascites. Tumor markers sent and notable for CA-125 of 2266. CEA
was 1.8.
Also reports intermittent r. thigh weakness for a week. Denies
aggravating or alleviating positions or factors.
Denies vaginal discharge or bleeding. Denies fever, chills,
chest pain, shortness of breath. Denies nausea, vomiting,
changes in bowel or bladder habits.
## SOCIAL HISTORY:
- Retired
- Lives alone w/ dog
- Drinks 2 glasses of wine QHS
- Denies smoking, illicit drug hx
## OUT:
Total 420ml, Urine Amt 420ml
Last 24 hours Total cumulative -1487ml
## IN:
Total 658ml, PO Amt 480ml, IV Amt Infused 178ml
## OUT:
Total 2145ml, Urine Amt 2120ml, JP LLQ 25ml, Wound Vac
0ml
## CV:
RRR, normal s1 and s2, no m/r/g
## LUNGS:
normal work of breathing, CTAB
## ABDOMEN:
soft, non-distended, non-tender, incision
clean/dry/intact
## EXTREMITIES:
1+ edema, symmetric, non-tender
## BRIEF HOSPITAL COURSE:
Ms. was admitted to the FICU service after undergoing an
exploratory laparotomy, radical primary cytoreductive surgery
including a total abdominal hysterectomy, bilateral
salpingo-oophorectomy, bilateral ureteral lysis, omentectomy,
resection of cul-de-sac tumor. Please see operative report for
full details.
## BRIEF FICU COURSE:
==================
Patient was transferred to the on after laproscopic
converted to ex-lap TAH/BSO for a large right ovarian mass
(presumptive diagnosis of high grade serous ovarian carcinoma).
Her operation was complicated by removal of L of ascites
removal with EBL of 1.5 L. She was hypotensive in the OR which
an intraoperative hct or 18 from a pre-op value of 41.3. She was
started on pressors and transferred to the for further
management and monitoring.
In the FICU, the patient was intubated and sedated on Propofol
and pressors. On , the massive transfusion protocol was
initiated as she remained hypotensive with increasing abdominal
distension, high pressor requirement, and high JP drain output
of sanguinous fluid. She received a total of 15 blood
transfusions, 7 platelet transfusions, 2 cryo transfusions, and
FFP trasnfusions on . Given her continued bleeding, a
CTA abd/pelvis was obtained which identified 5 aterial bleeds in
the pelvis. Thus, she was brought back to the OR by gyn-onc for
ex-lap to obtain hemostasis.
On , she had evacuation of L of hemoperitoneum and a
20 cm pelvic clot. it was ntoed that she had raw pelvic surfaces
with oozing in the right pelvic sidewall, sigmoid mesentery, and
left apex of the vaginal cuff. Please see op note for full
details.
She returned the FICU for post-procedural monitoring. She
required one further transfusion of pRBC. Her hemoglobin
stabilized on . Her pressors were able to be weaned off
and she was successfully extubated on .
Her FICU course was also notable for acute kidney injury, which
was most likely pre-renal in the setting of
hemorrhagic/hypovolemic shock. There likely is some overlap with
ATN given prolonged hypotension. And additional potential
contributor to the could have been contrast induced
nephropathy from her CTA as well. She peaked at 1.7 and her
creatinine gradually trended down by the time of transfer.
Patient was transferred by to the gynecologic oncology service
for ongoing post-operative care. The remainder of her hospital
course will be divided into systems.
Neuro
On postop day 8, patient was noted to have acute altered mental
status and a code stroke was called. Patient had a CTA of her
head which was noted to show adequate perfusion without evidence
of an acute process. An MRI was performed and showed evidence
of small vessel disease without evidence of any acute
intracranial process or intracranial metastasis. Shortly after
the event, patient was noted to have return of mental status to
her baseline. Decision was made to hold vital signs between the
hours of 11 AM. Patient's mood remained appropriate for
duration of stay.
Cardiovascular
During the remainder of her post-operative course her hematocrit
was trended and was stable around 33. During her code stroke on
postop day 8, an EKG was performed and was noted to have a
prolonged QT. Troponins were negative x2 and proBNP was noted
to be 18,711. Cardiology was consulted and recommended a TTE
which was notable for new onset biventricular cardiomyopathy
with an ejection fraction of 35% with severe global hypokinesis
of her right wall as well as systolic dysfunction. She was
started on 50 daily of metoprolol, 2.5 mg of lisinopril daily,
and 20 mg IV Lasix twice daily to optimize her cardiac function.
She was discharged home on the medications listed as well as PO
Lasix with close cardiac monitoring scheduled.
Pulmonary
After extubation in the FICU, patient was noted to be tachypneic
with tachycardia on postop day 5 requiring supplemental oxygen.
On a chest x-ray she was noted to have bilateral pleural
effusions worsened when compared to a prior chest x-ray. No
pulmonary edema was noted. Due to her fluid overload status,
ambulation was encouraged and she was diuresed.
Renal
The patient was noted to have as described above. After
she peaked around 1.7, she trended back down and was stable at a
nadir of 0.6 and was stable through the remainder of her stay.
Once her creatinine normalized she was diuresed as she was
volume overloaded as noted above. At time of discharge she had
adequate urinary output.
Endocrine
During the patient's systolic dysfunction work-up, she was noted
to have a TSH of 11 and a T4 of 0.9. She was started on
levothyroxine 25 mg daily on due to cardiac dosing.
Patient to follow with PCP for reducing and repeat labs.
Nutrition
During her stay in the FICU, the patient remained n.p.o. and was
slowly advanced to sips. On arrival to the floor the patient's
diet was advanced to regular which she tolerated without issue.
Patient was seen by nutrition and was started on 100 mg thiamine
which she continued for 5 days. Daily CBC/BMPs were drawn and
her electrolytes were repleted as needed.
Heme
Patient's pre-operative INR was 1.4. She had large volume blood
loss and was coagulopathic and received massive transfusion as
described above on POD#1. Total products received are as
follows: She received a total of 19 units packed red blood
cells, 12 units of FFP, 7 units platelets, and 2 units of
cryoprecipitate
The patient's postoperative course was also complicated by a
superficial right cephalic vein thrombosis. This was discovered
on upper extremity ultrasound which was performed bilaterally.
Discussed with patient that recommendation would include removal
of all IVs on right upper extremity. After noting risks,
patient declined IV removal. Warm compresses were continued.
For her prophylaxis she was transitioned from heparin to Lovenox
which she continued until day of discharge. The patient will go
home with prophylactic Lovenox which she will continue until 28
days postop.
ID
The patient received 24 hours of IV Ancef, ceftriaxone, and
Flagyl for prophylaxis. She remained afebrile during her stay.
Urine and blood cultures were negative.
Musculoskeletal
During her stay, the patient's was followed by Occupational
Therapy and physical therapy due to her deconditioning. She
underwent several inpatient treatments and was discharged home
with services.
Coping
Patient was followed by social work during her visit for coping
of her new diagnosis. Educational material and support was
provided.
By post-op day 11, she was tolerating a regular diet, ambulating
independently and her pain was well controlled without pain
medications. She was thus discharged to home with services with
close outpatient follow up scheduled including cardiology
follow-up.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Atenolol 100 mg PO DAILY
2. Atorvastatin 20 mg PO QPM
3. Hydrochlorothiazide 12.5 mg PO DAILY
4. Multivitamins 1 TAB PO DAILY
5. Omeprazole 20 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. Acetaminophen mg PO Q6H:PRN Pain - Mild/Fever
RX *acetaminophen 500 mg 1 tablet(s) by mouth every six (6)
hours Disp #*50 Tablet
## REFILLS:
*0
2. Docusate Sodium 100 mg PO BID:PRN Constipation - First Line
RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp
#*60
## TABLET REFILLS:
*0
3. Enoxaparin Sodium 40 mg SC DAILY
RX *enoxaparin 40 mg/0.4 mL 1 inj once a day Disp #*28 Syringe
Refills:*0
4. Furosemide 20 mg PO DAILY
RX *furosemide 20 mg 1 tablet(s) by mouth once a day Disp #*30
## TABLET REFILLS:
*0
5. Levothyroxine Sodium 25 mcg PO DAILY
RX *levothyroxine 25 mcg 1 tablet(s) by mouth once a day Disp
#*30
## TABLET REFILLS:
*0
6. Lisinopril 2.5 mg PO DAILY
RX *lisinopril 2.5 mg 1 tablet(s) by mouth once a day Disp #*50
Tablet Refills:*0
7. Metoprolol Succinate XL 50 mg PO DAILY
RX *metoprolol succinate 50 mg 1 tablet(s) by mouth once a day
Disp #*50 Tablet Refills:*0
8. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain -
Moderate
RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp
#*10 Tablet Refills:*0
9. Potassium Chloride 20 mEq PO DAILY
Hold for K >
RX *potassium chloride 20 mEq 1 tablet(s) by mouth once a day
Disp #*30 Tablet Refills:*0
10. Thiamine 100 mg PO DAILY Duration: 2 Days
RX *thiamine HCl (vitamin B1) [Vitamin B-1] 100 mg 1 tablet(s)
by mouth once a day Disp #*2 Tablet Refills:*0
11. Atorvastatin 20 mg PO QPM
12. Multivitamins 1 TAB PO DAILY
RX *multivitamin 1 tab-cap by mouth once a day Disp #*100
Tablet Refills:*0
13. Omeprazole 20 mg PO DAILY
## DISCHARGE DIAGNOSIS:
High grade serous ovarian carcinoma
## DISCHARGE INSTRUCTIONS:
Dear Ms.
You were admitted to the gynecologic oncology service after
undergoing the procedures listed below. You have recovered well
after your operation, and the team feels that you are safe to be
discharged home. Please follow these instructions:
Abdominal instructions:
* Your staples will be removed within 2 weeks from your surgery.
This appointment should already been scheduled for you. Please
call if you do not have an appointment scheduled.
* Take your medications as prescribed. We recommend you take
non-narcotics (i.e. Tylenol, ibuprofen) regularly for the first
few days post-operatively, and use the narcotic as needed. As
you start to feel better and need less medication, you should
decrease/stop the narcotic first.
* Take a stool softener to prevent constipation. You were
prescribed Colace. If you continue to feel constipated and have
not had a bowel movement within 48hrs of leaving the hospital
you can take a gentle laxative such as milk of magnesium.
* Do not drive while taking narcotics.
* Do not combine narcotic and sedative medications or alcohol.
* Do not take more than 4000mg acetaminophen (tylenol) in 24
hrs.
* No strenuous activity until your post-op appointment.
* Nothing in the vagina (no tampons, no douching, no sex) for 12
weeks.
* No heavy lifting of objects >10 lbs for 6 weeks.
* You may eat a regular diet.
* It is safe to walk up stairs.
Incision care:
* You may shower and allow soapy water to run over incision; no
scrubbing of incision. No bath tubs for 6 weeks.
* You should remove your port site dressings days after your
surgery, if they have not already been removed in the hospital.
Leave your steri-strips on. If they are still on after
days from surgery, you may remove them.
* If you have staples, they will be removed at your follow-up
visit.
## CONSTIPATION:
* Drink liters of water every day.
* Incorporate 20 to 35 grams of fiber into your daily diet to
maintain normal bowel function. Examples of high fiber foods
include:
Whole grain breads, Bran cereal, Prune juice, Fresh fruits and
vegetables, Dried fruits such as dried apricots and prunes,
Legumes, Nuts/seeds.
* Take Colace stool softener times daily.
* Use Dulcolax suppository daily as needed.
* Take Miralax laxative powder daily as needed.
* Stop constipation medications if you are having loose stools
or diarrhea.
To reach medical records to get the records from this
hospitalization sent to your doctor at home, call .
Call your doctor at for:
* fever > 100.4
* severe abdominal pain
* difficulty urinating
* vaginal bleeding requiring >1 pad/hr
* abnormal vaginal discharge
* redness or drainage from incision
* nausea/vomiting where you are unable to keep down fluids/food
or your medication
* chest pain or difficulty breathing
* onset of any concerning symptoms
Lovenox injections:
* Patients having surgery for cancer have risk of developing
blood clots after surgery. This risk is highest in the first
four weeks after surgery. You will be discharged with a daily
Lovenox (blood thinning) medication. This is a preventive dose
of medication to decrease your risk of a forming a blood clot. A
visiting nurse assist you in administering these
injections.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15397770", "visit_id": "26906710", "time": "2186-02-26 00:00:00"} |
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