Datasets:
DATEXIS
/
aci_bench_intent_annotated

Dataset card Data Studio Files
xet
Community
1
text
stringlengths
14
3.73k
encounter_id
stringclasses
207 values
text_id
int64
0
69
intents
listlengths
1
9
sections
listlengths
1
4
doc_only
stringlengths
6
3.62k
__index_level_0__
int64
0
5.29k
doctor: okay well i i'm lucky enough my friends had an adult easter hag hunt for me and so i was able to find a couple eggs yesterday myself so i i'm glad you were able to get a few of them alright so let's do that that physical exam on you so your vitals look good you do n't have any fever your blood pressure heart rate is fine so when i press here on your belly does that hurt patient: a little bit yeah
D2N052
12
[ "Physical Examination" ]
[ "Objective" ]
okay well i i'm lucky enough my friends had an adult easter hag hunt for me and so i was able to find a couple eggs yesterday myself so i i'm glad you were able to get a few of them alright so let's do that that physical exam on you so your vitals look good you do n't have any fever your blood pressure heart rate is fine so when i press here on your belly does that hurt
1,400
doctor: a little bit alright so on your exam of your abdomen there is mild pain and tenderness to palpation of the abdomen there's no rebound or guarding there is cva located near your flank tenderness on the right so that means that everything looks good but you do have what seems to be some inflammation of your kidney okay so we we were able to get a ct of your your side and it showed that you do have a stone measuring point five centimeters in size and it's located in the proximal right ureter and so that's that duck that passes from your kidney to your bladder alright i do n't see any evidence of hydronephrosis so that means that there's not obstructing ureter causing swelling in your kidney which is which is pretty good so let's talk a little bit about my assessment and plan so you do have that kidney stone on the right so what i'm recommending is i want you to push fluids just to help facilitate you passing that stone alright have you been taking in have you been drinking enough water do you think so far patient: probably not enough i drink some but
D2N052
13
[ "Physical Examination", "Discussion", "Other Treatments", "Radiology Examination", "Reassessment" ]
[ "Objective", "Assessment", "Plan" ]
a little bit alright so on your exam of your abdomen there is mild pain and tenderness to palpation of the abdomen there's no rebound or guarding there is cva located near your flank tenderness on the right so that means that everything looks good but you do have what seems to be some inflammation of your kidney okay so we we were able to get a ct of your your side and it showed that you do have a stone measuring point five centimeters in size and it's located in the proximal right ureter and so that's that duck that passes from your kidney to your bladder alright i do n't see any evidence of hydronephrosis so that means that there's not obstructing ureter causing swelling in your kidney which is which is pretty good so let's talk a little bit about my assessment and plan so you do have that kidney stone on the right so what i'm recommending is i want you to push fluids just to help facilitate you passing that stone alright have you been taking in have you been drinking enough water do you think so far
1,401
doctor: okay yeah i i want you to to drink try drink as much as possible just to see if we can get you hydrated and pass the stone what i'm gon na do is i'm gon na prescribe you ibuprofen eight hundred milligrams you can take that as needed for pain i know you said you were in that much pain just in case it does start to move you're in pain i want you to take the ibuprofen i'm also gon na give you a strainer for you to strain your pee so we can see you wan na know when that that stone does pass gon na order a bmp and a urinalysis and a urine culture and based on what the urinalysis shows we can decide if i can decide if i need to put you on antibiotics if you do have an infection of some kind and i wan na see you back in about a week to two weeks and if you're still having symptoms we can discuss further treatment such as a lithotripsy and it's it's a mainly minimally invasive procedure where we use shock waves to try to break up that stone but otherwise do you have any other questions for me patient: no i do n't think so
D2N052
14
[ "Follow-up", "Medication", "Other Treatments", "Diagnostic Testing" ]
[ "Plan" ]
okay yeah i i want you to to drink try drink as much as possible just to see if we can get you hydrated and pass the stone what i'm gon na do is i'm gon na prescribe you ibuprofen eight hundred milligrams you can take that as needed for pain i know you said you were in that much pain just in case it does start to move you're in pain i want you to take the ibuprofen i'm also gon na give you a strainer for you to strain your pee so we can see you wan na know when that that stone does pass gon na order a bmp and a urinalysis and a urine culture and based on what the urinalysis shows we can decide if i can decide if i need to put you on antibiotics if you do have an infection of some kind and i wan na see you back in about a week to two weeks and if you're still having symptoms we can discuss further treatment such as a lithotripsy and it's it's a mainly minimally invasive procedure where we use shock waves to try to break up that stone but otherwise do you have any other questions for me
1,402
doctor: alright so we will see you back in a week or two and i'll have my nurse come in with that prescription and hopefully with all the treatment you'll be able to pass the stone okay alright
D2N052
15
[ "Chitchat" ]
[ "Null" ]
doctor: alright so we will see you back in a week or two and i'll have my nurse come in with that prescription and hopefully with all the treatment you'll be able to pass the stone okay alright
1,403
doctor: so barbara i i know you are here for some itchy scalp pain can you tell me a little bit about how you're doing patient: yeah it's still quite a problem you know something i've been suffering with for so long now it's still quite itchy and it's really embarrassing too because i'll have dandruff so much like all over me but but i just ca n't stop itching
D2N053
0
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
so barbara i i know you are here for some itchy scalp pain can you tell me a little bit about how you're doing
1,404
doctor: okay when did you first notice this patient: i wan na say it's been a while but probably worsening in the past like six months or so
D2N053
1
[ "Acute Symptoms" ]
[ "Subjective" ]
okay when did you first notice this
1,405
doctor: okay okay and have you seen ever noticed any rashes either when it first started or intermittently anywhere else patient: on my body no not really
D2N053
2
[ "Acute Symptoms" ]
[ "Subjective" ]
okay okay and have you seen ever noticed any rashes either when it first started or intermittently anywhere else
1,406
doctor: okay okay just mainly up underneath your on your scalp there uh and i can i can see that man that looks really itchy and scaly have you died your hair recently or used any other chemicals you you know like a new hair spray or gel patient: nothing new i mean i do dye my hair but i've been doing that for years now but otherwise i do n't really use a lot of products in my hair
D2N053
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay okay just mainly up underneath your on your scalp there uh and i can i can see that man that looks really itchy and scaly have you died your hair recently or used any other chemicals you you know like a new hair spray or gel
1,407
doctor: yeah i you know it's funny you say that because i keep saying i earned this gray hair and i'm gon na keep it so yeah have you tried any over the counter treatments i know there is a lot out of there something you know like a t gel or any of those other have those helped patient: yeah i did that i did head and shoulders i even tried some castor oil and but none of them really seemed to be helping
D2N053
4
[ "Therapeutic History" ]
[ "Subjective" ]
yeah i you know it's funny you say that because i keep saying i earned this gray hair and i'm gon na keep it so yeah have you tried any over the counter treatments i know there is a lot out of there something you know like a t gel or any of those other have those helped
1,408
doctor: okay okay let's talk about some other symptoms any joint pain fever weight loss patient: not that i can recall i've been pretty good otherwise
D2N053
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay okay let's talk about some other symptoms any joint pain fever weight loss
1,409
doctor: okay good and going back you know to your grandparents has anybody else in the family had similar symptoms that you're aware of patient: no well maybe my sister
D2N053
6
[ "Family History" ]
[ "Subjective" ]
okay good and going back you know to your grandparents has anybody else in the family had similar symptoms that you're aware of
1,410
doctor: maybe your sister okay patient: yeah maybe my sister i mean i know she'll is no one has as bad as i do but she does report like just having a dry scalp
D2N053
7
[ "Family History" ]
[ "Subjective" ]
maybe your sister okay
1,411
doctor: okay okay now you know a lot of times we can see this with you know high levels of stress has there been any new mental or emotional stressors at work or at home patient: not really i mean it's basically the same things
D2N053
8
[ "Other Socials" ]
[ "Subjective" ]
okay okay now you know a lot of times we can see this with you know high levels of stress has there been any new mental or emotional stressors at work or at home
1,412
doctor: okay yeah i yeah we have a lot of that yes so let me go ahead and and look at this a little closer here the first off i wan na tell you the the vital signs that the my assistant took when you came in your blood pressure is one thirty over sixty eight your heart rate was ninety eight and your respiratory rate was eighteen so those all look good and appear normal and your temperature was ninety seven . seven and that is all normal now when i look at your scalp here i do notice that you have demarcated scaly erythematous plaques and that's just kind of explaining technically what's going on those patches and they're they're in a patchy format they're diffusely present across the back of your skull and that's probably why you you see all that that that white dander you know on your on your your clothes as you go through the day now lem me talk a little bit about my impression and plan i think that you have a scalp psoriasis and let's and here is my thoughts on that what i would like you to use is to use clobetasol that's a zero . zero five percent solution and i want you to use that twice daily on the the affected areas of your scalp so you're just gon na put this on and just kinda gently rub it in now i know to do it twice daily is going to be difficult but if you can do it first thing in the morning when you get up and then before you go to bed you know get a shower and before you go to bed that will be great i want you to continue to use t-gel shampoo that you listed when you first came in that's a very good solution shampoo for that and that will help with controlling a lot of this now there is no cure for this unfortunately and flareups can be unpredictable but we see that you know not a we do n't have a great finger on what causes the flare ups but i'm gon na give you some steroids that will help and we're gon na have to manage that on a ongoing basis but when you get do get a flare up i want you to be using these flare steroid that i give you as we go through that and then i wan na see you back here in three months or sooner if it gets significantly worse do you have any questions for me patient: no okay so i'll just use that steroid solution and then just as needed if it's really bad but then otherwise just use the t gel
D2N053
9
[ "Physical Examination", "Discussion", "Follow-up", "Medication", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay yeah i yeah we have a lot of that yes so let me go ahead and and look at this a little closer here the first off i wan na tell you the the vital signs that the my assistant took when you came in your blood pressure is one thirty over sixty eight your heart rate was ninety eight and your respiratory rate was eighteen so those all look good and appear normal and your temperature was ninety seven . seven and that is all normal now when i look at your scalp here i do notice that you have demarcated scaly erythematous plaques and that's just kind of explaining technically what's going on those patches and they're they're in a patchy format they're diffusely present across the back of your skull and that's probably why you you see all that that that white dander you know on your on your your clothes as you go through the day now lem me talk a little bit about my impression and plan i think that you have a scalp psoriasis and let's and here is my thoughts on that what i would like you to use is to use clobetasol that's a zero . zero five percent solution and i want you to use that twice daily on the the affected areas of your scalp so you're just gon na put this on and just kinda gently rub it in now i know to do it twice daily is going to be difficult but if you can do it first thing in the morning when you get up and then before you go to bed you know get a shower and before you go to bed that will be great i want you to continue to use t-gel shampoo that you listed when you first came in that's a very good solution shampoo for that and that will help with controlling a lot of this now there is no cure for this unfortunately and flareups can be unpredictable but we see that you know not a we do n't have a great finger on what causes the flare ups but i'm gon na give you some steroids that will help and we're gon na have to manage that on a ongoing basis but when you get do get a flare up i want you to be using these flare steroid that i give you as we go through that and then i wan na see you back here in three months or sooner if it gets significantly worse do you have any questions for me
1,413
doctor: yeah i want it's exactly what i want you to do i want you to use that that solution twice daily when you get that flare but then other than that just continue to use that t-gel shampoo patient: alright
D2N053
10
[ "Discussion", "Medication" ]
[ "Plan" ]
yeah i want it's exactly what i want you to do i want you to use that that solution twice daily when you get that flare but then other than that just continue to use that t-gel shampoo
1,414
doctor: okay i'm gon na have my nurse come in and get you discharged but i the we will see you again in three months or and again please if it gets worse please do n't hesitate to call me and come in sooner patient: alright perfect thank you
D2N053
11
[ "Follow-up" ]
[ "Plan" ]
okay i'm gon na have my nurse come in and get you discharged but i the we will see you again in three months or and again please if it gets worse please do n't hesitate to call me and come in sooner
1,415
doctor: thank you patient: okay bye
D2N053
12
[ "Chitchat" ]
[ "Null" ]
thank you
1,416
doctor: hey elijah how are you patient: i'm doing okay
D2N054
0
[ "Greetings" ]
[ "Subjective" ]
hey elijah how are you
1,417
doctor: so i see here that your primary care provider sent you over it looks like you were doing some yard work yesterday and dropped a landscape brick on your foot can what so what's going on with your right foot today patient: it's a little sore today but you know i hurt my foot before but this is the first time where i'm actually being seen for it
D2N054
1
[ "Acute Symptoms" ]
[ "Subjective" ]
so i see here that your primary care provider sent you over it looks like you were doing some yard work yesterday and dropped a landscape brick on your foot can what so what's going on with your right foot today
1,418
doctor: okay so you say you've injured your right foot before tell me a little bit about that injury patient: twenty years ago i broke my ankle i had to put in a cast but that seems to be okay but you know sometimes it'll give me trouble once in a while it feels a little sore it swells up at times
D2N054
2
[ "Personal History" ]
[ "Subjective" ]
okay so you say you've injured your right foot before tell me a little bit about that injury
1,419
doctor: okay alright so when you dropped that brick on your foot were you able to get up and keep working or did you have to get off your you know not stop weightbearing and and get off that foot can you tell me a little bit about after the traumatic incident patient: i you know it was a little sore i called a few names you know god damn why is this in my foot but you know i kept working putting it around a little bit but now it's got swollen so i got to see my doctor he told me i had to go see you here i am so tell me what's going on with it
D2N054
4
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright so when you dropped that brick on your foot were you able to get up and keep working or did you have to get off your you know not stop weightbearing and and get off that foot can you tell me a little bit about after the traumatic incident
1,420
doctor: so what have you been doing for the pain since the initial insult patient: lucken it up
D2N054
5
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
so what have you been doing for the pain since the initial insult
1,421
doctor: okay have you taken any medications safe for example tylenol or ibuprofen for the pain patient: no i feel like taking the medicine
D2N054
6
[ "Therapeutic History" ]
[ "Subjective" ]
okay have you taken any medications safe for example tylenol or ibuprofen for the pain
1,422
doctor: okay and then just out of curiosity you said you were doing some landscaping have you been over to landscapes warehouse new here in town my wife and i were just over there this last weekend and picked up a whole bunch of stuff you had a chance to make it over there yet patient: no not yet i heard about it though i might have to make a trip once my foot heals
D2N054
7
[ "Chitchat" ]
[ "Null" ]
okay and then just out of curiosity you said you were doing some landscaping have you been over to landscapes warehouse new here in town my wife and i were just over there this last weekend and picked up a whole bunch of stuff you had a chance to make it over there yet
1,423
doctor: alright that sounds good now just out of curiosity can you rate your pain for me right now zero being none ten being the worst pain you've ever been in your life patient: eleven out of ten
D2N054
8
[ "Acute Symptoms" ]
[ "Subjective" ]
alright that sounds good now just out of curiosity can you rate your pain for me right now zero being none ten being the worst pain you've ever been in your life
1,424
doctor: okay and then have you experienced any numbness or tingling of that foot since the incident patient: yeah the whole foot is numb
D2N054
9
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and then have you experienced any numbness or tingling of that foot since the incident
1,425
doctor: okay i'm gon na do a quick physical exam now your vitals look good and i would like to do a focused exam of your right foot the there is some bruising on the bottom part of your foot and on the top part as well and i do appreciate the associated swelling and i also recognize that you do have tenderness to palpation for midfoot now for your neurovascular exam of your right foot your capillary refill is brisk in less than three seconds i do note a strong bounding dorsalis pedis pulse with motor and sensation is intact for that foot i also like to call out the fact that it matches bilaterally which is important i'm gon na go ahead and review the diagnostic imaging results so we did a x-ray of that right foot and i do notice dorsal displacement of the base of the second metatarsal with a three millimeter separation of the first and second metatarsal bases and presence of bony fragments so let me tell you a little bit about my assessment and plan now your right foot pain is due to a lisfranc fracture which is a fracture to your second metatarsal bone and the top of your foot this is where the metatarsals meet those cuboids okay so it where the bones come together in your foot now there are a lot of ligaments in your foot so i do want to order an mri just to assess if there is any injuries to those ligaments now based on your exam and looking at the x-ray you're most likely going to need surgery now the reason why this is important is if we have poor bone alignment or ligament healing you can this can lead to losing the arch in your foot you could becoming flat-footed and also developing arthritis now what's gon na be key here is the surgery is going to allow those bones and ligaments to heal properly we are going to put them back into place using plates and screws now the key thing is going to be it's going to be outpatient surgery so it's going to be same day i'll see you in the morning and then you'll be discharged home that evening and we will do a follow-up i wan na see you in twenty four hours post procedure but then i'll see you again in two weeks you're gon na be in a cast and i'm gon na have you use crutches you're not gon na be able to weight-bear on that foot for six to eight weeks what we'll do is we'll advance your ambulating gradually based on how you heal and based on how you tolerate the procedure i know i have covered a lot of material quickly but this is really gon na be the best course of action for you to have a good outcome now do you have any questions come answers concerns before i have the nurse come in finish the paperwork and get you set up for your procedure which we are going to do tomorrow if you're agreeable to that patient: what about putting in a cast can i just stay in the cast
D2N054
11
[ "Physical Examination", "Discussion", "Follow-up", "Radiology Examination", "Acute Assessment", "Other Treatments" ]
[ "Objective", "Assessment", "Plan" ]
okay i'm gon na do a quick physical exam now your vitals look good and i would like to do a focused exam of your right foot the there is some bruising on the bottom part of your foot and on the top part as well and i do appreciate the associated swelling and i also recognize that you do have tenderness to palpation for midfoot now for your neurovascular exam of your right foot your capillary refill is brisk in less than three seconds i do note a strong bounding dorsalis pedis pulse with motor and sensation is intact for that foot i also like to call out the fact that it matches bilaterally which is important i'm gon na go ahead and review the diagnostic imaging results so we did a x-ray of that right foot and i do notice dorsal displacement of the base of the second metatarsal with a three millimeter separation of the first and second metatarsal bases and presence of bony fragments so let me tell you a little bit about my assessment and plan now your right foot pain is due to a lisfranc fracture which is a fracture to your second metatarsal bone and the top of your foot this is where the metatarsals meet those cuboids okay so it where the bones come together in your foot now there are a lot of ligaments in your foot so i do want to order an mri just to assess if there is any injuries to those ligaments now based on your exam and looking at the x-ray you're most likely going to need surgery now the reason why this is important is if we have poor bone alignment or ligament healing you can this can lead to losing the arch in your foot you could becoming flat-footed and also developing arthritis now what's gon na be key here is the surgery is going to allow those bones and ligaments to heal properly we are going to put them back into place using plates and screws now the key thing is going to be it's going to be outpatient surgery so it's going to be same day i'll see you in the morning and then you'll be discharged home that evening and we will do a follow-up i wan na see you in twenty four hours post procedure but then i'll see you again in two weeks you're gon na be in a cast and i'm gon na have you use crutches you're not gon na be able to weight-bear on that foot for six to eight weeks what we'll do is we'll advance your ambulating gradually based on how you heal and based on how you tolerate the procedure i know i have covered a lot of material quickly but this is really gon na be the best course of action for you to have a good outcome now do you have any questions come answers concerns before i have the nurse come in finish the paperwork and get you set up for your procedure which we are going to do tomorrow if you're agreeable to that
1,426
doctor: you could but what we found is the best outcome is aligning those bones with plates and screws to make sure that they heal properly so you have the best outcome possible patient: so if the surgery is going to be tomorrow when am i going to get my mri
D2N054
12
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
you could but what we found is the best outcome is aligning those bones with plates and screws to make sure that they heal properly so you have the best outcome possible
1,427
doctor: so what what we will do is the good news is we have an outpatient mri facility downstairs and i'm going to send the order down and we'll get you your mri this afternoon patient: can i think about it and we have some time
D2N054
13
[ "Discussion", "Diagnostic Testing" ]
[ "Plan" ]
so what what we will do is the good news is we have an outpatient mri facility downstairs and i'm going to send the order down and we'll get you your mri this afternoon
1,428
doctor: alright thanks elijah
D2N054
15
[ "Chitchat" ]
[ "Null" ]
doctor: alright thanks elijah
1,429
doctor: karen nelson is a 3 -year-old female with no significant past medical history who comes in for evaluation of a new right eye twitch karen is accompanied by her father hi karen how are you patient: i'm okay i guess
D2N055
0
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
karen nelson is a 3 -year-old female with no significant past medical history who comes in for evaluation of a new right eye twitch karen is accompanied by her father hi karen how are you
1,430
doctor: hey dad how are you doing patient: hey doc i am okay yeah karen has been having this eye twitch i noticed a couple of weeks ago when i talked to her pediatrician and they told me to come see you
D2N055
1
[ "Acute Symptoms" ]
[ "Subjective" ]
hey dad how are you doing
1,431
doctor: okay alright so karen have you felt the twitch patient: yeah well i mean i feel my face sometimes
D2N055
2
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright so karen have you felt the twitch
1,432
doctor: yeah and do you have any pain when it happens patient: no it it does n't really hurt but i noticed that dad looks real nervous when it happens
D2N055
3
[ "Acute Symptoms" ]
[ "Subjective" ]
yeah and do you have any pain when it happens
1,433
doctor: yeah i i i can understand that's because he loves you do you feel the urge to move your face patient: sometimes and then it moves and then i feel better
D2N055
4
[ "Acute Symptoms" ]
[ "Subjective" ]
yeah i i i can understand that's because he loves you do you feel the urge to move your face
1,434
doctor: okay okay and so so dad how often are you seeing the twitch on karen patient: i do n't know i mean it varies sometimes i see it several times an hour and there is other days we do n't see it at all until sometimes late afternoon but we definitely notice it you know everyday for the last several weeks
D2N055
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay okay and so so dad how often are you seeing the twitch on karen
1,435
doctor: okay so karen how is how is how is soccer patient: i like soccer
D2N055
6
[ "Other Socials" ]
[ "Subjective" ]
okay so karen how is how is how is soccer
1,436
doctor: does she patient: she yeah she tries to kick me and she pulls my hair and
D2N055
9
[ "Other Socials" ]
[ "Subjective" ]
does she
1,437
doctor: that is n't very nice you gon na have to show her that that's not very nice you're gon na have to teach her a lesson patient: yeah and and then sometimes after soccer we we go and i get mcdugge's and it and it's it makes for a nice day with dad
D2N055
11
[ "Other Socials" ]
[ "Subjective" ]
that is n't very nice you gon na have to show her that that's not very nice you're gon na have to teach her a lesson
1,438
doctor: is that your favorite at mcdonald's in the the mcnuggates patient: not not really but they are cheap so
D2N055
12
[ "Chitchat" ]
[ "Null" ]
is that your favorite at mcdonald's in the the mcnuggates
1,439
doctor: okay alright well you you made dad happy at least right patient: yeah that's what he says because i'm expensive because i want dresses and dogs and stuff all the time
D2N055
13
[ "Chitchat" ]
[ "Null" ]
okay alright well you you made dad happy at least right
1,440
doctor: yeah well yeah who does n't well okay well hopefully we will get you you know squared away here so you can you know play your soccer and go shopping for dresses with dad so so dad tell me does the karen seem bothered or any other and have any other issues when this happens patient: no i mean when it happens she just continues playing or doing whatever she was doing when it happens
D2N055
14
[ "Acute Symptoms" ]
[ "Subjective" ]
yeah well yeah who does n't well okay well hopefully we will get you you know squared away here so you can you know play your soccer and go shopping for dresses with dad so so dad tell me does the karen seem bothered or any other and have any other issues when this happens
1,441
doctor: okay alright has she has she otherwise been feeling okay since this started has she been acting normally patient: i i'd say she seems fine i mean she has been eating well and playing with her friends and she goes about her normal activities really
D2N055
15
[ "Personal History" ]
[ "Subjective" ]
okay alright has she has she otherwise been feeling okay since this started has she been acting normally
1,442
doctor: okay good patient: never even though anything was going on
D2N055
16
[ "Personal History" ]
[ "Subjective" ]
okay good
1,443
doctor: okay alright good so has has karen had any seizures in the past patient: no
D2N055
17
[ "Personal History" ]
[ "Subjective" ]
okay alright good so has has karen had any seizures in the past
1,444
doctor: no okay and then so tell me when the twitch occurs do you ever notice any you know parts of her like moving or twitching patient: well no uh it's just her face
D2N055
18
[ "Acute Symptoms" ]
[ "Subjective" ]
no okay and then so tell me when the twitch occurs do you ever notice any you know parts of her like moving or twitching
1,445
doctor: okay okay yeah that would be great to see that because i wan na see what's going on so thank you for that tell me is there any family history of seizures or like tourette's syndrome patient: well no history of seizures but i i i never heard of that tourette thing
D2N055
20
[ "Family History" ]
[ "Subjective" ]
okay okay yeah that would be great to see that because i wan na see what's going on so thank you for that tell me is there any family history of seizures or like tourette's syndrome
1,446
doctor: yeah so so toret is that it's a nervous system disorder that you know involves like repetitive movements or like unwanted sounds and it typically begins in childhood and i do n't know have you noticed anything like that with her when she was younger patient: really i had nobody in our family got anything like that
D2N055
21
[ "Personal History" ]
[ "Subjective" ]
yeah so so toret is that it's a nervous system disorder that you know involves like repetitive movements or like unwanted sounds and it typically begins in childhood and i do n't know have you noticed anything like that with her when she was younger
1,447
doctor: okay now tell me have you noticed any other symptoms how about like fever or chills patient: no
D2N055
22
[ "Vegetative History" ]
[ "Subjective" ]
okay now tell me have you noticed any other symptoms how about like fever or chills
1,448
doctor: okay coughing headache patient: ma'am
D2N055
23
[ "Vegetative History" ]
[ "Subjective" ]
okay coughing headache
1,449
doctor: okay how about any problems with karen's sleep patient: nope
D2N055
24
[ "Vegetative History" ]
[ "Subjective" ]
okay how about any problems with karen's sleep
1,450
doctor: okay okay good let's go ahead and do physical exam on karen here alright karen i'm just gon na take a look at you and and ask you to follow some commands okay patient: okay
D2N055
25
[ "Physical Examination" ]
[ "Objective" ]
okay okay good let's go ahead and do physical exam on karen here alright karen i'm just gon na take a look at you and and ask you to follow some commands okay
1,451
doctor: alright can you follow my finger with your eyes good now can you do me a favor walk across the room for me great job okay now i want you to close your eyes and reach out your arms in front of you good now keep your eyes closed can you feel me touch you here how about okay how about there patient: mm-hmm
D2N055
26
[ "Physical Examination" ]
[ "Objective" ]
alright can you follow my finger with your eyes good now can you do me a favor walk across the room for me great job okay now i want you to close your eyes and reach out your arms in front of you good now keep your eyes closed can you feel me touch you here how about okay how about there
1,452
doctor: does that feel the same patient: yeah
D2N055
27
[ "Physical Examination" ]
[ "Objective" ]
does that feel the same
1,453
doctor: okay alright so i'm just gon na check your reflexes okay alright now on your on the neurological exam the patient is awake alert and oriented times three speech is clear and fluent gait is steady heel toe walking is normal and the cranial nerves are intact without focal neurologic findings there is no pronator drift sensation is intact reflexes are two plus and symmetric at the biceps triceps knees and ankles so this means everything looks good karen patient: that's great
D2N055
28
[ "Physical Examination" ]
[ "Objective" ]
okay alright so i'm just gon na check your reflexes okay alright now on your on the neurological exam the patient is awake alert and oriented times three speech is clear and fluent gait is steady heel toe walking is normal and the cranial nerves are intact without focal neurologic findings there is no pronator drift sensation is intact reflexes are two plus and symmetric at the biceps triceps knees and ankles so this means everything looks good karen
1,454
doctor: good alright so i'm gon na go ahead and tell you what we're gon na do so i'm gon na tell you my assessment and plan here so dad so for the first problem i do believe that karen does have a tick eye tics are very common in children and as many as you know one in five children have a tick during their school years and tics can also include things like shoulder shrugging facial grimacing sniffling excessive throat clearing and uncontrolled vocalization i can say that essentially they're brief sudden and involuntary motor movements now we do n't have a full understanding of the cause of the tics but they typically occur around five to ten years of age but most ticks go away on their own and they disappear within a year so these are what we call transient tics and the best thing to do is ignore the tics so it does n't seem to be bothering karen and she seems to be doing well in school and activities so it may wax and wane over time but you might notice it more towards the end of the day when the child is tired so you may also you know see it if they're stressed so that's why it's important to just ignore it now when you draw attention to the tick it does make the child conscious so that can make the tic worse so we want to be careful again just to to kind of not to draw too much attention on it and do you have any questions for me patient: so you mean you're telling me you do n't think he had a seizure or a bit or nothing
D2N055
29
[ "Discussion", "Acute Assessment" ]
[ "Assessment", "Plan" ]
good alright so i'm gon na go ahead and tell you what we're gon na do so i'm gon na tell you my assessment and plan here so dad so for the first problem i do believe that karen does have a tick eye tics are very common in children and as many as you know one in five children have a tick during their school years and tics can also include things like shoulder shrugging facial grimacing sniffling excessive throat clearing and uncontrolled vocalization i can say that essentially they're brief sudden and involuntary motor movements now we do n't have a full understanding of the cause of the tics but they typically occur around five to ten years of age but most ticks go away on their own and they disappear within a year so these are what we call transient tics and the best thing to do is ignore the tics so it does n't seem to be bothering karen and she seems to be doing well in school and activities so it may wax and wane over time but you might notice it more towards the end of the day when the child is tired so you may also you know see it if they're stressed so that's why it's important to just ignore it now when you draw attention to the tick it does make the child conscious so that can make the tic worse so we want to be careful again just to to kind of not to draw too much attention on it and do you have any questions for me
1,455
doctor: yeah i do n't think it's i do n't think so because it's it is the same part of her body that's moving every time that and she reports that it's somewhat of an there is an urge to blink her eye and some relief afterwards patient: so you're not recommending any kind of treatment there is no pill or cream or nothing
D2N055
30
[ "Discussion" ]
[ "Plan" ]
yeah i do n't think it's i do n't think so because it's it is the same part of her body that's moving every time that and she reports that it's somewhat of an there is an urge to blink her eye and some relief afterwards
1,456
doctor: not at this time because she seems to be doing well overall and the tic has n't impacted her school or her activities but if it worsens then we can consider some treatment okay patient: alright alright sounds good
D2N055
31
[ "Discussion" ]
[ "Plan" ]
not at this time because she seems to be doing well overall and the tic has n't impacted her school or her activities but if it worsens then we can consider some treatment okay
1,457
doctor: alright thank you you guys have a good day patient: doctor
D2N055
32
[ "Chitchat" ]
[ "Null" ]
alright thank you you guys have a good day
1,458
doctor: bye karen
D2N055
33
[ "Chitchat" ]
[ "Null" ]
doctor: bye karen
1,459
doctor: alright thanks for coming in today i see on my chart here that you had a bunch of lower respiratory infections so first tell me how are you what's going on patient: you know i'm doing better now but you know last week i was really sick and i just have had enough like i was coughing a lot a lot of mucus even had some shortness of breath and even a low-grade fever
D2N056
0
[ "Personal History", "Greetings" ]
[ "Subjective" ]
alright thanks for coming in today i see on my chart here that you had a bunch of lower respiratory infections so first tell me how are you what's going on
1,460
doctor: wow that is a lot so what did you do for some of those symptoms patient: you know i ended up drinking a lot of fluid and taking some robitussin and i actually got better over the weekend and now i'm feeling much better but what concerns me is that i i tend to get pneumonia a lot
D2N056
1
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
wow that is a lot so what did you do for some of those symptoms
1,461
doctor: okay so when you say a lot like how frequently does it occur patient: i would say it seem honestly it seems like it's every month or every other month especially over the past six six months that i just keep getting sick and i usually will end up having to go to my primary care doctor or patient urgent care and i'll get prescribed some antibiotics and one time i actually ended up in the emergency room
D2N056
2
[ "Personal History" ]
[ "Subjective" ]
okay so when you say a lot like how frequently does it occur
1,462
doctor: wow and how long do your symptoms normally last for patient: you know it could be as few as like a couple of days but sometimes it could go even up to a week
D2N056
3
[ "Acute Symptoms" ]
[ "Subjective" ]
wow and how long do your symptoms normally last for
1,463
doctor: mm-hmm you mentioned that you are a farmer did you do you notice that your symptoms occur while doing certain things on the farm patient: you know i was trying to think about that and i've been working on the farm for some time but the only thing i can think about is that i've been helping my brother out and i've been started like unloading a lot of hay which i do n't usually do and i wan na say that my symptoms actually start the days that i'm unloading hay
D2N056
4
[ "Acute Symptoms" ]
[ "Subjective" ]
mm-hmm you mentioned that you are a farmer did you do you notice that your symptoms occur while doing certain things on the farm
1,464
doctor: alright do you wear a mask when you're unloading hay patient: no i do n't do that
D2N056
5
[ "Acute Symptoms" ]
[ "Subjective" ]
alright do you wear a mask when you're unloading hay
1,465
doctor: okay yeah so like that your brother does n't either patient: no i'm the only one who seems to be getting sick
D2N056
7
[ "Family History" ]
[ "Subjective" ]
okay yeah so like that your brother does n't either
1,466
doctor: alright so i know you said you were trying to like help out your brother like what's going on with him patient: you know we've just been getting really busy and so he has been working around doing other things so i've just been helping him just cover the extra load
D2N056
8
[ "Family History" ]
[ "Subjective" ]
alright so i know you said you were trying to like help out your brother like what's going on with him
1,467
doctor: mm-hmm okay alright do you have any other siblings patient: yeah there is actually ten of us
D2N056
9
[ "Family History" ]
[ "Subjective" ]
mm-hmm okay alright do you have any other siblings
1,468
doctor: wow okay that's that's a lot of siblings patient: yeah i'm okay
D2N056
10
[ "Chitchat" ]
[ "Null" ]
wow okay that's that's a lot of siblings
1,469
doctor: maybe maybe we could we could always stick them in they could get some work done the holidays must be fun at your place patient: yeah we do n't need to hire any i mean have anyone else this is our family
D2N056
11
[ "Chitchat" ]
[ "Null" ]
maybe maybe we could we could always stick them in they could get some work done the holidays must be fun at your place
1,470
doctor: you're right keep it in the family okay so speaking of family do you have do you or anyone have a history of seasonal allergies patient: no no i have never had any problems with allergies
D2N056
12
[ "Personal History", "Family History" ]
[ "Subjective" ]
you're right keep it in the family okay so speaking of family do you have do you or anyone have a history of seasonal allergies
1,471
doctor: okay and do you smoke patient: i do n't smoke
D2N056
13
[ "Drug History" ]
[ "Subjective" ]
okay and do you smoke
1,472
doctor: do you live with anybody who does patient: i do not
D2N056
14
[ "Other Socials" ]
[ "Subjective" ]
do you live with anybody who does
1,473
doctor: okay alright so okay so now i i wan na go ahead and do my physical exam i'm gon na call out some of my findings just to make sure that i'm documenting everything and if you have any questions about what it is that i'm saying please feel free to ask okay patient: okay
D2N056
15
[ "Chitchat" ]
[ "Null" ]
okay alright so okay so now i i wan na go ahead and do my physical exam i'm gon na call out some of my findings just to make sure that i'm documenting everything and if you have any questions about what it is that i'm saying please feel free to ask okay
1,474
doctor: so i reviewed your vitals and you appear to be breathing a little fast your respiratory rate is twenty but but your oxygen is you're satting kind of fine at ninety nine percent on room air so i'm not too worried about that on for on your heart exam i do you have a regular rate and regular rhythm i do not appreciate any murmurs rubs or gallops on your lung exam you know i do you do have some fine rales on your lung exam but no wheezes and on your musculoskeletal exam i do not appreciate any clubbing of your fingers so for your results i did review the results of your chest x-ray and i noticed some round glass opacities so let me tell you a little bit about like my assessment and plan for your first problem of recurrent lung infections your symptoms seem consistent with a condition we call hypersensitivity pneumonitis in your case another name is farmer's lung which you know is appropriate considering your job this could be caused by bacteria and or mold that is found in the hay when you inhale it it leads to an allergic reaction in your lungs this is why your symptoms occur every time you move hay for your current symptoms i'm gon na prescribe you a a course of an oral steroid this will help to decrease the inflammation that is occurring in your lungs i will also be ordering a cat scan of your lungs which will help confirm the diagnosis as as well a pulmonary function test to assess how severe your respiratory impairment is it would be best if you could eliminate your exposure to the hay or prevent further to prevent further damage to your lungs however if you are unable it's very important that you wear a respirator when moving hay around i know that that was a lot of information i think it boils down to pull in more of your siblings to help work around but do you have any questions patient: yeah so is this gon na help so i do n't keep getting sick
D2N056
16
[ "Physical Examination", "Discussion", "Diagnostic Testing", "Acute Assessment", "Other Treatments", "Radiology Examination", "Medication" ]
[ "Objective", "Assessment", "Plan" ]
so i reviewed your vitals and you appear to be breathing a little fast your respiratory rate is twenty but but your oxygen is you're satting kind of fine at ninety nine percent on room air so i'm not too worried about that on for on your heart exam i do you have a regular rate and regular rhythm i do not appreciate any murmurs rubs or gallops on your lung exam you know i do you do have some fine rales on your lung exam but no wheezes and on your musculoskeletal exam i do not appreciate any clubbing of your fingers so for your results i did review the results of your chest x-ray and i noticed some round glass opacities so let me tell you a little bit about like my assessment and plan for your first problem of recurrent lung infections your symptoms seem consistent with a condition we call hypersensitivity pneumonitis in your case another name is farmer's lung which you know is appropriate considering your job this could be caused by bacteria and or mold that is found in the hay when you inhale it it leads to an allergic reaction in your lungs this is why your symptoms occur every time you move hay for your current symptoms i'm gon na prescribe you a a course of an oral steroid this will help to decrease the inflammation that is occurring in your lungs i will also be ordering a cat scan of your lungs which will help confirm the diagnosis as as well a pulmonary function test to assess how severe your respiratory impairment is it would be best if you could eliminate your exposure to the hay or prevent further to prevent further damage to your lungs however if you are unable it's very important that you wear a respirator when moving hay around i know that that was a lot of information i think it boils down to pull in more of your siblings to help work around but do you have any questions
1,475
doctor: so ideally what we are doing i think this is the best course of action to deal with the deeper problem right of these infections and to kind of like clear up the pneumonia everything seems to hint on so what we're gon na do is treat your current infection we're going to either prevent you from being around hay or make it so that it's safe for you to be with hay and then we're gon na see like what we need to do moving forward does that help patient: okay it does
D2N056
17
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
so ideally what we are doing i think this is the best course of action to deal with the deeper problem right of these infections and to kind of like clear up the pneumonia everything seems to hint on so what we're gon na do is treat your current infection we're going to either prevent you from being around hay or make it so that it's safe for you to be with hay and then we're gon na see like what we need to do moving forward does that help
1,476
doctor: alright patient: thank you
D2N056
18
[ "Chitchat" ]
[ "Null" ]
alright
1,477
doctor: okay no problem patient: alright
D2N056
19
[ "Chitchat" ]
[ "Null" ]
okay no problem
1,478
doctor: hi good afternoon joseph how are you doing today patient: i'm doing well but my my big toe hurts and it's a little red too but it really hurts okay how long has this been going on i would say you know off and on for about two weeks but last week is is when it really became painful i was at a a trade show convention and i could n't walk the halls i could n't do anything i just had to stand there and it really hurt the whole time i was there
D2N057
0
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
hi good afternoon joseph how are you doing today
1,479
doctor: okay does it throb ache burn what kind of pain do you get with it patient: it's almost like a throbbing pain but occasionally it becomes almost like a a sharp stabbing pain especially if i move it or spend too much time walking i i find myself walking on my heel just to keep that toe from bending
D2N057
1
[ "Acute Symptoms" ]
[ "Subjective" ]
okay does it throb ache burn what kind of pain do you get with it
1,480
doctor: okay sorry i got a text and patient: well that's okay you know what i i you know i what i really you know i love to ride bikes have you you ride bike at all
D2N057
2
[ "Chitchat" ]
[ "Null" ]
okay sorry i got a text and
1,481
doctor: no i hate riding a bike i'm more of a runner patient: my gosh i love to ride i ride the lot of rails the trails i mean i go all the last year i put in over eight hundred miles on rails the trails
D2N057
3
[ "Chitchat" ]
[ "Null" ]
no i hate riding a bike i'm more of a runner
1,482
doctor: yeah those those are nice patient: yeah
D2N057
4
[ "Chitchat" ]
[ "Null" ]
yeah those those are nice
1,483
doctor: does it does riding your bike bother your big toe patient: no because i i kinda pedal with the the back of my feet you know on that side
D2N057
5
[ "Acute Symptoms" ]
[ "Subjective" ]
does it does riding your bike bother your big toe
1,484
doctor: okay do do you wear clips or are you just wearing a regular shoe and on a regular pedal patient: i'm on a regular shoe some most of the time i'm in my flip flops
D2N057
6
[ "Acute Symptoms" ]
[ "Subjective" ]
okay do do you wear clips or are you just wearing a regular shoe and on a regular pedal
1,485
doctor: okay okay the how is there anything that you were doing out of the ordinary when this started patient: no i do n't that's the thing i do n't remember an injury if it was something that i injured i think i would have just ignored it and would n't have showed up here but when it got red and warm to touch that's when i i was really concerned
D2N057
7
[ "Acute Symptoms" ]
[ "Subjective" ]
okay okay the how is there anything that you were doing out of the ordinary when this started
1,486
doctor: okay do does even light pressure to it bother it like at night when you're laying in bed do the sheets bother patient: absolutely i was just gon na say when i'm in bed at night and those sheets come down on it or i roll over yeah that hurts a lot
D2N057
8
[ "Acute Symptoms" ]
[ "Subjective" ]
okay do does even light pressure to it bother it like at night when you're laying in bed do the sheets bother
1,487
doctor: okay have you done anything to try to get it to feel better any soaks or taking any medicine patient: i take you know like a two ibuprofen a day and that does n't seem to help
D2N057
9
[ "Therapeutic History" ]
[ "Subjective" ]
okay have you done anything to try to get it to feel better any soaks or taking any medicine
1,488
doctor: let me see your your foot here and let me take your big toe through a range of motion if i push your top to bottom patient: yeah ouch
D2N057
11
[ "Physical Examination" ]
[ "Objective" ]
let me see your your foot here and let me take your big toe through a range of motion if i push your top to bottom
1,489
doctor: big toe joint that okay and let me move it up where as i bend it up does that hurt patient: it hurts but not as much as when you moved it down
D2N057
12
[ "Physical Examination" ]
[ "Objective" ]
big toe joint that okay and let me move it up where as i bend it up does that hurt
1,490
doctor: okay so i'm moving it down here and it i've got about ten degrees of plantar flexion does that hurt patient: yeah it a little when you take it a little further
D2N057
13
[ "Physical Examination" ]
[ "Objective" ]
okay so i'm moving it down here and it i've got about ten degrees of plantar flexion does that hurt
1,491
doctor: if i go a little bit further to twenty degrees does that hurt patient: that hurts more yeah
D2N057
14
[ "Physical Examination" ]
[ "Objective" ]
if i go a little bit further to twenty degrees does that hurt
1,492
doctor: okay if i push in on your big toe and move it back and forth does that hurt patient: yes it does and it it's almost like those joints that when you push it back it's almost like it's grinding a little bit too
D2N057
15
[ "Physical Examination" ]
[ "Objective" ]
okay if i push in on your big toe and move it back and forth does that hurt
1,493
doctor: okay if i push in between your big toe and your second toe here does that hurt patient: a little bit but not terrible
D2N057
16
[ "Physical Examination" ]
[ "Objective" ]
okay if i push in between your big toe and your second toe here does that hurt
1,494
doctor: okay what about if i push on the other side here patient: yeah yeah right there on the outside of it absolutely
D2N057
17
[ "Physical Examination" ]
[ "Objective" ]
okay what about if i push on the other side here
1,495
doctor: okay and i'm feeling a little bit of bone spur here as well let me let me get an x-ray patient: okay
D2N057
19
[ "Acute Symptoms", "Radiology Examination" ]
[ "Subjective", "Objective" ]
okay and i'm feeling a little bit of bone spur here as well let me let me get an x-ray
1,496
doctor: and after we take a peek at that we'll develop a plan patient: okay
D2N057
20
[ "Chitchat" ]
[ "Null" ]
and after we take a peek at that we'll develop a plan
1,497
doctor: so at this point what would i do if i'm going out of the room and then coming back patient: you could hit pause or hit the stop button and just restart it the next time you come in
D2N057
21
[ "Chitchat" ]
[ "Null" ]
so at this point what would i do if i'm going out of the room and then coming back
1,498
doctor: okay alrighty so taking a look at your x-ray and you do have you you have a large spur there on the top of your big toe joint patient: oh
D2N057
22
[ "Radiology Examination" ]
[ "Objective", "Assessment" ]
okay alrighty so taking a look at your x-ray and you do have you you have a large spur there on the top of your big toe joint
1,499