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doctor: i was just reviewing your records from dr. howard and he's referred you because the workup for headaches revealed a mass on your pituitary gland . i did review your mri images and you have a significant mass there . can you tell me about the issues you've been experiencing ? patient: yeah sure . so i'm really g...
D2N074
1
[ "Acute Symptoms", "Personal History" ]
[ "Subjective" ]
i was just reviewing your records from dr. howard and he's referred you because the workup for headaches revealed a mass on your pituitary gland . i did review your mri images and you have a significant mass there . can you tell me about the issues you've been experiencing ?
1,900
doctor: where are the headaches located and how would you describe that pain ? patient: located behind my eyes . it's like a dull nagging ache .
D2N074
2
[ "Acute Symptoms" ]
[ "Subjective" ]
where are the headaches located and how would you describe that pain ?
1,901
doctor: okay . was the onset gradual or sudden ? patient: well it started about three months ago . and they've been getting worse over time . at first it was like three out of 10 severity , and it just gradually worsened . and now it's about six out of 10 severity . the headaches do tend to be worse in the morning and ...
D2N074
3
[ "Personal History" ]
[ "Subjective" ]
okay . was the onset gradual or sudden ?
1,902
doctor: okay . can you tell me if the pain radiates , or if you have any other symptoms ? specifically feeling sick , fever , rashes , neck stiffness , numbness , weakness , passing out ? patient: no . i have n't been sick or felt sick . ca n't recall a fever or any kind of rash . no- no neck issues , no numbness , no ...
D2N074
4
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
okay . can you tell me if the pain radiates , or if you have any other symptoms ? specifically feeling sick , fever , rashes , neck stiffness , numbness , weakness , passing out ?
1,903
doctor: okay . have you noticed any change in your vision or with your balance ? patient: no i do n't think so . my eyes were checked in the fall .
D2N074
5
[ "Vegetative History" ]
[ "Subjective" ]
okay . have you noticed any change in your vision or with your balance ?
1,904
doctor: okay . let's see , do you have any other medical problems that you take medicine for ? patient: no i do n't have any medical problems and i do n't take any medicines . i tried tylenol a few times for the headaches but it did n't work , so i stopped .
D2N074
6
[ "Therapeutic History", "Personal History" ]
[ "Subjective" ]
okay . let's see , do you have any other medical problems that you take medicine for ?
1,905
doctor: i see . anyone in your family have any history of diseases ? patient: i was adopted so i really have no idea .
D2N074
7
[ "Family History" ]
[ "Subjective" ]
i see . anyone in your family have any history of diseases ?
1,906
doctor: okay . um , what kind of work do you do ? and are you married ? patient: i work as a computer programmer and i've been married for 25 years . we just bought a small house .
D2N074
8
[ "Other Socials" ]
[ "Subjective" ]
okay . um , what kind of work do you do ? and are you married ?
1,907
doctor: that's nice . um , do you drink any alcohol , smoke , or use recreational drugs ? patient: nope . i do n't do any of those and never have .
D2N074
9
[ "Drug History" ]
[ "Subjective" ]
that's nice . um , do you drink any alcohol , smoke , or use recreational drugs ?
1,908
doctor: okay . um , well let me take a good look at you . um , now you'll hear me calling out some details as i perform the examination . these will be noted for me in your record and i'll be happy to answer any questions you have once we're done . patient: sounds good , doc .
D2N074
10
[ "Physical Examination" ]
[ "Objective" ]
okay . um , well let me take a good look at you . um , now you'll hear me calling out some details as i perform the examination . these will be noted for me in your record and i'll be happy to answer any questions you have once we're done .
1,909
doctor: all right . the patient is alert , oriented to time , place , and person . affect is appropriate and speech is fluent . cranial nerve examination is grossly intact . no focal , motor , or sensory deficit in the upper or lower extremities . visual acuity and eye movements are normal . pupils are equal and reacti...
D2N074
11
[ "Physical Examination", "Diagnostic Testing", "Acute Assessment", "Radiology Examination" ]
[ "Objective", "Assessment", "Plan" ]
all right . the patient is alert , oriented to time , place , and person . affect is appropriate and speech is fluent . cranial nerve examination is grossly intact . no focal , motor , or sensory deficit in the upper or lower extremities . visual acuity and eye movements are normal . pupils are equal and reactive . vis...
1,910
doctor: no because you're having this vision loss from the mass compressing the optic chiasm , the only option we have is to do surgery . patient: okay , i understand . do you think i'll regain my vision ?
D2N074
12
[ "Acute Assessment", "Other Treatments" ]
[ "Assessment", "Plan" ]
no because you're having this vision loss from the mass compressing the optic chiasm , the only option we have is to do surgery .
1,911
doctor: well there's no guarantees , but it is a possibility . i'm gon na refer you to the eye doctor for a full exam and they'll do what's called visual field test . this will map our your peripheral vision or side vision prior to surgery . and we can monitor after surgery to see if your vision is improving . patient:...
D2N074
13
[ "Diagnostic Testing", "Referral", "Other Treatments" ]
[ "Plan" ]
well there's no guarantees , but it is a possibility . i'm gon na refer you to the eye doctor for a full exam and they'll do what's called visual field test . this will map our your peripheral vision or side vision prior to surgery . and we can monitor after surgery to see if your vision is improving .
1,912
doctor: and let's discuss the surgery a little more . um , we would do what's called a transsphenoidal approach to do the surgery . this is minimally invasive and we go through the sphenoid sinus . there are some risks i have to inform you of . uh , risk of anesthesia including but not limited to the risk of heart atta...
D2N074
14
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
and let's discuss the surgery a little more . um , we would do what's called a transsphenoidal approach to do the surgery . this is minimally invasive and we go through the sphenoid sinus . there are some risks i have to inform you of . uh , risk of anesthesia including but not limited to the risk of heart attack , str...
1,913
doctor: okay . so i will have you see our surgery scheduler , deborah , on the way out to get you set up . we will get this scheduled fairly quickly so i do n't want you to be alarmed . um , she'll also get you set up today or tomorrow to have the visual field test and you may not be able to see the eye doctor until af...
D2N074
15
[ "Diagnostic Testing", "Other Treatments" ]
[ "Plan" ]
okay . so i will have you see our surgery scheduler , deborah , on the way out to get you set up . we will get this scheduled fairly quickly so i do n't want you to be alarmed . um , she'll also get you set up today or tomorrow to have the visual field test and you may not be able to see the eye doctor until after surg...
1,914
doctor: yeah . come this way , we'll get your things lined up . please call if you think of any questions . patient: thanks , doctor .
D2N074
16
[ "Chitchat" ]
[ "Null" ]
yeah . come this way , we'll get your things lined up . please call if you think of any questions .
1,915
doctor: diagnosis will be pituitary adenoma . mr . ward is a very pleasant 52-year-old male who has benign appearing pituitary adenoma , incidentally discovered during workup for worsening headaches . he is symptomatic with clinical and radiographical evidence of optic chiasmal compression , therefor surgical intervent...
D2N074
17
[ "Acute Assessment", "Other Treatments" ]
[ "Assessment", "Plan" ]
doctor: diagnosis will be pituitary adenoma . mr . ward is a very pleasant 52-year-old male who has benign appearing pituitary adenoma , incidentally discovered during workup for worsening headaches . he is symptomatic with clinical and radiographical evidence of optic chiasmal compression , therefor surgical intervent...
1,916
doctor: next is betty hill , uh , date of birth is 2/21/1968 . she has a past medical history of uterine fibroids and anemia . she's a new patient with a referral from the er of esophagitis . um , i reviewed our records from the er , including the normal cardiac workup , and we're about to go in and see her now . good ...
D2N075
0
[ "Personal History", "Greetings" ]
[ "Subjective" ]
next is betty hill , uh , date of birth is 2/21/1968 . she has a past medical history of uterine fibroids and anemia . she's a new patient with a referral from the er of esophagitis . um , i reviewed our records from the er , including the normal cardiac workup , and we're about to go in and see her now . good morning ...
1,917
doctor: hey , i'm dr. sanders . it's nice to meet you . patient: nice to meet you too .
D2N075
1
[ "Chitchat" ]
[ "Null" ]
hey , i'm dr. sanders . it's nice to meet you .
1,918
doctor: so tell me about what brings you in today ? patient: well , i really needed to see you three months ... three months ago , but this was your first available appointment . when i called to make the appointment , i was having chest pains , but it stopped after four days , and i have n't had any since then .
D2N075
2
[ "Acute Symptoms" ]
[ "Subjective" ]
so tell me about what brings you in today ?
1,919
doctor: okay . when did these four days of chest pain occur ? patient: um , early october .
D2N075
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . when did these four days of chest pain occur ?
1,920
doctor: of 2020 , correct ? patient: yes .
D2N075
4
[ "Acute Symptoms" ]
[ "Subjective" ]
of 2020 , correct ?
1,921
doctor: okay . can you think of anything that might have caused the chest pain ? did you wake up with it ? patient: no . it just it randomly . i tolerated it for four days but then had to go to the emergency room because nothing i did relieved it . they did a bunch of testing and did n't find anything .
D2N075
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . can you think of anything that might have caused the chest pain ? did you wake up with it ?
1,922
doctor: okay . can you point to the area of your chest where the pain was located ? patient: well , it was here in the center of my chest , right behind my breastbone . it felt like i was having a heart attack . the pain was really sharp .
D2N075
6
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . can you point to the area of your chest where the pain was located ?
1,923
doctor: did they prescribe you any medications in the er ? patient: no . they ran an ekg and did blood tests , but like i said , everything was normal .
D2N075
7
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
did they prescribe you any medications in the er ?
1,924
doctor: okay . i see . patient: they thought it was something to do with the gi system , so that's why they referred me here .
D2N075
8
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay . i see .
1,925
doctor: interesting . uh , do you remember having any heartburn or indigestion at , at the time ? patient: uh , maybe . i do n't think i've ever had heartburn , so i'm not sure what that feels like .
D2N075
9
[ "Vegetative History" ]
[ "Subjective" ]
interesting . uh , do you remember having any heartburn or indigestion at , at the time ?
1,926
doctor: was the pain worse with eating or exercise ? patient: yes . with eating .
D2N075
10
[ "Vegetative History" ]
[ "Subjective" ]
was the pain worse with eating or exercise ?
1,927
doctor: okay . any difficulty swallowing ? patient: mm-hmm . i did .
D2N075
11
[ "Vegetative History" ]
[ "Subjective" ]
okay . any difficulty swallowing ?
1,928
doctor: okay . and that's also resolved since the initial episode three months ago ? patient: yes . thankfully . the chest pain and swallowing problem got better about three days after i went to the er . but i just feel like there's something wrong .
D2N075
12
[ "Personal History", "Vegetative History" ]
[ "Subjective" ]
okay . and that's also resolved since the initial episode three months ago ?
1,929
doctor: okay . so how has your weight been . patient: i've been trying to lose weight .
D2N075
13
[ "Vegetative History" ]
[ "Subjective" ]
okay . so how has your weight been .
1,930
doctor: that's good . any in- ... issues with abdominal pain ? patient: uh , no .
D2N075
14
[ "Vegetative History" ]
[ "Subjective" ]
that's good . any in- ... issues with abdominal pain ?
1,931
doctor: okay . good . and how about your bowel movements ; are they okay ? patient: they're normal .
D2N075
15
[ "Vegetative History" ]
[ "Subjective" ]
okay . good . and how about your bowel movements ; are they okay ?
1,932
doctor: all right . are you aware of any family history of gi problems ? patient: i do n't think so .
D2N075
16
[ "Family History" ]
[ "Subjective" ]
all right . are you aware of any family history of gi problems ?
1,933
doctor: have had you had any surgeries on your abdomen , or gall bladder , or appendix ? patient: yes . they took my gall bladder out several years ago .
D2N075
17
[ "Personal History" ]
[ "Subjective" ]
have had you had any surgeries on your abdomen , or gall bladder , or appendix ?
1,934
doctor: okay . if you wan na lay down here on the table for me and lets take a look at you . patient: okay .
D2N075
18
[ "Physical Examination" ]
[ "Objective" ]
okay . if you wan na lay down here on the table for me and lets take a look at you .
1,935
doctor: so when i push on your lower belly , do you have any pain , or does it feel tender ? patient: no .
D2N075
19
[ "Physical Examination" ]
[ "Objective" ]
so when i push on your lower belly , do you have any pain , or does it feel tender ?
1,936
doctor: okay . how about up here in your upper abdomen ? patient: yes . it , it hurts a little .
D2N075
20
[ "Physical Examination" ]
[ "Objective" ]
okay . how about up here in your upper abdomen ?
1,937
doctor: okay . and even when i press lightly like this ? patient: yes . uh , just a little uncomfortable .
D2N075
21
[ "Physical Examination" ]
[ "Objective" ]
okay . and even when i press lightly like this ?
1,938
doctor: okay . does it hurt more when i press over here on the left or over here on the right ? or is it about the same ? patient: i'd say it's about the same .
D2N075
22
[ "Physical Examination" ]
[ "Objective" ]
okay . does it hurt more when i press over here on the left or over here on the right ? or is it about the same ?
1,939
doctor: okay . so we'll say you have some mild tenderness to light palpation in the upper abdominal quadrants , but everything on your exam looks normal and looks good . patient: okay . good .
D2N075
23
[ "Physical Examination" ]
[ "Objective" ]
okay . so we'll say you have some mild tenderness to light palpation in the upper abdominal quadrants , but everything on your exam looks normal and looks good .
1,940
doctor: so let's talk about your symptoms real quick . obviously , with the chest discomfort , we worry about heart issues , but i'm reassured that those were ruled out with all the testing they did in the er . um , other potential causes could be anxiety , esophagitis , which is irritation of the esophagus . but typic...
D2N075
24
[ "Acute Assessment" ]
[ "Assessment" ]
so let's talk about your symptoms real quick . obviously , with the chest discomfort , we worry about heart issues , but i'm reassured that those were ruled out with all the testing they did in the er . um , other potential causes could be anxiety , esophagitis , which is irritation of the esophagus . but typically wit...
1,941
doctor: okay . that's good to know . so stress from this could be , um ... could be , uh ... could be very well have contributed to your condition . patient: okay .
D2N075
25
[ "Acute Assessment" ]
[ "Assessment" ]
okay . that's good to know . so stress from this could be , um ... could be , uh ... could be very well have contributed to your condition .
1,942
doctor: so we could do an , uh , egd or upper endoscopy to take a look at your esophagus and stomach . this would allow us to look for esophagitis . but your symptoms occurred three months ago and you have n't had any additional episodes , so likely if it were esophagitis , it's already healed by the point ... by this ...
D2N075
26
[ "Discussion", "Diagnostic Testing" ]
[ "Plan" ]
so we could do an , uh , egd or upper endoscopy to take a look at your esophagus and stomach . this would allow us to look for esophagitis . but your symptoms occurred three months ago and you have n't had any additional episodes , so likely if it were esophagitis , it's already healed by the point ... by this point , ...
1,943
doctor: that sounds good . um , so you can call the office if you have any additional episodes of pain or any other symptoms you're concerned about . if that happens , we'll get you scheduled for an egd to take a look . if not , you can follow up with me ... follow up with me as needed for any other gi complaints . pat...
D2N075
27
[ "Follow-up", "Diagnostic Testing" ]
[ "Plan" ]
that sounds good . um , so you can call the office if you have any additional episodes of pain or any other symptoms you're concerned about . if that happens , we'll get you scheduled for an egd to take a look . if not , you can follow up with me ... follow up with me as needed for any other gi complaints .
1,944
doctor: all right ? if you do n't have any questions for me , i'll walk you out to the check-out desk . patient: no . that's it . thank you .
D2N075
28
[ "Discussion" ]
[ "Plan" ]
all right ? if you do n't have any questions for me , i'll walk you out to the check-out desk .
1,945
doctor: you're welcome . right this way . all right . uh , in assessment , please summarize the patient's history briefly , and let's list her possible etiologies such as , uh , gerd , dyspepsia , esophagitis , musculoskeletal etiologies , and anxiety . uh , suspect she had an anxiety attack related to her job transiti...
D2N075
29
[ "Personal History", "Acute Assessment", "Discussion" ]
[ "Subjective", "Assessment", "Plan" ]
doctor: you're welcome . right this way . all right . uh , in assessment , please summarize the patient's history briefly , and let's list her possible etiologies such as , uh , gerd , dyspepsia , esophagitis , musculoskeletal etiologies , and anxiety . uh , suspect she had an anxiety attack related to her job transiti...
1,946
doctor: hello . patient_guest: hi .
D2N076
0
[ "Greetings" ]
[ "Subjective" ]
hello .
1,947
doctor: i'm dr. evelyn , one of the kidney doctors . it's good to meet you guys . patient_guest: it's nice to meet you also .
D2N076
1
[ "Chitchat" ]
[ "Null" ]
i'm dr. evelyn , one of the kidney doctors . it's good to meet you guys .
1,948
doctor: yeah . so i was reading about this syndrome that i actually have never heard of . patient_guest: yeah , me too .
D2N076
2
[ "Chitchat" ]
[ "Null" ]
yeah . so i was reading about this syndrome that i actually have never heard of .
1,949
doctor: i do n't think it's very common . patient_guest: definitely not . it's c- pretty rare .
D2N076
3
[ "Chitchat" ]
[ "Null" ]
i do n't think it's very common .
1,950
doctor: so- can you start at the beginning ? i know she's a twin , so are these your first two babies ? patient_guest: no , i have a son also who is nine . he also has autism .
D2N076
4
[ "Personal History", "Other Socials" ]
[ "Subjective" ]
so- can you start at the beginning ? i know she's a twin , so are these your first two babies ?
1,951
doctor: okay . patient_guest: and when the twins were born , katherine , she was about 4 pounds , 8 ounces . and her twin was a bit smaller , at 3 pounds , 13 ounces . and when the twins were born , katherine , she was about 4 pounds , 8 ounces . and her twin was a bit smaller , at 3 pounds , 13 ounces .
D2N076
5
[ "Personal History" ]
[ "Subjective" ]
okay .
1,952
doctor: like preemie type stuff ? patient_guest: uh- . yeah . she just had a hard time regulating her temperature , but she did fine . she does have a gi doctor , because she has reflex really bad . she also had a dietician , who told us to take her off cow's milk . which we did . and then she has seen an allergist , a...
D2N076
6
[ "Personal History" ]
[ "Subjective" ]
like preemie type stuff ?
1,953
doctor: yeah . patient_guest: but so now she is crawling and she is trying to take steps , so think she's doing pretty good .
D2N076
7
[ "Personal History" ]
[ "Subjective" ]
yeah .
1,954
doctor: good . is she in therapy ? patient_guest: she is in therapy . she's in feeding therapy , occupational therapy , and also physical therapy .
D2N076
8
[ "Personal History" ]
[ "Subjective" ]
good . is she in therapy ?
1,955
doctor: awesome . okay . patient_guest: and we also have speech therapy , who is going to be starting within the next couple of weeks .
D2N076
9
[ "Personal History" ]
[ "Subjective" ]
awesome . okay .
1,956
doctor: that's great . patient_guest: so , she has a lot of therapies . we have also seen an orthopedic and an ophthalmologist . i can never say that . we have seen everything , really .
D2N076
10
[ "Personal History" ]
[ "Subjective" ]
that's great .
1,957
doctor: and audiology too , right ? patient_guest: yes .
D2N076
11
[ "Personal History" ]
[ "Subjective" ]
and audiology too , right ?
1,958
doctor: yeah , wow. . patient_guest: yeah , it has definitely been a whirlwind of stuff . when we saw the geneticist , she told us that sometimes people with this syndrome , they have trouble with their kidneys . that they might actually fuse into one . she also said sometimes they have problems with their legs , so th...
D2N076
12
[ "Personal History" ]
[ "Subjective" ]
yeah , wow. .
1,959
doctor: okay . okay . patient_guest: so we have seen everybody , really . we are just here to make sure that her kidneys are looking good right now .
D2N076
13
[ "Personal History" ]
[ "Subjective" ]
okay . okay .
1,960
doctor: yeah , okay . so , um , tell me about how many wet diapers she has in a 24 hour period ? patient_guest: she has a lot .
D2N076
14
[ "Personal History" ]
[ "Subjective" ]
yeah , okay . so , um , tell me about how many wet diapers she has in a 24 hour period ?
1,961
doctor: so like normal 8 to 10 , or like 20 ? patient_guest: yeah , it's around 8 to 10 .
D2N076
15
[ "Personal History" ]
[ "Subjective" ]
so like normal 8 to 10 , or like 20 ?
1,962
doctor: okay . great . patient_guest: yeah , she seems to pee a lot , and it feels like she drinks a lot too .
D2N076
16
[ "Personal History" ]
[ "Subjective" ]
okay . great .
1,963
doctor: that's perfect . patient_guest: and she used to only drink milk , and then i took her off dairy milk . so when i say milk , i actually mean , you know , ripple pea protein milk .
D2N076
17
[ "Personal History" ]
[ "Subjective" ]
that's perfect .
1,964
doctor: sure , yeah . patient_guest: so i give her that milk , water now that she's used to it , and sometimes water with just a little bit of juice . so i do feel like she's drinking a lot better now .
D2N076
18
[ "Personal History" ]
[ "Subjective" ]
sure , yeah .
1,965
doctor: that's great . and she's how old now ? patient_guest: she'll be two mo- two next month .
D2N076
19
[ "Personal History" ]
[ "Subjective" ]
that's great . and she's how old now ?
1,966
doctor: okay . is her twin a boy or a girl ? patient_guest: she's a girl .
D2N076
20
[ "Family History" ]
[ "Subjective" ]
okay . is her twin a boy or a girl ?
1,967
doctor: okay , and how's she doing ? patient_guest: she's doing really good . she's running around , and she does n't have any problems .
D2N076
21
[ "Family History" ]
[ "Subjective" ]
okay , and how's she doing ?
1,968
doctor: all right . is she bigger than her or the same size ? patient_guest: they're about the same size . they're able to wear the same clothes , so ...
D2N076
22
[ "Family History" ]
[ "Subjective" ]
all right . is she bigger than her or the same size ?
1,969
doctor: okay . patient_guest: i do n't even think she's a pound hav- heavier , actually .
D2N076
23
[ "Family History" ]
[ "Subjective" ]
okay .
1,970
doctor: yeah . yeah . patient_guest: but she is a little bit taller than her ... um , katherine . she's just sh- a little shorter and chunkier , but i think that's a part of her syndrome .
D2N076
24
[ "Family History" ]
[ "Subjective" ]
yeah . yeah .
1,971
doctor: yeah . yeah , i was reading all the things associated with the syndrome . it sounds like we're looking for continual- congenital anomalies wi- of the kidney and urinary tract . which is basically something is wrong with the plumbing . patient_guest: okay .
D2N076
25
[ "Acute Assessment" ]
[ "Assessment" ]
yeah . yeah , i was reading all the things associated with the syndrome . it sounds like we're looking for continual- congenital anomalies wi- of the kidney and urinary tract . which is basically something is wrong with the plumbing .
1,972
doctor: so the only way to know that , is to do a kidney ultrasound . patient_guest: okay , that sounds okay .
D2N076
26
[ "Diagnostic Testing" ]
[ "Plan" ]
so the only way to know that , is to do a kidney ultrasound .
1,973
doctor: okay . let me put that into the system , and then downstairs they can do the ultrasound . patient_guest: all right , thank you .
D2N076
27
[ "Chitchat" ]
[ "Null" ]
okay . let me put that into the system , and then downstairs they can do the ultrasound .
1,974
doctor: okay , yeah . where do you all live ? patient_guest: uh , we live in dallas .
D2N076
28
[ "Other Socials" ]
[ "Subjective" ]
okay , yeah . where do you all live ?
1,975
doctor: okay . anybody in the family with kidney failure , dialysis or transplant ? patient_guest: no .
D2N076
29
[ "Family History" ]
[ "Subjective" ]
okay . anybody in the family with kidney failure , dialysis or transplant ?
1,976
doctor: okay . so let's get your ultrasound done , and we'll see how it goes . patient_guest: all right , that sounds good .
D2N076
30
[ "Diagnostic Testing" ]
[ "Plan" ]
okay . so let's get your ultrasound done , and we'll see how it goes .
1,977
doctor: all right . let me take a quick look at her . patient_guest: sure .
D2N076
31
[ "Physical Examination" ]
[ "Objective" ]
all right . let me take a quick look at her .
1,978
doctor: all right . please use my physical exam template . um , i wan na take a quick listen to her heart and lungs . i'll look in her ears too . and she can sit , she can just sit on your lap . patient_guest: okay .
D2N076
32
[ "Physical Examination" ]
[ "Objective" ]
all right . please use my physical exam template . um , i wan na take a quick listen to her heart and lungs . i'll look in her ears too . and she can sit , she can just sit on your lap .
1,979
doctor: all right . that's it . patient_guest: all right , that was n't too bad .
D2N076
33
[ "Chitchat" ]
[ "Null" ]
all right . that's it .
1,980
doctor: hmm . so , let's complete the ultrasound today . i'll call you with the results . if it's normal , you wo n't need to see me again , but if it's abnormal , you can see me in kennesaw . patient_guest: okay , that sounds good .
D2N076
34
[ "Discussion", "Diagnostic Testing", "Follow-up" ]
[ "Plan" ]
hmm . so , let's complete the ultrasound today . i'll call you with the results . if it's normal , you wo n't need to see me again , but if it's abnormal , you can see me in kennesaw .
1,981
doctor: okay . we'll determine what the next steps are if there are any , after we see her results . patient_guest: all right , sounds good . thank you .
D2N076
35
[ "Discussion" ]
[ "Plan" ]
okay . we'll determine what the next steps are if there are any , after we see her results .
1,982
doctor: you're welcome . the nurse will be in to have you complete some paperwork , and give you instructions for the ultrasound . we'll talk soon . patient_guest: all right . thank you , and have a good day .
D2N076
36
[ "Chitchat" ]
[ "Null" ]
you're welcome . the nurse will be in to have you complete some paperwork , and give you instructions for the ultrasound . we'll talk soon .
1,983
doctor: you too . all right . physical exams show the well-nourished female , who is slightly fussy when examined . eyes are small appearing . she has mild hypotonia of the lower extremities in her arms . normal external female genitalia . assessment and plan . katherine is a 22-month-old former 34 and 3-week-old , twi...
D2N076
37
[ "Physical Examination", "Acute Assessment", "Follow-up" ]
[ "Objective", "Assessment", "Plan" ]
doctor: you too . all right . physical exams show the well-nourished female , who is slightly fussy when examined . eyes are small appearing . she has mild hypotonia of the lower extremities in her arms . normal external female genitalia . assessment and plan . katherine is a 22-month-old former 34 and 3-week-old , twi...
1,984
doctor: hey diana it's good to see you in here so i see that you injured your wrist could you tell me a bit about what happened patient: yeah i was walking up and down the stairs i was doing my laundry and i slipped and i tried to catch myself and i put my arms out to catch myself and then all of a sudden i just my wri...
D2N077
0
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
hey diana it's good to see you in here so i see that you injured your wrist could you tell me a bit about what happened
1,985
doctor: wow okay so which wrist are we talking about left or right patient: it's my right one of course
D2N077
1
[ "Acute Symptoms" ]
[ "Subjective" ]
wow okay so which wrist are we talking about left or right
1,986
doctor: okay and then have you ever injured this arm before patient: no i have not
D2N077
2
[ "Personal History" ]
[ "Subjective" ]
okay and then have you ever injured this arm before
1,987
doctor: okay alright so on a scale of one to ten how severe is the pain patient: gosh it's like a nine
D2N077
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright so on a scale of one to ten how severe is the pain
1,988
doctor: wow okay have you done anything to ease it patient: yeah i did the ice thing i put ice on it and then i you know i even i have a ace wrap at home i try to do that
D2N077
4
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
wow okay have you done anything to ease it
1,989
doctor: mm-hmm patient: and then i took some ibuprofen but it helps a little bit but it's just it's it's just not right
D2N077
5
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
mm-hmm
1,990
doctor: yeah okay have you sorry i'm trying to think how long ago did this injury happen patient: this happened yesterday morning
D2N077
7
[ "Acute Symptoms" ]
[ "Subjective" ]
yeah okay have you sorry i'm trying to think how long ago did this injury happen
1,991
doctor: okay no i understand okay so i'm going so you said you were doing laundry patient: yes i had my back hit my basket and for some reason this cold started to kinda fall out a little bit i was trying to catch it i missed a step and i just totally
D2N077
10
[ "Acute Symptoms" ]
[ "Subjective" ]
okay no i understand okay so i'm going so you said you were doing laundry
1,992
doctor: okay alright any does the pain extend anywhere patient: no not really
D2N077
11
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright any does the pain extend anywhere
1,993
doctor: okay any numbness any tingling patient: a little one and one ca n't tell if it's just because of the swelling in my wrist but just i can like i can feel it my fingers still
D2N077
13
[ "Acute Symptoms" ]
[ "Subjective" ]
okay any numbness any tingling
1,994
doctor: mm-hmm patient: but just maybe a little bit of tingling
D2N077
14
[ "Acute Symptoms" ]
[ "Subjective" ]
mm-hmm
1,995
doctor: okay alright and are you so so okay i'm gon na think on this but in the meantime i'm gon na do my physical exam alright patient: okay
D2N077
15
[ "Physical Examination" ]
[ "Objective" ]
okay alright and are you so so okay i'm gon na think on this but in the meantime i'm gon na do my physical exam alright
1,996
doctor: okay so you know looking at your looking at your head and your neck i do n't appreciate any like adenopathy no thyromegaly no no carotid bruit looking at your listening to your heart i do n't appreciate any murmur no rub no gallop your lungs are clear to auscultation bilaterally your lower legs you have palpabl...
D2N077
16
[ "Physical Examination" ]
[ "Objective" ]
okay so you know looking at your looking at your head and your neck i do n't appreciate any like adenopathy no thyromegaly no no carotid bruit looking at your listening to your heart i do n't appreciate any murmur no rub no gallop your lungs are clear to auscultation bilaterally your lower legs you have palpable pulses...
1,997
doctor: and what about the outside does that hurt as well patient: yeah it does
D2N077
18
[ "Physical Examination" ]
[ "Objective" ]
and what about the outside does that hurt as well
1,998
doctor: are you able to move your wrist towards your arm like patient: not without extreme pain
D2N077
19
[ "Physical Examination" ]
[ "Objective" ]
are you able to move your wrist towards your arm like
1,999