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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 getting fed up with these headaches . i've been trying my best to deal with them but they've been going on for months now and i'm really struggling .
|
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 it feels like a dull ache behind the eyes . they last a few hours at a time , nothing makes them better or worse .
|
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 tingling . and i've never passed out in my life . but , um , for some reason recently i seem to be bumping into door frames .
|
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 reactive . visual field testing reveals bitemporal hemianopia . and color vision is normal . all right , mr. ward . i'm going to review these pictures from the mri with you . um , now this appears to be a benign pituitary adenoma , but there's no way to be sure without sending the removed adenoma to pathology to make the diagnosis , which we will do . um , here you can see it's a well defined mass . and it's pressing right here on what we call the optic chiasm . and today when i was having you look at my fingers , you could n't see them off to the sides , that's what we call bitemporal hemianopia . and explains why you have been bumping into door frames . patient: yeah i never noticed that i could n't see out of the side until you did that test , and you closed one eye with both eyes . i really could n't tell .
|
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 . visual field testing reveals bitemporal hemianopia . and color vision is normal . all right , mr. ward . i'm going to review these pictures from the mri with you . um , now this appears to be a benign pituitary adenoma , but there's no way to be sure without sending the removed adenoma to pathology to make the diagnosis , which we will do . um , here you can see it's a well defined mass . and it's pressing right here on what we call the optic chiasm . and today when i was having you look at my fingers , you could n't see them off to the sides , that's what we call bitemporal hemianopia . and explains why you have been bumping into door frames .
| 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: all right .
|
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 attack , stroke , and death . risk of surgery include infection , need for further surgery , wound issues such as spinal fluid leak or infection , uh , which may require long , prolonged hospitalization or additional procedure . uh , seizure , stroke , permanent numbness , weakness , difficulty speaking , or even death . patient: well i guess we have to do it regardless .
|
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 , stroke , and death . risk of surgery include infection , need for further surgery , wound issues such as spinal fluid leak or infection , uh , which may require long , prolonged hospitalization or additional procedure . uh , seizure , stroke , permanent numbness , weakness , difficulty speaking , or even death .
| 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 after surgery . but we have the pre-surgery visual field test for comparison after surgery . patient: okay . i look forward to these headaches going away . i never thought it could be something like this going on .
|
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 surgery . but we have the pre-surgery visual field test for comparison after surgery .
| 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 intervention to excise and decompress the pituitary fossa is indicated . end of note .
|
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 intervention to excise and decompress the pituitary fossa is indicated . end of note .
| 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 morning . you miss hill ? patient: good morning . yes . that's me .
|
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 . you miss hill ?
| 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 typically with these , um ... but typically , these cause the pain that would last for a long time rather than that isolated incident like you had . um , it's also possible that you had intense heartburn for a few days . patient: well , since you mention anxiety , i was going through a really stressful job transition right around the time this happened .
|
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 with these , um ... but typically , these cause the pain that would last for a long time rather than that isolated incident like you had . um , it's also possible that you had intense heartburn for a few days .
| 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 point , and we would n't be able to see anything . the other option is just to continue to monitor , uh , for any additional symptoms at which point we could do the egd . uh , with you being asymptomatic for so long right now , i'm comfortable with that option . but what do you think ? patient: i'd like to hold off on the egd and wait to see if i have more symptoms .
|
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 , and we would n't be able to see anything . the other option is just to continue to monitor , uh , for any additional symptoms at which point we could do the egd . uh , with you being asymptomatic for so long right now , i'm comfortable with that option . but what do you think ?
| 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 . patient: okay .
|
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 transition , plus or minus a contribution from her musculoskeletal etiologies . um , in the plan , include our discussion of the egd versus monderning ... monitoring for symptom . patient elected to self-monitor her symptoms and will call with any reoccurrence or change . thanks .
|
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 transition , plus or minus a contribution from her musculoskeletal etiologies . um , in the plan , include our discussion of the egd versus monderning ... monitoring for symptom . patient elected to self-monitor her symptoms and will call with any reoccurrence or change . thanks .
| 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 , and also a neurologist ... who diagnosed her with this syndrome , because she still does n't walk and she was n't sitting by herself a year old .
|
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 that was why we saw ortho .
|
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 , twin with smith magenis syndrome . several organ systems can be affected by this chromosomal deletion syndrome . congenital anomalies of the kidney and urinary tract have been reported in the literature . we will obtain the screening of the kidneys by ultrasound today . if there are abnormalities on the kidney ultrasound , we will determine next steps and future follow-up . the family lives in dallas , georgia , so her follow-up should be at the town center location . end of recording .
|
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 , twin with smith magenis syndrome . several organ systems can be affected by this chromosomal deletion syndrome . congenital anomalies of the kidney and urinary tract have been reported in the literature . we will obtain the screening of the kidneys by ultrasound today . if there are abnormalities on the kidney ultrasound , we will determine next steps and future follow-up . the family lives in dallas , georgia , so her follow-up should be at the town center location . end of recording .
| 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 wrist started to hurt real bad and it got real swollen
|
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 palpable pulses no lower edema your shoulders every like your upper extremities i see normal range of movement with your right wrist let's go ahead and focus on it so when i push on the inside here does it hurt patient: yes
|
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 no lower edema your shoulders every like your upper extremities i see normal range of movement with your right wrist let's go ahead and focus on it so when i push on the inside here does it hurt
| 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
|
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