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1. Odynophagia.,2. Dysphagia.,3. Gastroesophageal reflux disease rule out stricture.,POSTOPERATIVE DIAGNOSES:,1. Antral gastritis.,2. Hiatal hernia.,PROCEDURE PERFORMED: EGD with photos and biopsies.,GROSS FINDINGS: This is a 75-year-old female who presents with difficulty swallowing, occasional choking, and odynophagia. She has a previous history of hiatal hernia. She was on Prevacid currently. At this time, an EGD was performed to rule out stricture. At the time of EGD, there was noted some antral gastritis and hiatal hernia. There are no strictures, tumors, masses, or varices present.,OPERATIVE PROCEDURE: The patient was taken to the Endoscopy Suite in the lateral decubitus position. She was given sedation by the Department Of Anesthesia. Once adequate sedation was reached, the Olympus gastroscope was inserted into oropharynx. With air insufflation entered through the proximal esophagus to the GE junction. The esophagus was without evidence of tumors, masses, ulcerations, esophagitis, strictures, or varices. There was a hiatal hernia present. The scope was passed through the hiatal hernia into the body of the stomach. In the distal antrum, there was some erythema with patchy erythematous changes with small superficial erosions. Multiple biopsies were obtained. The scope was passed through the pylorus into the duodenal bulb and duodenal suite, they appeared within normal limits. The scope was pulled back from the stomach, retroflexed upon itself, _____ fundus and GE junction. As stated, multiple biopsies were obtained.,The scope was then slowly withdrawn. The patient tolerated the procedure well and sent to recovery room in satisfactory condition.

odynophagia dysphagia gastroesophageal reflux disease rule stricturepostoperative diagnoses antral gastritis hiatal herniaprocedure performed egd photos biopsiesgross findings yearold female presents difficulty swallowing occasional choking odynophagia previous history hiatal hernia prevacid currently time egd performed rule stricture time egd noted antral gastritis hiatal hernia strictures tumors masses varices presentoperative procedure patient taken endoscopy suite lateral decubitus position given sedation department anesthesia adequate sedation reached olympus gastroscope inserted oropharynx air insufflation entered proximal esophagus ge junction esophagus without evidence tumors masses ulcerations esophagitis strictures varices hiatal hernia present scope passed hiatal hernia body stomach distal antrum erythema patchy erythematous changes small superficial erosions multiple biopsies obtained scope passed pylorus duodenal bulb duodenal suite appeared within normal limits scope pulled back stomach retroflexed upon _____ fundus ge junction stated multiple biopsies obtainedthe scope slowly withdrawn patient tolerated procedure well sent recovery room satisfactory condition

### Instruction: find the medical speciality for this medical test. ### Input: 1. Odynophagia.,2. Dysphagia.,3. Gastroesophageal reflux disease rule out stricture.,POSTOPERATIVE DIAGNOSES:,1. Antral gastritis.,2. Hiatal hernia.,PROCEDURE PERFORMED: EGD with photos and biopsies.,GROSS FINDINGS: This is a 75-year-old female who presents with difficulty swallowing, occasional choking, and odynophagia. She has a previous history of hiatal hernia. She was on Prevacid currently. At this time, an EGD was performed to rule out stricture. At the time of EGD, there was noted some antral gastritis and hiatal hernia. There are no strictures, tumors, masses, or varices present.,OPERATIVE PROCEDURE: The patient was taken to the Endoscopy Suite in the lateral decubitus position. She was given sedation by the Department Of Anesthesia. Once adequate sedation was reached, the Olympus gastroscope was inserted into oropharynx. With air insufflation entered through the proximal esophagus to the GE junction. The esophagus was without evidence of tumors, masses, ulcerations, esophagitis, strictures, or varices. There was a hiatal hernia present. The scope was passed through the hiatal hernia into the body of the stomach. In the distal antrum, there was some erythema with patchy erythematous changes with small superficial erosions. Multiple biopsies were obtained. The scope was passed through the pylorus into the duodenal bulb and duodenal suite, they appeared within normal limits. The scope was pulled back from the stomach, retroflexed upon itself, _____ fundus and GE junction. As stated, multiple biopsies were obtained.,The scope was then slowly withdrawn. The patient tolerated the procedure well and sent to recovery room in satisfactory condition. ### Response: Gastroenterology, Surgery

1. Pelvic tumor.,2. Cystocele.,3. Rectocele.,POSTOPERATIVE DIAGNOSES:,1. Degenerated joint.,2. Uterine fibroid.,3. Cystocele.,4. Rectocele.,PROCEDURE PERFORMED: ,1. Total abdominal hysterectomy.,2. Bilateral salpingooophorectomy.,3. Repair of bladder laceration.,4. Appendectomy.,5. Marshall-Marchetti-Krantz cystourethropexy.,6. Posterior colpoperineoplasty.,GROSS FINDINGS: The patient had a history of a rapidly growing mass on the abdomen, extending from the pelvis over the past two to three months. She had a recent D&C and laparoscopy, and enlarged mass was noted and could not be determined if it was from the ovary or the uterus. Curettings were negative for malignancy. The patient did have a large cystocele and rectocele, and a collapsed anterior and posterior vaginal wall.,Upon laparotomy, there was a giant uterine tumor extending from the pelvis up to the above the umbilicus compatible with approximately four to five-month pregnancy. The ovaries appeared to be within normal limits. There was marked adherence between the bladder and the giant uterus and mass with edema and inflammation, and during dissection, a laceration inadvertently occurred and it was immediately recognized. No other pathology noted from the abdominal cavity or adhesions. The upper right quadrant of the abdomen compatible with a previous gallbladder surgery. The appendix is in its normal anatomic position. The ileum was within normal limits with no Meckel's diverticulum seen and no other gross pathology evident. There was no evidence of metastasis or tumors in the left lobe of the liver.,Upon frozen section, diagnosis of initial and partial is that of a degenerating uterine fibroid rather than a malignancy.,OPERATIVE PROCEDURE: The patient was taken to the Operating Room, prepped and draped in the low lithotomy position under general anesthesia. A midline incision was made around the umbilicus down to the lower abdomen. With a #10 Bard Parker blade knife, the incision was carried down through the fascia. The fascia was incised in the midline, muscle fibers were splint in the midline, the peritoneum was grasped with hemostats and with a #10 Bard Parker blade after incision was made with Mayo scissors. A Balfour retractor was placed into the wound. This giant uterus was soft and compatible with a possible leiomyosarcoma or degenerating fibroid was handled with care. The infundibular ligament on the right side was isolated and ligated with #0 Vicryl suture brought to an avascular area, doubly clamped and divided from the ovary and the ligament again re-ligated with #0 Vicryl suture. The right round ligament was ligated with #0 Vicryl suture, brought to an avascular space within the broad ligament and divided from the uterus. The infundibulopelvic ligament on the left side was treated in a similar fashion as well as the round ligament. An attempt was made to dissect the bladder flap from the anterior surface of the uterus and this was remarkably edematous and difficult to do, and during dissection the bladder was inadvertently entered. After this was immediately recognized, the bladder flap was wiped away from the anterior surface of the uterus. The bladder was then repaired with a running locking stitch #0 Vicryl suture incorporating serosal muscularis mucosa and then the second layer of overlapping seromuscular sutures were used to make a two-layer closure of #0 Vicryl suture. After removing the uterus, the bladder was tested with approximately 400 cc of sterile water and there appeared to be no leak. Progressing and removing of the uterus was then carried out and the broad ligament was clamped bilaterally with a straight Ochsner forceps and divided from the uterus with Mayo scissors, and the straight Ochsner was placed by #0 Vicryl suture thus controlling the uterine blood supply. The cardinal ligaments containing the cervical blood supply was serially clamped bilaterally with a curved Ochsner forceps, divided from the uterus with #10 Bard Parker blade knife and a curved Ochsner was placed by #0 Vicryl suture. The cervix was again grasped with a Lahey tenaculum and pubovesicocervical ligament was entered and was divided using #10 Bard Parker blade knife and then the vaginal vault and with a double pointed sharp scissors. A single-toothed tenaculum was placed on the cervix and then the uterus was removed from the vagina using hysterectomy scissors. The vaginal cuff was then closed using a running #0 Vicryl suture in locking stitch incorporating all layers of the vagina, the cardinal ligaments of the lateral aspect and uterosacral ligaments on the posterior aspect. The round ligaments were approximated to the vaginal cuff with #0 Vicryl suture and the bladder flap approximated to the round ligaments with #000 Vicryl suture. The ______ was re-peritonealized with #000 Vicryl suture and then the cecum brought into the incision. The pelvis was irrigated with approximately 500 cc of water. The appendix was grasped with Babcock forceps. The mesoappendix was doubly clamped with curved hemostats and divided with Metzenbaum scissors. The curved hemostats were placed with #00 Vicryl suture. The base of the appendix was ligated with #0 plain gut suture, doubly clamped and divided from the distal appendix with #10 Bard Parker blade knife, and the base inverted with a pursestring suture with #00 Vicryl. No bleeding was noted. Sponge, instrument, and needle counts were found to be correct. All packs and retractors were removed. The peritoneum muscle fascia was closed in single-layer closure using running looped #1 PDS, but prior to closure, a Marshall-Marchetti-Krantz cystourethropexy was carried out by dissecting the space of Retzius identifying the urethra in the vesical junction approximating the periurethral connective tissue to the symphysis pubis with interrupted #0 Vicryl suture. Following this, the abdominal wall was closed as previously described and the skin was closed using skin staples. Attention was then turned to the vagina, where the introitus of the vagina was grasped with an Allis forceps at the level of the Bartholin glands. An incision was made between the mucous and the cutaneous junction and then a midline incision was made at the posterior vaginal mucosa in a tunneling fashion with Metzenbaum scissors. The flaps were created bilaterally by making an incision in the posterior connective tissue of the vagina and wiping the rectum away from the posterior vaginal mucosa, and flaps were created bilaterally. In this fashion, the rectocele was reduced and the levator ani muscles were approximated in the midline with interrupted #0 Vicryl suture. Excess vaginal mucosa was excised and the vaginal mucosa closed with running #00 Vicryl suture. The bulbocavernosus and transverse perinei muscles were approximated in the midline with interrupted #00 Vicryl suture. The skin was closed with a running #000 plain gut subcuticular stitch. The vaginal vault was packed with a Betadine-soaked Kling gauze sponge. Sterile dressing was applied. The patient was sent to recovery room in stable condition.

pelvic tumor cystocele rectocelepostoperative diagnoses degenerated joint uterine fibroid cystocele rectoceleprocedure performed total abdominal hysterectomy bilateral salpingooophorectomy repair bladder laceration appendectomy marshallmarchettikrantz cystourethropexy posterior colpoperineoplastygross findings patient history rapidly growing mass abdomen extending pelvis past two three months recent dc laparoscopy enlarged mass noted could determined ovary uterus curettings negative malignancy patient large cystocele rectocele collapsed anterior posterior vaginal wallupon laparotomy giant uterine tumor extending pelvis umbilicus compatible approximately four fivemonth pregnancy ovaries appeared within normal limits marked adherence bladder giant uterus mass edema inflammation dissection laceration inadvertently occurred immediately recognized pathology noted abdominal cavity adhesions upper right quadrant abdomen compatible previous gallbladder surgery appendix normal anatomic position ileum within normal limits meckels diverticulum seen gross pathology evident evidence metastasis tumors left lobe liverupon frozen section diagnosis initial partial degenerating uterine fibroid rather malignancyoperative procedure patient taken operating room prepped draped low lithotomy position general anesthesia midline incision made around umbilicus lower abdomen bard parker blade knife incision carried fascia fascia incised midline muscle fibers splint midline peritoneum grasped hemostats bard parker blade incision made mayo scissors balfour retractor placed wound giant uterus soft compatible possible leiomyosarcoma degenerating fibroid handled care infundibular ligament right side isolated ligated vicryl suture brought avascular area doubly clamped divided ovary ligament religated vicryl suture right round ligament ligated vicryl suture brought avascular space within broad ligament divided uterus infundibulopelvic ligament left side treated similar fashion well round ligament attempt made dissect bladder flap anterior surface uterus remarkably edematous difficult dissection bladder inadvertently entered immediately recognized bladder flap wiped away anterior surface uterus bladder repaired running locking stitch vicryl suture incorporating serosal muscularis mucosa second layer overlapping seromuscular sutures used make twolayer closure vicryl suture removing uterus bladder tested approximately cc sterile water appeared leak progressing removing uterus carried broad ligament clamped bilaterally straight ochsner forceps divided uterus mayo scissors straight ochsner placed vicryl suture thus controlling uterine blood supply cardinal ligaments containing cervical blood supply serially clamped bilaterally curved ochsner forceps divided uterus bard parker blade knife curved ochsner placed vicryl suture cervix grasped lahey tenaculum pubovesicocervical ligament entered divided using bard parker blade knife vaginal vault double pointed sharp scissors singletoothed tenaculum placed cervix uterus removed vagina using hysterectomy scissors vaginal cuff closed using running vicryl suture locking stitch incorporating layers vagina cardinal ligaments lateral aspect uterosacral ligaments posterior aspect round ligaments approximated vaginal cuff vicryl suture bladder flap approximated round ligaments vicryl suture ______ reperitonealized vicryl suture cecum brought incision pelvis irrigated approximately cc water appendix grasped babcock forceps mesoappendix doubly clamped curved hemostats divided metzenbaum scissors curved hemostats placed vicryl suture base appendix ligated plain gut suture doubly clamped divided distal appendix bard parker blade knife base inverted pursestring suture vicryl bleeding noted sponge instrument needle counts found correct packs retractors removed peritoneum muscle fascia closed singlelayer closure using running looped pds prior closure marshallmarchettikrantz cystourethropexy carried dissecting space retzius identifying urethra vesical junction approximating periurethral connective tissue symphysis pubis interrupted vicryl suture following abdominal wall closed previously described skin closed using skin staples attention turned vagina introitus vagina grasped allis forceps level bartholin glands incision made mucous cutaneous junction midline incision made posterior vaginal mucosa tunneling fashion metzenbaum scissors flaps created bilaterally making incision posterior connective tissue vagina wiping rectum away posterior vaginal mucosa flaps created bilaterally fashion rectocele reduced levator ani muscles approximated midline interrupted vicryl suture excess vaginal mucosa excised vaginal mucosa closed running vicryl suture bulbocavernosus transverse perinei muscles approximated midline interrupted vicryl suture skin closed running plain gut subcuticular stitch vaginal vault packed betadinesoaked kling gauze sponge sterile dressing applied patient sent recovery room stable condition

### Instruction: find the medical speciality for this medical test. ### Input: 1. Pelvic tumor.,2. Cystocele.,3. Rectocele.,POSTOPERATIVE DIAGNOSES:,1. Degenerated joint.,2. Uterine fibroid.,3. Cystocele.,4. Rectocele.,PROCEDURE PERFORMED: ,1. Total abdominal hysterectomy.,2. Bilateral salpingooophorectomy.,3. Repair of bladder laceration.,4. Appendectomy.,5. Marshall-Marchetti-Krantz cystourethropexy.,6. Posterior colpoperineoplasty.,GROSS FINDINGS: The patient had a history of a rapidly growing mass on the abdomen, extending from the pelvis over the past two to three months. She had a recent D&C and laparoscopy, and enlarged mass was noted and could not be determined if it was from the ovary or the uterus. Curettings were negative for malignancy. The patient did have a large cystocele and rectocele, and a collapsed anterior and posterior vaginal wall.,Upon laparotomy, there was a giant uterine tumor extending from the pelvis up to the above the umbilicus compatible with approximately four to five-month pregnancy. The ovaries appeared to be within normal limits. There was marked adherence between the bladder and the giant uterus and mass with edema and inflammation, and during dissection, a laceration inadvertently occurred and it was immediately recognized. No other pathology noted from the abdominal cavity or adhesions. The upper right quadrant of the abdomen compatible with a previous gallbladder surgery. The appendix is in its normal anatomic position. The ileum was within normal limits with no Meckel's diverticulum seen and no other gross pathology evident. There was no evidence of metastasis or tumors in the left lobe of the liver.,Upon frozen section, diagnosis of initial and partial is that of a degenerating uterine fibroid rather than a malignancy.,OPERATIVE PROCEDURE: The patient was taken to the Operating Room, prepped and draped in the low lithotomy position under general anesthesia. A midline incision was made around the umbilicus down to the lower abdomen. With a #10 Bard Parker blade knife, the incision was carried down through the fascia. The fascia was incised in the midline, muscle fibers were splint in the midline, the peritoneum was grasped with hemostats and with a #10 Bard Parker blade after incision was made with Mayo scissors. A Balfour retractor was placed into the wound. This giant uterus was soft and compatible with a possible leiomyosarcoma or degenerating fibroid was handled with care. The infundibular ligament on the right side was isolated and ligated with #0 Vicryl suture brought to an avascular area, doubly clamped and divided from the ovary and the ligament again re-ligated with #0 Vicryl suture. The right round ligament was ligated with #0 Vicryl suture, brought to an avascular space within the broad ligament and divided from the uterus. The infundibulopelvic ligament on the left side was treated in a similar fashion as well as the round ligament. An attempt was made to dissect the bladder flap from the anterior surface of the uterus and this was remarkably edematous and difficult to do, and during dissection the bladder was inadvertently entered. After this was immediately recognized, the bladder flap was wiped away from the anterior surface of the uterus. The bladder was then repaired with a running locking stitch #0 Vicryl suture incorporating serosal muscularis mucosa and then the second layer of overlapping seromuscular sutures were used to make a two-layer closure of #0 Vicryl suture. After removing the uterus, the bladder was tested with approximately 400 cc of sterile water and there appeared to be no leak. Progressing and removing of the uterus was then carried out and the broad ligament was clamped bilaterally with a straight Ochsner forceps and divided from the uterus with Mayo scissors, and the straight Ochsner was placed by #0 Vicryl suture thus controlling the uterine blood supply. The cardinal ligaments containing the cervical blood supply was serially clamped bilaterally with a curved Ochsner forceps, divided from the uterus with #10 Bard Parker blade knife and a curved Ochsner was placed by #0 Vicryl suture. The cervix was again grasped with a Lahey tenaculum and pubovesicocervical ligament was entered and was divided using #10 Bard Parker blade knife and then the vaginal vault and with a double pointed sharp scissors. A single-toothed tenaculum was placed on the cervix and then the uterus was removed from the vagina using hysterectomy scissors. The vaginal cuff was then closed using a running #0 Vicryl suture in locking stitch incorporating all layers of the vagina, the cardinal ligaments of the lateral aspect and uterosacral ligaments on the posterior aspect. The round ligaments were approximated to the vaginal cuff with #0 Vicryl suture and the bladder flap approximated to the round ligaments with #000 Vicryl suture. The ______ was re-peritonealized with #000 Vicryl suture and then the cecum brought into the incision. The pelvis was irrigated with approximately 500 cc of water. The appendix was grasped with Babcock forceps. The mesoappendix was doubly clamped with curved hemostats and divided with Metzenbaum scissors. The curved hemostats were placed with #00 Vicryl suture. The base of the appendix was ligated with #0 plain gut suture, doubly clamped and divided from the distal appendix with #10 Bard Parker blade knife, and the base inverted with a pursestring suture with #00 Vicryl. No bleeding was noted. Sponge, instrument, and needle counts were found to be correct. All packs and retractors were removed. The peritoneum muscle fascia was closed in single-layer closure using running looped #1 PDS, but prior to closure, a Marshall-Marchetti-Krantz cystourethropexy was carried out by dissecting the space of Retzius identifying the urethra in the vesical junction approximating the periurethral connective tissue to the symphysis pubis with interrupted #0 Vicryl suture. Following this, the abdominal wall was closed as previously described and the skin was closed using skin staples. Attention was then turned to the vagina, where the introitus of the vagina was grasped with an Allis forceps at the level of the Bartholin glands. An incision was made between the mucous and the cutaneous junction and then a midline incision was made at the posterior vaginal mucosa in a tunneling fashion with Metzenbaum scissors. The flaps were created bilaterally by making an incision in the posterior connective tissue of the vagina and wiping the rectum away from the posterior vaginal mucosa, and flaps were created bilaterally. In this fashion, the rectocele was reduced and the levator ani muscles were approximated in the midline with interrupted #0 Vicryl suture. Excess vaginal mucosa was excised and the vaginal mucosa closed with running #00 Vicryl suture. The bulbocavernosus and transverse perinei muscles were approximated in the midline with interrupted #00 Vicryl suture. The skin was closed with a running #000 plain gut subcuticular stitch. The vaginal vault was packed with a Betadine-soaked Kling gauze sponge. Sterile dressing was applied. The patient was sent to recovery room in stable condition. ### Response: Obstetrics / Gynecology, Surgery, Urology

1. The left ventricular cavity size and wall thickness appear normal. The wall motion and left ventricular systolic function appears hyperdynamic with estimated ejection fraction of 70% to 75%. There is near-cavity obliteration seen. There also appears to be increased left ventricular outflow tract gradient at the mid cavity level consistent with hyperdynamic left ventricular systolic function. There is abnormal left ventricular relaxation pattern seen as well as elevated left atrial pressures seen by Doppler examination.,2. The left atrium appears mildly dilated.,3. The right atrium and right ventricle appear normal.,4. The aortic root appears normal.,5. The aortic valve appears calcified with mild aortic valve stenosis, calculated aortic valve area is 1.3 cm square with a maximum instantaneous gradient of 34 and a mean gradient of 19 mm.,6. There is mitral annular calcification extending to leaflets and supportive structures with thickening of mitral valve leaflets with mild mitral regurgitation.,7. The tricuspid valve appears normal with trace tricuspid regurgitation with moderate pulmonary artery hypertension. Estimated pulmonary artery systolic pressure is 49 mmHg. Estimated right atrial pressure of 10 mmHg.,8. The pulmonary valve appears normal with trace pulmonary insufficiency.,9. There is no pericardial effusion or intracardiac mass seen.,10. There is a color Doppler suggestive of a patent foramen ovale with lipomatous hypertrophy of the interatrial septum.,11. The study was somewhat technically limited and hence subtle abnormalities could be missed from the study.,

left ventricular cavity size wall thickness appear normal wall motion left ventricular systolic function appears hyperdynamic estimated ejection fraction nearcavity obliteration seen also appears increased left ventricular outflow tract gradient mid cavity level consistent hyperdynamic left ventricular systolic function abnormal left ventricular relaxation pattern seen well elevated left atrial pressures seen doppler examination left atrium appears mildly dilated right atrium right ventricle appear normal aortic root appears normal aortic valve appears calcified mild aortic valve stenosis calculated aortic valve area cm square maximum instantaneous gradient mean gradient mm mitral annular calcification extending leaflets supportive structures thickening mitral valve leaflets mild mitral regurgitation tricuspid valve appears normal trace tricuspid regurgitation moderate pulmonary artery hypertension estimated pulmonary artery systolic pressure mmhg estimated right atrial pressure mmhg pulmonary valve appears normal trace pulmonary insufficiency pericardial effusion intracardiac mass seen color doppler suggestive patent foramen ovale lipomatous hypertrophy interatrial septum study somewhat technically limited hence subtle abnormalities could missed study

### Instruction: find the medical speciality for this medical test. ### Input: 1. The left ventricular cavity size and wall thickness appear normal. The wall motion and left ventricular systolic function appears hyperdynamic with estimated ejection fraction of 70% to 75%. There is near-cavity obliteration seen. There also appears to be increased left ventricular outflow tract gradient at the mid cavity level consistent with hyperdynamic left ventricular systolic function. There is abnormal left ventricular relaxation pattern seen as well as elevated left atrial pressures seen by Doppler examination.,2. The left atrium appears mildly dilated.,3. The right atrium and right ventricle appear normal.,4. The aortic root appears normal.,5. The aortic valve appears calcified with mild aortic valve stenosis, calculated aortic valve area is 1.3 cm square with a maximum instantaneous gradient of 34 and a mean gradient of 19 mm.,6. There is mitral annular calcification extending to leaflets and supportive structures with thickening of mitral valve leaflets with mild mitral regurgitation.,7. The tricuspid valve appears normal with trace tricuspid regurgitation with moderate pulmonary artery hypertension. Estimated pulmonary artery systolic pressure is 49 mmHg. Estimated right atrial pressure of 10 mmHg.,8. The pulmonary valve appears normal with trace pulmonary insufficiency.,9. There is no pericardial effusion or intracardiac mass seen.,10. There is a color Doppler suggestive of a patent foramen ovale with lipomatous hypertrophy of the interatrial septum.,11. The study was somewhat technically limited and hence subtle abnormalities could be missed from the study., ### Response: Cardiovascular / Pulmonary, Radiology

2-D ECHOCARDIOGRAM,Multiple views of the heart and great vessels reveal normal intracardiac and great vessel relationships. Cardiac function is normal. There is no significant chamber enlargement or hypertrophy. There is no pericardial effusion or vegetations seen. Doppler interrogation, including color flow imaging, reveals systemic venous return to the right atrium with normal tricuspid inflow. Pulmonary outflow is normal at the valve. Pulmonary venous return is to the left atrium. The interatrial septum is intact. Mitral inflow and ascending aorta flow are normal. The aortic valve is trileaflet. The coronary arteries appear to be normal in their origins. The aortic arch is left-sided and patent with normal descending aorta pulsatility.

echocardiogrammultiple views heart great vessels reveal normal intracardiac great vessel relationships cardiac function normal significant chamber enlargement hypertrophy pericardial effusion vegetations seen doppler interrogation including color flow imaging reveals systemic venous return right atrium normal tricuspid inflow pulmonary outflow normal valve pulmonary venous return left atrium interatrial septum intact mitral inflow ascending aorta flow normal aortic valve trileaflet coronary arteries appear normal origins aortic arch leftsided patent normal descending aorta pulsatility

### Instruction: find the medical speciality for this medical test. ### Input: 2-D ECHOCARDIOGRAM,Multiple views of the heart and great vessels reveal normal intracardiac and great vessel relationships. Cardiac function is normal. There is no significant chamber enlargement or hypertrophy. There is no pericardial effusion or vegetations seen. Doppler interrogation, including color flow imaging, reveals systemic venous return to the right atrium with normal tricuspid inflow. Pulmonary outflow is normal at the valve. Pulmonary venous return is to the left atrium. The interatrial septum is intact. Mitral inflow and ascending aorta flow are normal. The aortic valve is trileaflet. The coronary arteries appear to be normal in their origins. The aortic arch is left-sided and patent with normal descending aorta pulsatility. ### Response: Cardiovascular / Pulmonary, Radiology

2-D M-MODE: , ,1. Left atrial enlargement with left atrial diameter of 4.7 cm.,2. Normal size right and left ventricle.,3. Normal LV systolic function with left ventricular ejection fraction of 51%.,4. Normal LV diastolic function.,5. No pericardial effusion.,6. Normal morphology of aortic valve, mitral valve, tricuspid valve, and pulmonary valve.,7. PA systolic pressure is 36 mmHg.,DOPPLER: , ,1. Mild mitral and tricuspid regurgitation.,2. Trace aortic and pulmonary regurgitation.

mmode left atrial enlargement left atrial diameter cm normal size right left ventricle normal lv systolic function left ventricular ejection fraction normal lv diastolic function pericardial effusion normal morphology aortic valve mitral valve tricuspid valve pulmonary valve pa systolic pressure mmhgdoppler mild mitral tricuspid regurgitation trace aortic pulmonary regurgitation

### Instruction: find the medical speciality for this medical test. ### Input: 2-D M-MODE: , ,1. Left atrial enlargement with left atrial diameter of 4.7 cm.,2. Normal size right and left ventricle.,3. Normal LV systolic function with left ventricular ejection fraction of 51%.,4. Normal LV diastolic function.,5. No pericardial effusion.,6. Normal morphology of aortic valve, mitral valve, tricuspid valve, and pulmonary valve.,7. PA systolic pressure is 36 mmHg.,DOPPLER: , ,1. Mild mitral and tricuspid regurgitation.,2. Trace aortic and pulmonary regurgitation. ### Response: Cardiovascular / Pulmonary, Radiology

2-D STUDY,1. Mild aortic stenosis, widely calcified, minimally restricted.,2. Mild left ventricular hypertrophy but normal systolic function.,3. Moderate biatrial enlargement.,4. Normal right ventricle.,5. Normal appearance of the tricuspid and mitral valves.,6. Normal left ventricle and left ventricular systolic function.,DOPPLER,1. There is 1 to 2+ aortic regurgitation easily seen, but no aortic stenosis.,2. Mild tricuspid regurgitation with only mild increase in right heart pressures, 30-35 mmHg maximum.,SUMMARY,1. Normal left ventricle.,2. Moderate biatrial enlargement.,3. Mild tricuspid regurgitation, but only mild increase in right heart pressures.

study mild aortic stenosis widely calcified minimally restricted mild left ventricular hypertrophy normal systolic function moderate biatrial enlargement normal right ventricle normal appearance tricuspid mitral valves normal left ventricle left ventricular systolic functiondoppler aortic regurgitation easily seen aortic stenosis mild tricuspid regurgitation mild increase right heart pressures mmhg maximumsummary normal left ventricle moderate biatrial enlargement mild tricuspid regurgitation mild increase right heart pressures

### Instruction: find the medical speciality for this medical test. ### Input: 2-D STUDY,1. Mild aortic stenosis, widely calcified, minimally restricted.,2. Mild left ventricular hypertrophy but normal systolic function.,3. Moderate biatrial enlargement.,4. Normal right ventricle.,5. Normal appearance of the tricuspid and mitral valves.,6. Normal left ventricle and left ventricular systolic function.,DOPPLER,1. There is 1 to 2+ aortic regurgitation easily seen, but no aortic stenosis.,2. Mild tricuspid regurgitation with only mild increase in right heart pressures, 30-35 mmHg maximum.,SUMMARY,1. Normal left ventricle.,2. Moderate biatrial enlargement.,3. Mild tricuspid regurgitation, but only mild increase in right heart pressures. ### Response: Cardiovascular / Pulmonary, Radiology

3-DIMENSIONAL SIMULATION,This patient is undergoing 3-dimensionally planned radiation therapy in order to adequately target structures at risk while diminishing the degree of exposure to uninvolved adjacent normal structures. This optimizes the chance of controlling tumor while diminishing the acute and long-term side effects. With conformal 3-dimensional simulation, there is extended physician, therapist, and dosimetrist effort and time expended. The patient is initially taken into a conventional simulator room where appropriate markers are placed and the patient is positioned and immobilized. Preliminary filed sizes and arrangements, including gantry angles, collimator angles, and number of fields are conceived. Radiographs are taken and these films are approved by the physician. Appropriate marks are placed on the patient's skin or on the immobilization device.,The patient is transferred to the diagnostic facility and placed on a flat CT scan table. Scans are performed through the targeted area. The scans are evaluated by the radiation oncologist and the tumor volume, target volume, and critical structures are outlined on the CT images. The dosimetrist then evaluates the slices in the treatment-planning computer with appropriately marked structures. This volume is reconstructed in a virtual 3-dimensional space utilizing the beam's-eye view features. Appropriate blocks are designed. Multiplane computerized dosimetry is performed throughout the volume. Field arrangements and blocking are modified as necessary to provide coverage of the target volume while minimizing dose to normal structures.,Once appropriate beam parameters and isodose distributions have been confirmed on the computer scan, the individual slices are then reviewed by the physician. The beam's-eye view, block design, and appropriate volumes are also printed and reviewed by the physician. Once these are approved, physical blocks or multi-leaf collimator equivalents will be devised. If significant changes are made in the field arrangements from the original simulation, the patient is brought back to the simulator where computer designed fields are re-simulated.,In view of the extensive effort and time expenditure required, this procedure justifies the special procedure code, 77470.

dimensional simulationthis patient undergoing dimensionally planned radiation therapy order adequately target structures risk diminishing degree exposure uninvolved adjacent normal structures optimizes chance controlling tumor diminishing acute longterm side effects conformal dimensional simulation extended physician therapist dosimetrist effort time expended patient initially taken conventional simulator room appropriate markers placed patient positioned immobilized preliminary filed sizes arrangements including gantry angles collimator angles number fields conceived radiographs taken films approved physician appropriate marks placed patients skin immobilization devicethe patient transferred diagnostic facility placed flat ct scan table scans performed targeted area scans evaluated radiation oncologist tumor volume target volume critical structures outlined ct images dosimetrist evaluates slices treatmentplanning computer appropriately marked structures volume reconstructed virtual dimensional space utilizing beamseye view features appropriate blocks designed multiplane computerized dosimetry performed throughout volume field arrangements blocking modified necessary provide coverage target volume minimizing dose normal structuresonce appropriate beam parameters isodose distributions confirmed computer scan individual slices reviewed physician beamseye view block design appropriate volumes also printed reviewed physician approved physical blocks multileaf collimator equivalents devised significant changes made field arrangements original simulation patient brought back simulator computer designed fields resimulatedin view extensive effort time expenditure required procedure justifies special procedure code

### Instruction: find the medical speciality for this medical test. ### Input: 3-DIMENSIONAL SIMULATION,This patient is undergoing 3-dimensionally planned radiation therapy in order to adequately target structures at risk while diminishing the degree of exposure to uninvolved adjacent normal structures. This optimizes the chance of controlling tumor while diminishing the acute and long-term side effects. With conformal 3-dimensional simulation, there is extended physician, therapist, and dosimetrist effort and time expended. The patient is initially taken into a conventional simulator room where appropriate markers are placed and the patient is positioned and immobilized. Preliminary filed sizes and arrangements, including gantry angles, collimator angles, and number of fields are conceived. Radiographs are taken and these films are approved by the physician. Appropriate marks are placed on the patient's skin or on the immobilization device.,The patient is transferred to the diagnostic facility and placed on a flat CT scan table. Scans are performed through the targeted area. The scans are evaluated by the radiation oncologist and the tumor volume, target volume, and critical structures are outlined on the CT images. The dosimetrist then evaluates the slices in the treatment-planning computer with appropriately marked structures. This volume is reconstructed in a virtual 3-dimensional space utilizing the beam's-eye view features. Appropriate blocks are designed. Multiplane computerized dosimetry is performed throughout the volume. Field arrangements and blocking are modified as necessary to provide coverage of the target volume while minimizing dose to normal structures.,Once appropriate beam parameters and isodose distributions have been confirmed on the computer scan, the individual slices are then reviewed by the physician. The beam's-eye view, block design, and appropriate volumes are also printed and reviewed by the physician. Once these are approved, physical blocks or multi-leaf collimator equivalents will be devised. If significant changes are made in the field arrangements from the original simulation, the patient is brought back to the simulator where computer designed fields are re-simulated.,In view of the extensive effort and time expenditure required, this procedure justifies the special procedure code, 77470. ### Response: Hematology - Oncology, Radiology

A 1 cm infraumbilical skin incision was made. Through this a Veress needle was inserted into the abdominal cavity. The abdomen was filled with approximately 2 liters of CO2 gas. The Veress needle was withdrawn. A trocar sleeve was placed through the incision into the abdominal cavity. The trocar was withdrawn and replaced with the laparoscope. A 1 cm suprapubic skin incision was made. Through this a second trocar sleeve was placed into the abdominal cavity using direct observation with the laparoscope. The trocar was withdrawn and replaced with a probe.,The patient was placed in Trendelenburg position, and the bowel was pushed out of the pelvis. Upon visualization of the pelvis organs, the uterus, fallopian tubes and ovaries were all normal. The probe was withdrawn and replaced with the bipolar cautery instrument. The right fallopian tube was grasped approximately 1 cm distal to the cornual region of the uterus. Electrical current was applied to the tube at this point and fulgurated. The tube was then regrasped just distal to this and refulgurated. It was then regrasped just distal to the lateral point and refulgurated again. The same procedure was then carried out on the opposite tube. The bipolar cautery instrument was withdrawn and replaced with the probe. The fallopian tubes were again traced to their fimbriated ends to confirm the burn points on the tubes. The upper abdomen was visualized, and the liver surface was normal. The gas was allowed to escape from the abdomen, and the instruments were removed. The skin incisions were repaired. The instruments were removed from the vagina.,There were no complications to the procedure. Blood loss was minimal. The patient went to the postanesthesia recovery room in stable condition.

cm infraumbilical skin incision made veress needle inserted abdominal cavity abdomen filled approximately liters co gas veress needle withdrawn trocar sleeve placed incision abdominal cavity trocar withdrawn replaced laparoscope cm suprapubic skin incision made second trocar sleeve placed abdominal cavity using direct observation laparoscope trocar withdrawn replaced probethe patient placed trendelenburg position bowel pushed pelvis upon visualization pelvis organs uterus fallopian tubes ovaries normal probe withdrawn replaced bipolar cautery instrument right fallopian tube grasped approximately cm distal cornual region uterus electrical current applied tube point fulgurated tube regrasped distal refulgurated regrasped distal lateral point refulgurated procedure carried opposite tube bipolar cautery instrument withdrawn replaced probe fallopian tubes traced fimbriated ends confirm burn points tubes upper abdomen visualized liver surface normal gas allowed escape abdomen instruments removed skin incisions repaired instruments removed vaginathere complications procedure blood loss minimal patient went postanesthesia recovery room stable condition

### Instruction: find the medical speciality for this medical test. ### Input: A 1 cm infraumbilical skin incision was made. Through this a Veress needle was inserted into the abdominal cavity. The abdomen was filled with approximately 2 liters of CO2 gas. The Veress needle was withdrawn. A trocar sleeve was placed through the incision into the abdominal cavity. The trocar was withdrawn and replaced with the laparoscope. A 1 cm suprapubic skin incision was made. Through this a second trocar sleeve was placed into the abdominal cavity using direct observation with the laparoscope. The trocar was withdrawn and replaced with a probe.,The patient was placed in Trendelenburg position, and the bowel was pushed out of the pelvis. Upon visualization of the pelvis organs, the uterus, fallopian tubes and ovaries were all normal. The probe was withdrawn and replaced with the bipolar cautery instrument. The right fallopian tube was grasped approximately 1 cm distal to the cornual region of the uterus. Electrical current was applied to the tube at this point and fulgurated. The tube was then regrasped just distal to this and refulgurated. It was then regrasped just distal to the lateral point and refulgurated again. The same procedure was then carried out on the opposite tube. The bipolar cautery instrument was withdrawn and replaced with the probe. The fallopian tubes were again traced to their fimbriated ends to confirm the burn points on the tubes. The upper abdomen was visualized, and the liver surface was normal. The gas was allowed to escape from the abdomen, and the instruments were removed. The skin incisions were repaired. The instruments were removed from the vagina.,There were no complications to the procedure. Blood loss was minimal. The patient went to the postanesthesia recovery room in stable condition. ### Response: Obstetrics / Gynecology, Surgery

A colonoscope was then passed through the rectum, all the way toward the cecum, which was identified by the presence of the appendiceal orifice and ileocecal valve. This was done without difficulty and the bowel preparation was good. The ileocecal valve was intubated and the distal 2 to 3 cm of terminal ileum was inspected and was normal. The colonoscope was then slowly withdrawn and a careful examination of the mucosa was performed.,COMPLICATIONS: , None.

colonoscope passed rectum way toward cecum identified presence appendiceal orifice ileocecal valve done without difficulty bowel preparation good ileocecal valve intubated distal cm terminal ileum inspected normal colonoscope slowly withdrawn careful examination mucosa performedcomplications none

### Instruction: find the medical speciality for this medical test. ### Input: A colonoscope was then passed through the rectum, all the way toward the cecum, which was identified by the presence of the appendiceal orifice and ileocecal valve. This was done without difficulty and the bowel preparation was good. The ileocecal valve was intubated and the distal 2 to 3 cm of terminal ileum was inspected and was normal. The colonoscope was then slowly withdrawn and a careful examination of the mucosa was performed.,COMPLICATIONS: , None. ### Response: Gastroenterology, Surgery

A fluorescein angiogram was ordered at today's visit to rule out macular edema. We have asked her to return in one to two weeks' time to discuss the results of her angiogram and possible intervention and will be sure to keep you apprised of her ongoing progress. A copy of the angiogram is enclosed for your records.

fluorescein angiogram ordered todays visit rule macular edema asked return one two weeks time discuss results angiogram possible intervention sure keep apprised ongoing progress copy angiogram enclosed records

### Instruction: find the medical speciality for this medical test. ### Input: A fluorescein angiogram was ordered at today's visit to rule out macular edema. We have asked her to return in one to two weeks' time to discuss the results of her angiogram and possible intervention and will be sure to keep you apprised of her ongoing progress. A copy of the angiogram is enclosed for your records. ### Response: Ophthalmology, SOAP / Chart / Progress Notes

ACROMIOCLAVICULAR JOINT INJECTION,PROCEDURE:,: Informed consent was obtained from the patient. All possible complications were mentioned including joint swelling, infection, and bruising. The joint was prepared with Betadine and alcohol. Then 1 mL of Depo-Medrol and 2 mL of 0.25% Marcaine were injected using the anterior approach. This was injected easily using a 25 gauge needle with the patient sitting and the shoulder propped up on a pillow. The joint was entered easily without any great difficulty. Aspiration was performed prior to the injection to make sure there was no intravascular injection. There were no complications and good relief of symptoms.,POST PROCEDURE INSTRUCTIONS:, The patient has been asked to report to us any redness, swelling, inflammation, or fevers. The patient has been asked to restrict the use of the * extremity for the next 24 hours.

acromioclavicular joint injectionprocedure informed consent obtained patient possible complications mentioned including joint swelling infection bruising joint prepared betadine alcohol ml depomedrol ml marcaine injected using anterior approach injected easily using gauge needle patient sitting shoulder propped pillow joint entered easily without great difficulty aspiration performed prior injection make sure intravascular injection complications good relief symptomspost procedure instructions patient asked report us redness swelling inflammation fevers patient asked restrict use extremity next hours

### Instruction: find the medical speciality for this medical test. ### Input: ACROMIOCLAVICULAR JOINT INJECTION,PROCEDURE:,: Informed consent was obtained from the patient. All possible complications were mentioned including joint swelling, infection, and bruising. The joint was prepared with Betadine and alcohol. Then 1 mL of Depo-Medrol and 2 mL of 0.25% Marcaine were injected using the anterior approach. This was injected easily using a 25 gauge needle with the patient sitting and the shoulder propped up on a pillow. The joint was entered easily without any great difficulty. Aspiration was performed prior to the injection to make sure there was no intravascular injection. There were no complications and good relief of symptoms.,POST PROCEDURE INSTRUCTIONS:, The patient has been asked to report to us any redness, swelling, inflammation, or fevers. The patient has been asked to restrict the use of the * extremity for the next 24 hours. ### Response: Pain Management

ADENOIDECTOMY,PROCEDURE:, The patient was brought into the operating room suite, anesthesia administered via endotracheal tube. Following this the patient was draped in standard fashion. The Crowe-Davis mouth gag was inserted in the oral cavity. The palate and tonsils were inspected, the palate was suspended with a red rubber catheter passed through the right nostril. Following this, the mirror was used to visualize the adenoid pad and an adenoid curet was seated against the vomer. The adenoid pad was removed without difficulty. The nasopharynx was packed. Following this, the nasopharynx was unpacked, several discrete bleeding sites were gently coagulated with electrocautery and the nasopharynx and oral cavity were irrigated. The Crowe-Davis was released.,The patient tolerated the procedure without difficulty and was in stable condition on transfer to recovery.

adenoidectomyprocedure patient brought operating room suite anesthesia administered via endotracheal tube following patient draped standard fashion crowedavis mouth gag inserted oral cavity palate tonsils inspected palate suspended red rubber catheter passed right nostril following mirror used visualize adenoid pad adenoid curet seated vomer adenoid pad removed without difficulty nasopharynx packed following nasopharynx unpacked several discrete bleeding sites gently coagulated electrocautery nasopharynx oral cavity irrigated crowedavis releasedthe patient tolerated procedure without difficulty stable condition transfer recovery

### Instruction: find the medical speciality for this medical test. ### Input: ADENOIDECTOMY,PROCEDURE:, The patient was brought into the operating room suite, anesthesia administered via endotracheal tube. Following this the patient was draped in standard fashion. The Crowe-Davis mouth gag was inserted in the oral cavity. The palate and tonsils were inspected, the palate was suspended with a red rubber catheter passed through the right nostril. Following this, the mirror was used to visualize the adenoid pad and an adenoid curet was seated against the vomer. The adenoid pad was removed without difficulty. The nasopharynx was packed. Following this, the nasopharynx was unpacked, several discrete bleeding sites were gently coagulated with electrocautery and the nasopharynx and oral cavity were irrigated. The Crowe-Davis was released.,The patient tolerated the procedure without difficulty and was in stable condition on transfer to recovery. ### Response: ENT - Otolaryngology, Surgery

ADMISSION DIAGNOSES,1. Neck pain with right upper extremity radiculopathy.,2. Cervical spondylosis with herniated nucleus pulposus C4-C5, C5-C6, and C6-C7 with stenosis.,DISCHARGE DIAGNOSES,1. Neck pain with right upper extremity radiculopathy.,2. Cervical spondylosis with herniated nucleus pulposus C4-C5, C5-C6, and C6-C7 with stenosis.,OPERATIVE PROCEDURES,1. Anterior cervical discectomy with decompression C4-C5, C5-C6, and C6-C7.,2. Arthrodesis with anterior interbody fusion C4-C5, C5-C6, and C6-C7.,3. Spinal instrumentation C4 through C7.,4. Implant.,5. Allograft.,COMPLICATIONS:, None.,COURSE ON ADMISSION: , This is the case of a very pleasant 41-year-old Caucasian female who was seen in clinic as an initial consultation on 09/13/07 complaining of intense neck pain radiating to the right shoulder blade to top of the right shoulder in to the right upper extremity to the patient's hand. The patient's symptoms have been persistent and had gotten worse with subjective weakness of the right upper extremity since its onset for several weeks now. The patient has been treated with medications, which has been unrelenting. The patient had imaging studies that showed evidence of cervical spondylosis with herniated disk and stenosis at C4-C5, C5-C6 and C6-C7. The patient underwent liver surgery and postoperatively her main issue was that of some degree of on and off right shoulder pain and some operative site soreness, which was treated well with IV morphine. The patient has resolution of the pain down the arm, but she does have some tingling of the right thumb and right index finger. The patient apparently is doing well with slight dysphagia, we treated her with Decadron and we will send her home with Medrol. The patient will have continued pain medication coverage with Darvocet and Flexeril. The patient will follow up with me as scheduled. Instructions have been given.

admission diagnoses neck pain right upper extremity radiculopathy cervical spondylosis herniated nucleus pulposus cc cc cc stenosisdischarge diagnoses neck pain right upper extremity radiculopathy cervical spondylosis herniated nucleus pulposus cc cc cc stenosisoperative procedures anterior cervical discectomy decompression cc cc cc arthrodesis anterior interbody fusion cc cc cc spinal instrumentation c c implant allograftcomplications nonecourse admission case pleasant yearold caucasian female seen clinic initial consultation complaining intense neck pain radiating right shoulder blade top right shoulder right upper extremity patients hand patients symptoms persistent gotten worse subjective weakness right upper extremity since onset several weeks patient treated medications unrelenting patient imaging studies showed evidence cervical spondylosis herniated disk stenosis cc cc cc patient underwent liver surgery postoperatively main issue degree right shoulder pain operative site soreness treated well iv morphine patient resolution pain arm tingling right thumb right index finger patient apparently well slight dysphagia treated decadron send home medrol patient continued pain medication coverage darvocet flexeril patient follow scheduled instructions given

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES,1. Neck pain with right upper extremity radiculopathy.,2. Cervical spondylosis with herniated nucleus pulposus C4-C5, C5-C6, and C6-C7 with stenosis.,DISCHARGE DIAGNOSES,1. Neck pain with right upper extremity radiculopathy.,2. Cervical spondylosis with herniated nucleus pulposus C4-C5, C5-C6, and C6-C7 with stenosis.,OPERATIVE PROCEDURES,1. Anterior cervical discectomy with decompression C4-C5, C5-C6, and C6-C7.,2. Arthrodesis with anterior interbody fusion C4-C5, C5-C6, and C6-C7.,3. Spinal instrumentation C4 through C7.,4. Implant.,5. Allograft.,COMPLICATIONS:, None.,COURSE ON ADMISSION: , This is the case of a very pleasant 41-year-old Caucasian female who was seen in clinic as an initial consultation on 09/13/07 complaining of intense neck pain radiating to the right shoulder blade to top of the right shoulder in to the right upper extremity to the patient's hand. The patient's symptoms have been persistent and had gotten worse with subjective weakness of the right upper extremity since its onset for several weeks now. The patient has been treated with medications, which has been unrelenting. The patient had imaging studies that showed evidence of cervical spondylosis with herniated disk and stenosis at C4-C5, C5-C6 and C6-C7. The patient underwent liver surgery and postoperatively her main issue was that of some degree of on and off right shoulder pain and some operative site soreness, which was treated well with IV morphine. The patient has resolution of the pain down the arm, but she does have some tingling of the right thumb and right index finger. The patient apparently is doing well with slight dysphagia, we treated her with Decadron and we will send her home with Medrol. The patient will have continued pain medication coverage with Darvocet and Flexeril. The patient will follow up with me as scheduled. Instructions have been given. ### Response: Discharge Summary, Orthopedic

ADMISSION DIAGNOSES: ,Fracture of the right femoral neck, also history of Alzheimer's dementia, and hypothyroidism.,DISCHARGE DIAGNOSES: , Fracture of the right femoral neck, also history of Alzheimer's dementia, hypothyroidism, and status post hemiarthroplasty of the hip.,PROCEDURE PERFORMED: ,Hemiarthroplasty, right hip.,CONSULTATIONS: ,Medicine for management of multiple medical problems including Alzheimer's.,HOSPITAL COURSE: , The patient was admitted on 08/06/2007 after a fall with subsequent fracture of the right hip. The patient was admitted to Orthopedics and consulted Medicine. The patient was actually taken to the operating room, consent signed by durable power of attorney, taken on 08/06/2007, had right hip hemiarthroplasty, recovered without incidence. The patient had continued confusion and dementia, which is apparently his baseline secondary to his Alzheimer's. Brief elevation of white count following the surgery, which did subside. Studies, UA and blood culture were negative. The patient was stable and was discharged to Heartland.,CONDITION ON DISCHARGE: , Stable.,DISCHARGE INSTRUCTIONS:, Transfer to ABC for rehab and continued care. Diabetic diet. Activity, ambulate as tolerated with posterior hip precautions. Rehab potential fair. He will need nursing, Social Work, PT/OT, and nutrition consults. Resume home meds, DVT prophylaxis, aspirin, and compression stockings. Follow up Dr. X in one to two weeks; call 123-4567 for an appointment.

admission diagnoses fracture right femoral neck also history alzheimers dementia hypothyroidismdischarge diagnoses fracture right femoral neck also history alzheimers dementia hypothyroidism status post hemiarthroplasty hipprocedure performed hemiarthroplasty right hipconsultations medicine management multiple medical problems including alzheimershospital course patient admitted fall subsequent fracture right hip patient admitted orthopedics consulted medicine patient actually taken operating room consent signed durable power attorney taken right hip hemiarthroplasty recovered without incidence patient continued confusion dementia apparently baseline secondary alzheimers brief elevation white count following surgery subside studies ua blood culture negative patient stable discharged heartlandcondition discharge stabledischarge instructions transfer abc rehab continued care diabetic diet activity ambulate tolerated posterior hip precautions rehab potential fair need nursing social work ptot nutrition consults resume home meds dvt prophylaxis aspirin compression stockings follow dr x one two weeks call appointment

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES: ,Fracture of the right femoral neck, also history of Alzheimer's dementia, and hypothyroidism.,DISCHARGE DIAGNOSES: , Fracture of the right femoral neck, also history of Alzheimer's dementia, hypothyroidism, and status post hemiarthroplasty of the hip.,PROCEDURE PERFORMED: ,Hemiarthroplasty, right hip.,CONSULTATIONS: ,Medicine for management of multiple medical problems including Alzheimer's.,HOSPITAL COURSE: , The patient was admitted on 08/06/2007 after a fall with subsequent fracture of the right hip. The patient was admitted to Orthopedics and consulted Medicine. The patient was actually taken to the operating room, consent signed by durable power of attorney, taken on 08/06/2007, had right hip hemiarthroplasty, recovered without incidence. The patient had continued confusion and dementia, which is apparently his baseline secondary to his Alzheimer's. Brief elevation of white count following the surgery, which did subside. Studies, UA and blood culture were negative. The patient was stable and was discharged to Heartland.,CONDITION ON DISCHARGE: , Stable.,DISCHARGE INSTRUCTIONS:, Transfer to ABC for rehab and continued care. Diabetic diet. Activity, ambulate as tolerated with posterior hip precautions. Rehab potential fair. He will need nursing, Social Work, PT/OT, and nutrition consults. Resume home meds, DVT prophylaxis, aspirin, and compression stockings. Follow up Dr. X in one to two weeks; call 123-4567 for an appointment. ### Response: Discharge Summary, Orthopedic

ADMISSION DIAGNOSES: , Hyperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, and hypertension.,DISCHARGE DIAGNOSES: , Hyperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, hypertension, and cholecystitis.,PROCEDURE: , Laparoscopic cholecystectomy.,SERVICE: , Surgery.,HISTORY OF PRESENT ILLNESS:, Ms. ABC is a 57-year-old woman. She suffers from morbid obesity. She also has diabetes and obstructive sleep apnea. She was evaluated in the Bariatric Surgical Center for placement of a band. During her workup, she was noted to have evidence of cholelithiasis. It was felt that the patient would benefit from removal of her gallbladder prior to having band placement secondary to her diabetes and the risk of infection of the band. The patient was scheduled to undergo her procedure on 12/31/09; however, at blood glucose check, the patient was noted to be hyperglycemic, her sugar was 438. She was admitted to the hospital for treatment of her hyperglycemia.,HOSPITAL COURSE: , Ms. ABC was admitted to the hospital. She was seen by Dr. A. He put her on an insulin drip. Her sugars slowly did come down to normal down to between 115 and 134. On the next day, she was then taken to the operating room, where she underwent her laparoscopic cholecystectomy. She was noted to be a difficult intubation for the procedure. There were some indications of chronic cholecystitis, a little bit of edema, mild edema and adhesions of omentum around the gallbladder. She underwent the procedure. She tolerated without difficulty. She was recovered in the Postoperative Care Unit and then returned to the floor. Her blood sugar postprocedure was noted to be 233. She was started back on a sliding scale insulin. She continued to do well and was felt to be stable for discharge following the procedure.,DISCHARGE INSTRUCTIONS: ,To return to the Medifast diet. To continue with her blood glucose. She needs to follow up with Dr. B, and she will see me next week on Friday. We will determine if we will proceed with her lap band at that time. She may shower. She needs to keep her wounds clean and dry. No heavy lifting. No driving on narcotic pain medicines. She needs to continue with her CPAP machine and continue to monitor her sugars.

admission diagnoses hyperglycemia cholelithiasis obstructive sleep apnea diabetes mellitus hypertensiondischarge diagnoses hyperglycemia cholelithiasis obstructive sleep apnea diabetes mellitus hypertension cholecystitisprocedure laparoscopic cholecystectomyservice surgeryhistory present illness ms abc yearold woman suffers morbid obesity also diabetes obstructive sleep apnea evaluated bariatric surgical center placement band workup noted evidence cholelithiasis felt patient would benefit removal gallbladder prior band placement secondary diabetes risk infection band patient scheduled undergo procedure however blood glucose check patient noted hyperglycemic sugar admitted hospital treatment hyperglycemiahospital course ms abc admitted hospital seen dr put insulin drip sugars slowly come normal next day taken operating room underwent laparoscopic cholecystectomy noted difficult intubation procedure indications chronic cholecystitis little bit edema mild edema adhesions omentum around gallbladder underwent procedure tolerated without difficulty recovered postoperative care unit returned floor blood sugar postprocedure noted started back sliding scale insulin continued well felt stable discharge following proceduredischarge instructions return medifast diet continue blood glucose needs follow dr b see next week friday determine proceed lap band time may shower needs keep wounds clean dry heavy lifting driving narcotic pain medicines needs continue cpap machine continue monitor sugars

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES: , Hyperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, and hypertension.,DISCHARGE DIAGNOSES: , Hyperglycemia, cholelithiasis, obstructive sleep apnea, diabetes mellitus, hypertension, and cholecystitis.,PROCEDURE: , Laparoscopic cholecystectomy.,SERVICE: , Surgery.,HISTORY OF PRESENT ILLNESS:, Ms. ABC is a 57-year-old woman. She suffers from morbid obesity. She also has diabetes and obstructive sleep apnea. She was evaluated in the Bariatric Surgical Center for placement of a band. During her workup, she was noted to have evidence of cholelithiasis. It was felt that the patient would benefit from removal of her gallbladder prior to having band placement secondary to her diabetes and the risk of infection of the band. The patient was scheduled to undergo her procedure on 12/31/09; however, at blood glucose check, the patient was noted to be hyperglycemic, her sugar was 438. She was admitted to the hospital for treatment of her hyperglycemia.,HOSPITAL COURSE: , Ms. ABC was admitted to the hospital. She was seen by Dr. A. He put her on an insulin drip. Her sugars slowly did come down to normal down to between 115 and 134. On the next day, she was then taken to the operating room, where she underwent her laparoscopic cholecystectomy. She was noted to be a difficult intubation for the procedure. There were some indications of chronic cholecystitis, a little bit of edema, mild edema and adhesions of omentum around the gallbladder. She underwent the procedure. She tolerated without difficulty. She was recovered in the Postoperative Care Unit and then returned to the floor. Her blood sugar postprocedure was noted to be 233. She was started back on a sliding scale insulin. She continued to do well and was felt to be stable for discharge following the procedure.,DISCHARGE INSTRUCTIONS: ,To return to the Medifast diet. To continue with her blood glucose. She needs to follow up with Dr. B, and she will see me next week on Friday. We will determine if we will proceed with her lap band at that time. She may shower. She needs to keep her wounds clean and dry. No heavy lifting. No driving on narcotic pain medicines. She needs to continue with her CPAP machine and continue to monitor her sugars. ### Response: Discharge Summary, General Medicine

ADMISSION DIAGNOSES:,1. Atypical chest pain.,2. Nausea.,3. Vomiting.,4. Diabetes.,5. Hypokalemia.,6. Diarrhea.,7. Panic and depression.,8. Hypertension.,DISCHARGE DIAGNOSES:,1. Serotonin syndrome secondary to high doses of Prozac.,2. Atypical chest pain with myocardial infarction ruled out.,3. Diabetes mellitus.,4. Hypertension.,5. Diarrhea resolved.,ADMISSION SUMMARY: , The patient is a 53-year-old woman with history of hypertension, diabetes, and depression. Unfortunately her husband left her 10 days prior to admission and she developed severe anxiety and depression. She was having chest pains along with significant vomiting and diarrhea. Of note, she had a nuclear stress test performed in February of this year, which was normal. She was readmitted to the hospital to rule out myocardial infarction and for further evaluation.,ADMISSION PHYSICAL: , Significant for her being afebrile. Apparently there was one temperature registered mildly high at 100. Her blood pressure was 140/82, heart rate 83, oxygen saturation was 100%. She was tearful. HEART: Heart sounds were regular. LUNGS: Clear. ABDOMEN: Soft. Apparently there were some level of restlessness and acathexia. She was also pacing.,ADMISSION LABS: ,Showed CBC with a white count of 16.9, hematocrit of 46.9, platelets 318,000. She had 80% neutrophils, no bands. UA on 05/02 came out negative. Chemistry panel shows sodium 138, potassium 3.5, creatinine 0.6, calcium 8.3, lactate 0.9, ALT was 39, AST 38, total bilirubin 0.6. Her initial CK came out at 922. CK-MB was low. Troponin was 0.04. She had a normal amylase and lipase. Previous TSH few days prior was normal. Chest x-ray was negative.,HOSPITAL COURSE:,1. Serotonin syndrome. After reevaluation of the patient including evaluation of the lab abnormalities it was felt that she likely had serotonin syndrome with obvious restlessness, increased bowel activity, agitation, and elevated white count and CPK. She did not have fever, tremor or hyperreflexia. Her CPK improved with IV fluids. She dramatically improved with this discontinuation of her Prozac. Her white count came back down towards normal. At time of discharge, she was really feeling back to normal.,2. Depression and anxiety with history of panic attacks exacerbated by her husband leaving her 2 weeks ago. We discussed this. Also, discussed the situation with a psychiatrist who is available on Friday and I discussed the situation with the patient. In regards to her medications, we are discontinuing the Prozac and she is being reevaluated by Dr. X on Monday or Tuesday. Cymbalta has been recommended as a good alternative medication for her. The patient does have a counselor. It is going to be difficult for her to go home alone. I discussed the resources with her. She has a daughter who will be coming to town in a couple of weeks, but she does have a friend that she can call and stay the next few days with.,3. Hypertension. She will continue on her usual medications.,4. Diabetes mellitus. She will continue on her usual medications.,5. Diarrhea resolved. Her electrolyte abnormalities resolved. She had received fluid rehydration.,DISPOSITION:, She is being discharged to home. She will stay with a friend for a couple of days. She will be following up with Dr. X on Monday or Tuesday. Apparently Dr. Y has already discussed the situation and the plan with her. She will continue on her usual medications except for discontinuing the Prozac.,DISCHARGE MEDICATIONS: , Include,1. Omeprazole 20 mg daily.,2. Temazepam 15 mg at night.,3. Ativan 1 mg one-half to one three times a day as needed.,4. Cozaar 50 daily.,5. Prandin 1 mg before meals.,6. Aspirin 81 mg.,7. Multivitamin daily.,8. Lantus 60 units at bedtime.,9. Percocet 10/325 one to two at night for chronic pain. She is running out of that, so we are calling a prescription for #10 of those.

admission diagnoses atypical chest pain nausea vomiting diabetes hypokalemia diarrhea panic depression hypertensiondischarge diagnoses serotonin syndrome secondary high doses prozac atypical chest pain myocardial infarction ruled diabetes mellitus hypertension diarrhea resolvedadmission summary patient yearold woman history hypertension diabetes depression unfortunately husband left days prior admission developed severe anxiety depression chest pains along significant vomiting diarrhea note nuclear stress test performed february year normal readmitted hospital rule myocardial infarction evaluationadmission physical significant afebrile apparently one temperature registered mildly high blood pressure heart rate oxygen saturation tearful heart heart sounds regular lungs clear abdomen soft apparently level restlessness acathexia also pacingadmission labs showed cbc white count hematocrit platelets neutrophils bands ua came negative chemistry panel shows sodium potassium creatinine calcium lactate alt ast total bilirubin initial ck came ckmb low troponin normal amylase lipase previous tsh days prior normal chest xray negativehospital course serotonin syndrome reevaluation patient including evaluation lab abnormalities felt likely serotonin syndrome obvious restlessness increased bowel activity agitation elevated white count cpk fever tremor hyperreflexia cpk improved iv fluids dramatically improved discontinuation prozac white count came back towards normal time discharge really feeling back normal depression anxiety history panic attacks exacerbated husband leaving weeks ago discussed also discussed situation psychiatrist available friday discussed situation patient regards medications discontinuing prozac reevaluated dr x monday tuesday cymbalta recommended good alternative medication patient counselor going difficult go home alone discussed resources daughter coming town couple weeks friend call stay next days hypertension continue usual medications diabetes mellitus continue usual medications diarrhea resolved electrolyte abnormalities resolved received fluid rehydrationdisposition discharged home stay friend couple days following dr x monday tuesday apparently dr already discussed situation plan continue usual medications except discontinuing prozacdischarge medications include omeprazole mg daily temazepam mg night ativan mg onehalf one three times day needed cozaar daily prandin mg meals aspirin mg multivitamin daily lantus units bedtime percocet one two night chronic pain running calling prescription

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES:,1. Atypical chest pain.,2. Nausea.,3. Vomiting.,4. Diabetes.,5. Hypokalemia.,6. Diarrhea.,7. Panic and depression.,8. Hypertension.,DISCHARGE DIAGNOSES:,1. Serotonin syndrome secondary to high doses of Prozac.,2. Atypical chest pain with myocardial infarction ruled out.,3. Diabetes mellitus.,4. Hypertension.,5. Diarrhea resolved.,ADMISSION SUMMARY: , The patient is a 53-year-old woman with history of hypertension, diabetes, and depression. Unfortunately her husband left her 10 days prior to admission and she developed severe anxiety and depression. She was having chest pains along with significant vomiting and diarrhea. Of note, she had a nuclear stress test performed in February of this year, which was normal. She was readmitted to the hospital to rule out myocardial infarction and for further evaluation.,ADMISSION PHYSICAL: , Significant for her being afebrile. Apparently there was one temperature registered mildly high at 100. Her blood pressure was 140/82, heart rate 83, oxygen saturation was 100%. She was tearful. HEART: Heart sounds were regular. LUNGS: Clear. ABDOMEN: Soft. Apparently there were some level of restlessness and acathexia. She was also pacing.,ADMISSION LABS: ,Showed CBC with a white count of 16.9, hematocrit of 46.9, platelets 318,000. She had 80% neutrophils, no bands. UA on 05/02 came out negative. Chemistry panel shows sodium 138, potassium 3.5, creatinine 0.6, calcium 8.3, lactate 0.9, ALT was 39, AST 38, total bilirubin 0.6. Her initial CK came out at 922. CK-MB was low. Troponin was 0.04. She had a normal amylase and lipase. Previous TSH few days prior was normal. Chest x-ray was negative.,HOSPITAL COURSE:,1. Serotonin syndrome. After reevaluation of the patient including evaluation of the lab abnormalities it was felt that she likely had serotonin syndrome with obvious restlessness, increased bowel activity, agitation, and elevated white count and CPK. She did not have fever, tremor or hyperreflexia. Her CPK improved with IV fluids. She dramatically improved with this discontinuation of her Prozac. Her white count came back down towards normal. At time of discharge, she was really feeling back to normal.,2. Depression and anxiety with history of panic attacks exacerbated by her husband leaving her 2 weeks ago. We discussed this. Also, discussed the situation with a psychiatrist who is available on Friday and I discussed the situation with the patient. In regards to her medications, we are discontinuing the Prozac and she is being reevaluated by Dr. X on Monday or Tuesday. Cymbalta has been recommended as a good alternative medication for her. The patient does have a counselor. It is going to be difficult for her to go home alone. I discussed the resources with her. She has a daughter who will be coming to town in a couple of weeks, but she does have a friend that she can call and stay the next few days with.,3. Hypertension. She will continue on her usual medications.,4. Diabetes mellitus. She will continue on her usual medications.,5. Diarrhea resolved. Her electrolyte abnormalities resolved. She had received fluid rehydration.,DISPOSITION:, She is being discharged to home. She will stay with a friend for a couple of days. She will be following up with Dr. X on Monday or Tuesday. Apparently Dr. Y has already discussed the situation and the plan with her. She will continue on her usual medications except for discontinuing the Prozac.,DISCHARGE MEDICATIONS: , Include,1. Omeprazole 20 mg daily.,2. Temazepam 15 mg at night.,3. Ativan 1 mg one-half to one three times a day as needed.,4. Cozaar 50 daily.,5. Prandin 1 mg before meals.,6. Aspirin 81 mg.,7. Multivitamin daily.,8. Lantus 60 units at bedtime.,9. Percocet 10/325 one to two at night for chronic pain. She is running out of that, so we are calling a prescription for #10 of those. ### Response: Discharge Summary, General Medicine

ADMISSION DIAGNOSES:,1. Menometrorrhagia.,2. Dysmenorrhea.,3. Small uterine fibroids.,DISCHARGE DIAGNOSES:,1. Menorrhagia.,2. Dysmenorrhea.,3. Small uterine fibroids.,OPERATION PERFORMED: ,Total vaginal hysterectomy.,BRIEF HISTORY AND PHYSICAL: ,The patient is a 42 year-old white female, gravida 3, para 2, with two prior vaginal deliveries. She is having increasing menometrorrhagia and dysmenorrhea. Ultrasound shows a small uterine fibroid. She has failed oral contraceptives and surgical therapy is planned.,PAST HISTORY: , Significant for reflux.,SURGICAL HISTORY: ,Tubal ligation.,PHYSICAL EXAMINATION: , A top normal sized uterus with normal adnexa.,LABORATORY VALUES: ,Her discharge hemoglobin is 12.4.,HOSPITAL COURSE: , She was taken to the operating room on 11/05/07 where a total vaginal hysterectomy was performed under general anesthesia. Postoperatively, she has done well. Bowel and bladder function have returned normally. She is ambulating well, tolerating a regular diet. Routine postoperative instructions given and said follow up will be in four weeks in the office.,DISCHARGE MEDICATIONS: , Preoperative meds plus Vicodin for pain.,DISCHARGE CONDITION: , Good.

admission diagnoses menometrorrhagia dysmenorrhea small uterine fibroidsdischarge diagnoses menorrhagia dysmenorrhea small uterine fibroidsoperation performed total vaginal hysterectomybrief history physical patient yearold white female gravida para two prior vaginal deliveries increasing menometrorrhagia dysmenorrhea ultrasound shows small uterine fibroid failed oral contraceptives surgical therapy plannedpast history significant refluxsurgical history tubal ligationphysical examination top normal sized uterus normal adnexalaboratory values discharge hemoglobin hospital course taken operating room total vaginal hysterectomy performed general anesthesia postoperatively done well bowel bladder function returned normally ambulating well tolerating regular diet routine postoperative instructions given said follow four weeks officedischarge medications preoperative meds plus vicodin paindischarge condition good

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES:,1. Menometrorrhagia.,2. Dysmenorrhea.,3. Small uterine fibroids.,DISCHARGE DIAGNOSES:,1. Menorrhagia.,2. Dysmenorrhea.,3. Small uterine fibroids.,OPERATION PERFORMED: ,Total vaginal hysterectomy.,BRIEF HISTORY AND PHYSICAL: ,The patient is a 42 year-old white female, gravida 3, para 2, with two prior vaginal deliveries. She is having increasing menometrorrhagia and dysmenorrhea. Ultrasound shows a small uterine fibroid. She has failed oral contraceptives and surgical therapy is planned.,PAST HISTORY: , Significant for reflux.,SURGICAL HISTORY: ,Tubal ligation.,PHYSICAL EXAMINATION: , A top normal sized uterus with normal adnexa.,LABORATORY VALUES: ,Her discharge hemoglobin is 12.4.,HOSPITAL COURSE: , She was taken to the operating room on 11/05/07 where a total vaginal hysterectomy was performed under general anesthesia. Postoperatively, she has done well. Bowel and bladder function have returned normally. She is ambulating well, tolerating a regular diet. Routine postoperative instructions given and said follow up will be in four weeks in the office.,DISCHARGE MEDICATIONS: , Preoperative meds plus Vicodin for pain.,DISCHARGE CONDITION: , Good. ### Response: Discharge Summary, Obstetrics / Gynecology

ADMISSION DIAGNOSES:,1. Menorrhagia.,2. Uterus enlargement.,3. Pelvic pain.,DISCHARGE DIAGNOSIS: , Status post vaginal hysterectomy.,COMPLICATIONS: , None.,BRIEF HISTORY OF PRESENT ILLNESS: , This is a 36-year-old, gravida 3, para 3 female who presented initially to the office with abnormal menstrual bleeding and increase in flow during her period. She also had symptoms of back pain, dysmenorrhea, and dysuria. The symptoms had been worsening over time. The patient was noted also to have increasing pelvic pain over the past 8 months and she was noted to have uterine enlargement upon examination.,PROCEDURE:, The patient underwent a total vaginal hysterectomy.,HOSPITAL COURSE: ,The patient was admitted on 09/04/2007 to undergo total vaginal hysterectomy. The procedure preceded as planned without complication. Uterus was sent for pathologic analysis. The patient was monitored in the hospital, 2 days postoperatively. She recovered quite well and vitals remained stable.,Laboratory studies, H&H were followed and appeared stable on 09/05/2007 with hemoglobin of 11.2 and hematocrit of 31.8.,The patient was ready for discharge on Monday morning of 09/06/2007.,LABORATORY FINDINGS: , Please see chart for full studies during admission.,DISPOSITION: ,The patient was discharged to home in stable condition. She was instructed to follow up in the office postoperatively.

admission diagnoses menorrhagia uterus enlargement pelvic paindischarge diagnosis status post vaginal hysterectomycomplications nonebrief history present illness yearold gravida para female presented initially office abnormal menstrual bleeding increase flow period also symptoms back pain dysmenorrhea dysuria symptoms worsening time patient noted also increasing pelvic pain past months noted uterine enlargement upon examinationprocedure patient underwent total vaginal hysterectomyhospital course patient admitted undergo total vaginal hysterectomy procedure preceded planned without complication uterus sent pathologic analysis patient monitored hospital days postoperatively recovered quite well vitals remained stablelaboratory studies hh followed appeared stable hemoglobin hematocrit patient ready discharge monday morning laboratory findings please see chart full studies admissiondisposition patient discharged home stable condition instructed follow office postoperatively

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES:,1. Menorrhagia.,2. Uterus enlargement.,3. Pelvic pain.,DISCHARGE DIAGNOSIS: , Status post vaginal hysterectomy.,COMPLICATIONS: , None.,BRIEF HISTORY OF PRESENT ILLNESS: , This is a 36-year-old, gravida 3, para 3 female who presented initially to the office with abnormal menstrual bleeding and increase in flow during her period. She also had symptoms of back pain, dysmenorrhea, and dysuria. The symptoms had been worsening over time. The patient was noted also to have increasing pelvic pain over the past 8 months and she was noted to have uterine enlargement upon examination.,PROCEDURE:, The patient underwent a total vaginal hysterectomy.,HOSPITAL COURSE: ,The patient was admitted on 09/04/2007 to undergo total vaginal hysterectomy. The procedure preceded as planned without complication. Uterus was sent for pathologic analysis. The patient was monitored in the hospital, 2 days postoperatively. She recovered quite well and vitals remained stable.,Laboratory studies, H&H were followed and appeared stable on 09/05/2007 with hemoglobin of 11.2 and hematocrit of 31.8.,The patient was ready for discharge on Monday morning of 09/06/2007.,LABORATORY FINDINGS: , Please see chart for full studies during admission.,DISPOSITION: ,The patient was discharged to home in stable condition. She was instructed to follow up in the office postoperatively. ### Response: Discharge Summary, Obstetrics / Gynecology

ADMISSION DIAGNOSES:,1. Pneumonia, failed outpatient treatment.,2. Hypoxia.,3. Rheumatoid arthritis.,DISCHARGE DIAGNOSES:,1. Atypical pneumonia, suspected viral.,2. Hypoxia.,3. Rheumatoid arthritis.,4. Suspected mild stress-induced adrenal insufficiency.,HOSPITAL COURSE: , This very independent 79-year old had struggled with cough, fevers, weakness, and chills for the week prior to admission. She was seen on multiple occasions at Urgent Care and in her physician's office. Initial x-ray showed some mild diffuse patchy infiltrates. She was first started on Avelox, but had a reaction, switched to Augmentin, which caused loose stools, and then three days prior to admission was given daily 1 g Rocephin and started on azithromycin. Her O2 saturations drifted downward. They were less than 88% when active; at rest, varied between 88% and 92%. Decision was made because of failed outpatient treatment of pneumonia. Her medical history is significant for rheumatoid arthritis. She is on 20 mg of methotrexate every week as well as Remicade every eight weeks. Her last dose of Remicade was in the month of June. Hospital course was relatively unremarkable. CT scan was performed and no specific focal pathology was seen. Dr. X, pulmonologist was consulted. He also was uncertain as to the exact etiology, but viral etiology was most highly suspected. Because of her loose stools, C. difficile toxin was ordered, although that is pending at the time of discharge. She was continued on Rocephin IV and azithromycin. Her fever broke 18 hours prior to discharge, and O2 saturations improved, as did her overall strength and clinical status. She was instructed to finish azithromycin. She has two pills left at home. She is to follow up with Dr. X in two to three days. Because she is on chronic prednisone therapy, it was suspected that she was mildly adrenal insufficient from the stress of her pneumonia. She is to continue the increased dose of prednisone at 20 mg (up from 5 mg per day). We will consult her rheumatologist as to whether to continue her methotrexate, which we held this past Friday. Methotrexate is known on some occasions to cause pneumonitis.

admission diagnoses pneumonia failed outpatient treatment hypoxia rheumatoid arthritisdischarge diagnoses atypical pneumonia suspected viral hypoxia rheumatoid arthritis suspected mild stressinduced adrenal insufficiencyhospital course independent year old struggled cough fevers weakness chills week prior admission seen multiple occasions urgent care physicians office initial xray showed mild diffuse patchy infiltrates first started avelox reaction switched augmentin caused loose stools three days prior admission given daily g rocephin started azithromycin saturations drifted downward less active rest varied decision made failed outpatient treatment pneumonia medical history significant rheumatoid arthritis mg methotrexate every week well remicade every eight weeks last dose remicade month june hospital course relatively unremarkable ct scan performed specific focal pathology seen dr x pulmonologist consulted also uncertain exact etiology viral etiology highly suspected loose stools c difficile toxin ordered although pending time discharge continued rocephin iv azithromycin fever broke hours prior discharge saturations improved overall strength clinical status instructed finish azithromycin two pills left home follow dr x two three days chronic prednisone therapy suspected mildly adrenal insufficient stress pneumonia continue increased dose prednisone mg mg per day consult rheumatologist whether continue methotrexate held past friday methotrexate known occasions cause pneumonitis

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES:,1. Pneumonia, failed outpatient treatment.,2. Hypoxia.,3. Rheumatoid arthritis.,DISCHARGE DIAGNOSES:,1. Atypical pneumonia, suspected viral.,2. Hypoxia.,3. Rheumatoid arthritis.,4. Suspected mild stress-induced adrenal insufficiency.,HOSPITAL COURSE: , This very independent 79-year old had struggled with cough, fevers, weakness, and chills for the week prior to admission. She was seen on multiple occasions at Urgent Care and in her physician's office. Initial x-ray showed some mild diffuse patchy infiltrates. She was first started on Avelox, but had a reaction, switched to Augmentin, which caused loose stools, and then three days prior to admission was given daily 1 g Rocephin and started on azithromycin. Her O2 saturations drifted downward. They were less than 88% when active; at rest, varied between 88% and 92%. Decision was made because of failed outpatient treatment of pneumonia. Her medical history is significant for rheumatoid arthritis. She is on 20 mg of methotrexate every week as well as Remicade every eight weeks. Her last dose of Remicade was in the month of June. Hospital course was relatively unremarkable. CT scan was performed and no specific focal pathology was seen. Dr. X, pulmonologist was consulted. He also was uncertain as to the exact etiology, but viral etiology was most highly suspected. Because of her loose stools, C. difficile toxin was ordered, although that is pending at the time of discharge. She was continued on Rocephin IV and azithromycin. Her fever broke 18 hours prior to discharge, and O2 saturations improved, as did her overall strength and clinical status. She was instructed to finish azithromycin. She has two pills left at home. She is to follow up with Dr. X in two to three days. Because she is on chronic prednisone therapy, it was suspected that she was mildly adrenal insufficient from the stress of her pneumonia. She is to continue the increased dose of prednisone at 20 mg (up from 5 mg per day). We will consult her rheumatologist as to whether to continue her methotrexate, which we held this past Friday. Methotrexate is known on some occasions to cause pneumonitis. ### Response: Cardiovascular / Pulmonary, Discharge Summary, General Medicine

ADMISSION DIAGNOSES:,1. Pneumonia, likely secondary to aspiration.,2. Chronic obstructive pulmonary disease (COPD) exacerbation.,3. Systemic inflammatory response syndrome.,4. Hyperglycemia.,DISCHARGE DIAGNOSES:,1. Aspiration pneumonia.,2. Aspiration disorder in setting of severe chronic obstructive pulmonary disease.,3. Chronic obstructive pulmonary disease (COPD) exacerbation.,4. Acute respiratory on chronic respiratory failure secondary to chronic obstructive pulmonary disease exacerbation.,5. Hypercapnia on admission secondary to chronic obstructive pulmonary disease.,6. Systemic inflammatory response syndrome secondary to aspiration pneumonia. No bacteria identified with blood cultures or sputum culture.,7. Atrial fibrillation with episodic rapid ventricular rate, now rate control.,8. Hyperglycemia secondary to poorly controlled type ii diabetes mellitus, insulin requiring.,9. Benign essential hypertension, poorly controlled on admission, now well controlled on discharge.,10. Aspiration disorder exacerbated by chronic obstructive pulmonary disease and acute respiratory failure.,11. Hyperlipidemia.,12. Acute renal failure on chronic renal failure on admission, now resolved.,HISTORY OF PRESENT ILLNESS:, Briefly, this is 73-year-old white male with history of multiple hospital admissions for COPD exacerbation and pneumonia who presented to the emergency room on 04/23/08, complaining of severe shortness of breath. The patient received 3 nebulizers at home without much improvement. He was subsequently treated successfully with supplemental oxygen provided by normal nasal cannula initially and subsequently changed to BiPAP.,HOSPITAL COURSE: ,The patient was admitted to the hospitalist service, treated with frequent small volume nebulizers, treated with IV Solu-Medrol and BiPAP support for COPD exacerbation. The patient also noted with poorly controlled atrial fibrillation with a rate in the low 100s to mid 100s. The patient subsequently received diltiazem, also received p.o. digoxin. The patient subsequently responded well as well received IV antibiotics including Levaquin and Zosyn. The patient made slow, but steady improvement over the course of his hospitalization. The patient subsequently was able to be weaned off BiPAP during the day, but continued BiPAP at night and will continue with BiPAP if needed. The patient may require a sleep study after discharge, but by the third day prior to discharge he was no longer utilizing BiPAP, was simply using supplemental O2 at night and was able to maintain appropriate and satisfactory O2 saturations on one-liter per minute supplemental O2 per nasal cannula. The patient was able to participate with physical therapy, able to ambulate from his bed to the bathroom, and was able to tolerate a dysphagia 2 diet. Note that speech therapy did provide a consultation during this hospitalization and his modified barium swallow was thought to be unremarkable and really related only to the patient's severe shortness of breath during meal time. The patient's chest x-ray on admission revealed some mild vascular congestion and bilateral pleural effusions that appeared to be unchanged. There was also more pronounced patchy alveolar opacity, which appeared to be, "mass like" in the right suprahilar region. This subsequently resolved and the patient's infiltrate slowly improved over the course of his hospitalization. On the day prior to discharge, the patient had a chest x-ray 2 views, which allowing for differences in technique revealed little change in the bibasilar infiltrates and atelectatic changes at the bases bilaterally. This was compared with an examination performed 3 days prior. The patient also had minimal bilateral effusions. The patient will continue with clindamycin for the next 2 weeks after discharge. Home health has been ordered and the case has been discussed in detail with Shaun Eagan, physician assistant at Eureka Community Health Center. The patient was discharged as well on a dysphagia 2 diet, thin liquids are okay. The patient discharged on the following medications.,DISCHARGE MEDICATIONS:,1. Home oxygen 1 to 2 liters to maintain O2 saturations at 89 to 91% at all times.,2. Ativan 1 mg p.o. t.i.d.,3. Metformin 1000 mg p.o. b.i.d.,4. Glucotrol 5 mg p.o. daily.,5. Spiriva 1 puff b.i.d.,6. Lantus 25 units subcu q.a.m.,7. Cardizem CD 180 mg p.o. q.a.m.,8. Advair 250/50 mcg, 1 puff b.i.d. The patient is instructed to rinse with mouthwash after each use.,9. Iron 325 mg p.o. b.i.d.,10. Aspirin 325 mg p.o. daily.,11. Lipitor 10 mg p.o. bedtime.,12. Digoxin 0.25 mg p.o. daily.,13. Lisinopril 20 mg p.o. q.a.m.,14. DuoNeb every 4 hours for the next several weeks, then q.6 h. thereafter, dispensed 180 DuoNeb ampule's with one refill.,15. Prednisone 40 mg p.o. q.a.m. x3 days followed by 30 mg p.o. q.a.m. x3 days, then followed by 20 mg p.o. q.a.m. x5 days, then 10 mg p.o. q.a.m. x14 days, then discontinue, #30 days supply given. No refills.,16. Clindamycin 300 mg p.o. q.i.d. x2 weeks, dispensed #64 with one refill.,The patient's aspiration pneumonia was discussed in detail. He is agreeable to obtaining a chest x-ray PA and lateral after 2 weeks of treatment. Note that this patient did not have community-acquired pneumonia. His discharge diagnosis is aspiration pneumonia. The patient will continue with a dysphagia 2 diet with thin liquids after discharge. The patient discharged with home health. A dietary and speech therapy evaluation has been ordered. Speech therapy to treat for chronic dysphagia and aspiration in the setting of severe chronic obstructive pulmonary disease.,Total discharge time was greater than 30 minutes.

admission diagnoses pneumonia likely secondary aspiration chronic obstructive pulmonary disease copd exacerbation systemic inflammatory response syndrome hyperglycemiadischarge diagnoses aspiration pneumonia aspiration disorder setting severe chronic obstructive pulmonary disease chronic obstructive pulmonary disease copd exacerbation acute respiratory chronic respiratory failure secondary chronic obstructive pulmonary disease exacerbation hypercapnia admission secondary chronic obstructive pulmonary disease systemic inflammatory response syndrome secondary aspiration pneumonia bacteria identified blood cultures sputum culture atrial fibrillation episodic rapid ventricular rate rate control hyperglycemia secondary poorly controlled type ii diabetes mellitus insulin requiring benign essential hypertension poorly controlled admission well controlled discharge aspiration disorder exacerbated chronic obstructive pulmonary disease acute respiratory failure hyperlipidemia acute renal failure chronic renal failure admission resolvedhistory present illness briefly yearold white male history multiple hospital admissions copd exacerbation pneumonia presented emergency room complaining severe shortness breath patient received nebulizers home without much improvement subsequently treated successfully supplemental oxygen provided normal nasal cannula initially subsequently changed bipaphospital course patient admitted hospitalist service treated frequent small volume nebulizers treated iv solumedrol bipap support copd exacerbation patient also noted poorly controlled atrial fibrillation rate low mid patient subsequently received diltiazem also received po digoxin patient subsequently responded well well received iv antibiotics including levaquin zosyn patient made slow steady improvement course hospitalization patient subsequently able weaned bipap day continued bipap night continue bipap needed patient may require sleep study discharge third day prior discharge longer utilizing bipap simply using supplemental night able maintain appropriate satisfactory saturations oneliter per minute supplemental per nasal cannula patient able participate physical therapy able ambulate bed bathroom able tolerate dysphagia diet note speech therapy provide consultation hospitalization modified barium swallow thought unremarkable really related patients severe shortness breath meal time patients chest xray admission revealed mild vascular congestion bilateral pleural effusions appeared unchanged also pronounced patchy alveolar opacity appeared mass like right suprahilar region subsequently resolved patients infiltrate slowly improved course hospitalization day prior discharge patient chest xray views allowing differences technique revealed little change bibasilar infiltrates atelectatic changes bases bilaterally compared examination performed days prior patient also minimal bilateral effusions patient continue clindamycin next weeks discharge home health ordered case discussed detail shaun eagan physician assistant eureka community health center patient discharged well dysphagia diet thin liquids okay patient discharged following medicationsdischarge medications home oxygen liters maintain saturations times ativan mg po tid metformin mg po bid glucotrol mg po daily spiriva puff bid lantus units subcu qam cardizem cd mg po qam advair mcg puff bid patient instructed rinse mouthwash use iron mg po bid aspirin mg po daily lipitor mg po bedtime digoxin mg po daily lisinopril mg po qam duoneb every hours next several weeks q h thereafter dispensed duoneb ampules one refill prednisone mg po qam x days followed mg po qam x days followed mg po qam x days mg po qam x days discontinue days supply given refills clindamycin mg po qid x weeks dispensed one refillthe patients aspiration pneumonia discussed detail agreeable obtaining chest xray pa lateral weeks treatment note patient communityacquired pneumonia discharge diagnosis aspiration pneumonia patient continue dysphagia diet thin liquids discharge patient discharged home health dietary speech therapy evaluation ordered speech therapy treat chronic dysphagia aspiration setting severe chronic obstructive pulmonary diseasetotal discharge time greater minutes

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES:,1. Pneumonia, likely secondary to aspiration.,2. Chronic obstructive pulmonary disease (COPD) exacerbation.,3. Systemic inflammatory response syndrome.,4. Hyperglycemia.,DISCHARGE DIAGNOSES:,1. Aspiration pneumonia.,2. Aspiration disorder in setting of severe chronic obstructive pulmonary disease.,3. Chronic obstructive pulmonary disease (COPD) exacerbation.,4. Acute respiratory on chronic respiratory failure secondary to chronic obstructive pulmonary disease exacerbation.,5. Hypercapnia on admission secondary to chronic obstructive pulmonary disease.,6. Systemic inflammatory response syndrome secondary to aspiration pneumonia. No bacteria identified with blood cultures or sputum culture.,7. Atrial fibrillation with episodic rapid ventricular rate, now rate control.,8. Hyperglycemia secondary to poorly controlled type ii diabetes mellitus, insulin requiring.,9. Benign essential hypertension, poorly controlled on admission, now well controlled on discharge.,10. Aspiration disorder exacerbated by chronic obstructive pulmonary disease and acute respiratory failure.,11. Hyperlipidemia.,12. Acute renal failure on chronic renal failure on admission, now resolved.,HISTORY OF PRESENT ILLNESS:, Briefly, this is 73-year-old white male with history of multiple hospital admissions for COPD exacerbation and pneumonia who presented to the emergency room on 04/23/08, complaining of severe shortness of breath. The patient received 3 nebulizers at home without much improvement. He was subsequently treated successfully with supplemental oxygen provided by normal nasal cannula initially and subsequently changed to BiPAP.,HOSPITAL COURSE: ,The patient was admitted to the hospitalist service, treated with frequent small volume nebulizers, treated with IV Solu-Medrol and BiPAP support for COPD exacerbation. The patient also noted with poorly controlled atrial fibrillation with a rate in the low 100s to mid 100s. The patient subsequently received diltiazem, also received p.o. digoxin. The patient subsequently responded well as well received IV antibiotics including Levaquin and Zosyn. The patient made slow, but steady improvement over the course of his hospitalization. The patient subsequently was able to be weaned off BiPAP during the day, but continued BiPAP at night and will continue with BiPAP if needed. The patient may require a sleep study after discharge, but by the third day prior to discharge he was no longer utilizing BiPAP, was simply using supplemental O2 at night and was able to maintain appropriate and satisfactory O2 saturations on one-liter per minute supplemental O2 per nasal cannula. The patient was able to participate with physical therapy, able to ambulate from his bed to the bathroom, and was able to tolerate a dysphagia 2 diet. Note that speech therapy did provide a consultation during this hospitalization and his modified barium swallow was thought to be unremarkable and really related only to the patient's severe shortness of breath during meal time. The patient's chest x-ray on admission revealed some mild vascular congestion and bilateral pleural effusions that appeared to be unchanged. There was also more pronounced patchy alveolar opacity, which appeared to be, "mass like" in the right suprahilar region. This subsequently resolved and the patient's infiltrate slowly improved over the course of his hospitalization. On the day prior to discharge, the patient had a chest x-ray 2 views, which allowing for differences in technique revealed little change in the bibasilar infiltrates and atelectatic changes at the bases bilaterally. This was compared with an examination performed 3 days prior. The patient also had minimal bilateral effusions. The patient will continue with clindamycin for the next 2 weeks after discharge. Home health has been ordered and the case has been discussed in detail with Shaun Eagan, physician assistant at Eureka Community Health Center. The patient was discharged as well on a dysphagia 2 diet, thin liquids are okay. The patient discharged on the following medications.,DISCHARGE MEDICATIONS:,1. Home oxygen 1 to 2 liters to maintain O2 saturations at 89 to 91% at all times.,2. Ativan 1 mg p.o. t.i.d.,3. Metformin 1000 mg p.o. b.i.d.,4. Glucotrol 5 mg p.o. daily.,5. Spiriva 1 puff b.i.d.,6. Lantus 25 units subcu q.a.m.,7. Cardizem CD 180 mg p.o. q.a.m.,8. Advair 250/50 mcg, 1 puff b.i.d. The patient is instructed to rinse with mouthwash after each use.,9. Iron 325 mg p.o. b.i.d.,10. Aspirin 325 mg p.o. daily.,11. Lipitor 10 mg p.o. bedtime.,12. Digoxin 0.25 mg p.o. daily.,13. Lisinopril 20 mg p.o. q.a.m.,14. DuoNeb every 4 hours for the next several weeks, then q.6 h. thereafter, dispensed 180 DuoNeb ampule's with one refill.,15. Prednisone 40 mg p.o. q.a.m. x3 days followed by 30 mg p.o. q.a.m. x3 days, then followed by 20 mg p.o. q.a.m. x5 days, then 10 mg p.o. q.a.m. x14 days, then discontinue, #30 days supply given. No refills.,16. Clindamycin 300 mg p.o. q.i.d. x2 weeks, dispensed #64 with one refill.,The patient's aspiration pneumonia was discussed in detail. He is agreeable to obtaining a chest x-ray PA and lateral after 2 weeks of treatment. Note that this patient did not have community-acquired pneumonia. His discharge diagnosis is aspiration pneumonia. The patient will continue with a dysphagia 2 diet with thin liquids after discharge. The patient discharged with home health. A dietary and speech therapy evaluation has been ordered. Speech therapy to treat for chronic dysphagia and aspiration in the setting of severe chronic obstructive pulmonary disease.,Total discharge time was greater than 30 minutes. ### Response: Cardiovascular / Pulmonary, Discharge Summary

ADMISSION DIAGNOSES:,1. Pyelonephritis.,2. History of uterine cancer and ileal conduit urinary diversion.,3. Hypertension.,4. Renal insufficiency.,5. Anemia.,DISCHARGE DIAGNOSES:,1. Pyelonephritis likely secondary to mucous plugging of indwelling Foley in the ileal conduit.,2. Hypertension.,3. Mild renal insufficiency.,4. Anemia, which has been present chronically over the past year.,HOSPITAL COURSE:, The patient was admitted with suspected pyelonephritis. Renal was consulted. It was thought that there was a thick mucous plug in the Foley in the ileal conduit that was irrigated by Dr. X. Her symptoms responded to IV antibiotics and she remained clinically stable. Klebsiella was isolated in this urine, which was sensitive to Bactrim and she was discharged on p.o. Bactrim. She was scheduled on 08/07/2007 for further surgery. She is to follow up with Dr. Y in 7-10 days. She also complained of right knee pain and the right knee showed no sign of effusion. She was exquisitely tender to touch of the patellar tendon. It was thought that this did not represent intraarticular process. She was advised to use ibuprofen over-the-counter two to three tabs t.i.d.

admission diagnoses pyelonephritis history uterine cancer ileal conduit urinary diversion hypertension renal insufficiency anemiadischarge diagnoses pyelonephritis likely secondary mucous plugging indwelling foley ileal conduit hypertension mild renal insufficiency anemia present chronically past yearhospital course patient admitted suspected pyelonephritis renal consulted thought thick mucous plug foley ileal conduit irrigated dr x symptoms responded iv antibiotics remained clinically stable klebsiella isolated urine sensitive bactrim discharged po bactrim scheduled surgery follow dr days also complained right knee pain right knee showed sign effusion exquisitely tender touch patellar tendon thought represent intraarticular process advised use ibuprofen overthecounter two three tabs tid

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES:,1. Pyelonephritis.,2. History of uterine cancer and ileal conduit urinary diversion.,3. Hypertension.,4. Renal insufficiency.,5. Anemia.,DISCHARGE DIAGNOSES:,1. Pyelonephritis likely secondary to mucous plugging of indwelling Foley in the ileal conduit.,2. Hypertension.,3. Mild renal insufficiency.,4. Anemia, which has been present chronically over the past year.,HOSPITAL COURSE:, The patient was admitted with suspected pyelonephritis. Renal was consulted. It was thought that there was a thick mucous plug in the Foley in the ileal conduit that was irrigated by Dr. X. Her symptoms responded to IV antibiotics and she remained clinically stable. Klebsiella was isolated in this urine, which was sensitive to Bactrim and she was discharged on p.o. Bactrim. She was scheduled on 08/07/2007 for further surgery. She is to follow up with Dr. Y in 7-10 days. She also complained of right knee pain and the right knee showed no sign of effusion. She was exquisitely tender to touch of the patellar tendon. It was thought that this did not represent intraarticular process. She was advised to use ibuprofen over-the-counter two to three tabs t.i.d. ### Response: Discharge Summary, General Medicine, Nephrology

ADMISSION DIAGNOSES:,1. Seizure.,2. Hypoglycemia.,3. Anemia.,4. Hypotension.,5. Dyspnea.,6. Edema.,DISCHARGE DIAGNOSES:,1. Colon cancer, status post right hemicolectomy.,2. Anemia.,3. Hospital-acquired pneumonia.,4. Hypertension.,5. Congestive heart failure.,6. Seizure disorder.,PROCEDURES PERFORMED:,1. Colonoscopy.,2. Right hemicolectomy.,HOSPITAL COURSE: , The patient is a 59-year-old female with multiple medical problems including diabetes mellitus requiring insulin for 26 years, previous MI and coronary artery disease, history of seizure disorder, GERD, bipolar disorder, and anemia. She was admitted due to a seizure and myoclonic jerks as well as hypoglycemia and anemia. Regarding the seizure disorder, Neurology was consulted. Noncontrast CT of the head was negative. Neurology felt that the only necessary intervention at that time would be to increase her Lamictal to 150 mg in the morning and 100 mg in the evening with gradual increase of the dosage until she was on 200 mg b.i.d. Regarding the hypoglycemia, the patient has diabetic gastroparesis and was being fed on J-tube intermittent feedings throughout the night at the rate of 120 an hour. Her insulin pump had a basal rate of roughly three at night during the feedings. While in the hospital, the insulin pump rate was turned down to 1.5 and then subsequently decreased a few other times. She seemed to tolerate the insulin pump rate well throughout her hospital course. There were a few episodes of hypoglycemia as well as hyperglycemia, but the episode seem to be related to the patient's n.p.o. status and the changing rates of tube feedings throughout her hospital course.,At discharge, her endocrinologist was contacted. It was decided to change her insulin pump rate to 3 units per hour from midnight till 6 a.m., from 0.8 units per hour from 6 a.m. until 8 a.m., and then at 0.2 units per hour from 8 a.m. until 6 p.m. The insulin was to be NovoLog. Regarding the anemia, the gastroenterologists were consulted regarding her positive Hemoccult stools. A colonoscopy was performed, which found a mass at the right hepatic flexure. General Surgery was then consulted and a right hemicolectomy was performed on the patient. The patient tolerated the procedure well and tube feeds were slowly restarted following the procedure, and prior to discharge were back at her predischarge rates of 120 per hour. Regarding the cancer itself, it was found that 1 out of 53 nodes were positive for cancer. CT of the abdomen and pelvis revealed no metastasis, a CT of the chest revealed possible lung metastasis. Later in hospital course, the patient developed a septic-like picture likely secondary to hospital-acquired pneumonia. She was treated with Zosyn, Levaquin, and vancomycin, and tolerated the medications well. Her symptoms decreased and serial chest x-rays were followed, which showed some resolution of the illness. The patient was seen by the Infectious Disease specialist. The Infectious Disease specialist recommended vancomycin to cover MRSA bacteria, which was found at the J-tube site. At discharge, the patient was given three additional days of p.o. Levaquin 750 mg as well as three additional days of Bactrim DS every 12 hours. The Bactrim was used to cover the MRSA at the J-tube site. It was found that MRSA was sensitive to Bactrim. Throughout her hospital course, the patient continued to receive Coreg 12.5 mg daily and Lasix 40 mg twice a day for her congestive heart failure, which remains stable. She also received Lipitor for her high cholesterol. Her seizure disorder remained stable and she was discharged on a dose of 100 mg in the morning and 150 mg at night. The dosage increases can begin on an outpatient basis.,DISCHARGE INSTRUCTIONS/MEDICATIONS: , The patient was discharged to home. She was told to shy away from strenuous activity. Her discharge diet was to be her usual diet of isotonic fiber feeding through the J-tube at a rate of 120 per hour throughout the night. The discharge medications were as follows:,1. Coreg 12.5 mg p.o. b.i.d.,2. Lipitor 10 mg p.o. at bedtime.,3. Nitro-Dur patch 0.3 mg per hour one patch daily.,4. Phenergan syrup 6.25 mg p.o. q.4h. p.r.n.,5. Synthroid 0.175 mg p.o. daily.,6. Zyrtec 10 mg p.o. daily.,7. Lamictal 100 mg p.o. daily.,8. Lamictal 150 mg p.o. at bedtime.,9. Ferrous sulfate drops 325 mg, PEG tube b.i.d.,10. Nexium 40 mg p.o. at breakfast.,11. Neurontin 400 mg p.o. t.i.d.,12. Lasix 40 mg p.o. b.i.d.,13. Fentanyl 50 mcg patch transdermal q.72h.,14. Calcium and vitamin D combination, calcium carbonate 500 mg/vitamin D 200 units one tab p.o. t.i.d.,15. Bactrim DS 800mg/160 mg tablet one tablet q.12h. x3 days.,16. Levaquin 750 mg one tablet p.o. x3 days.,The medications listed above, one listed as p.o. are to be administered via the J-tube.,FOLLOWUP: ,The patient was instructed to see Dr. X in approximately five to seven days. She was given a lab sheet to have a CBC with diff as well as a CMP to be drawn prior to her appointment with Dr. X. She is instructed to follow up with Dr. Y if her condition changes regarding her colon cancer. She was instructed to follow up with Dr. Z, her oncologist, regarding the positive lymph nodes. We were unable to contact Dr. Z, but his telephone number was given to the patient and she was instructed to make a followup appointment. She was also instructed to follow up with her endocrinologist, Dr. A, regarding any insulin pump adjustments, which were necessary and she was also instructed to follow up with Dr. B, her gastroenterologist, regarding any issues with her J-tube.,CONDITION ON DISCHARGE: , Stable.

admission diagnoses seizure hypoglycemia anemia hypotension dyspnea edemadischarge diagnoses colon cancer status post right hemicolectomy anemia hospitalacquired pneumonia hypertension congestive heart failure seizure disorderprocedures performed colonoscopy right hemicolectomyhospital course patient yearold female multiple medical problems including diabetes mellitus requiring insulin years previous mi coronary artery disease history seizure disorder gerd bipolar disorder anemia admitted due seizure myoclonic jerks well hypoglycemia anemia regarding seizure disorder neurology consulted noncontrast ct head negative neurology felt necessary intervention time would increase lamictal mg morning mg evening gradual increase dosage mg bid regarding hypoglycemia patient diabetic gastroparesis fed jtube intermittent feedings throughout night rate hour insulin pump basal rate roughly three night feedings hospital insulin pump rate turned subsequently decreased times seemed tolerate insulin pump rate well throughout hospital course episodes hypoglycemia well hyperglycemia episode seem related patients npo status changing rates tube feedings throughout hospital courseat discharge endocrinologist contacted decided change insulin pump rate units per hour midnight till units per hour units per hour pm insulin novolog regarding anemia gastroenterologists consulted regarding positive hemoccult stools colonoscopy performed found mass right hepatic flexure general surgery consulted right hemicolectomy performed patient patient tolerated procedure well tube feeds slowly restarted following procedure prior discharge back predischarge rates per hour regarding cancer found nodes positive cancer ct abdomen pelvis revealed metastasis ct chest revealed possible lung metastasis later hospital course patient developed septiclike picture likely secondary hospitalacquired pneumonia treated zosyn levaquin vancomycin tolerated medications well symptoms decreased serial chest xrays followed showed resolution illness patient seen infectious disease specialist infectious disease specialist recommended vancomycin cover mrsa bacteria found jtube site discharge patient given three additional days po levaquin mg well three additional days bactrim ds every hours bactrim used cover mrsa jtube site found mrsa sensitive bactrim throughout hospital course patient continued receive coreg mg daily lasix mg twice day congestive heart failure remains stable also received lipitor high cholesterol seizure disorder remained stable discharged dose mg morning mg night dosage increases begin outpatient basisdischarge instructionsmedications patient discharged home told shy away strenuous activity discharge diet usual diet isotonic fiber feeding jtube rate per hour throughout night discharge medications follows coreg mg po bid lipitor mg po bedtime nitrodur patch mg per hour one patch daily phenergan syrup mg po qh prn synthroid mg po daily zyrtec mg po daily lamictal mg po daily lamictal mg po bedtime ferrous sulfate drops mg peg tube bid nexium mg po breakfast neurontin mg po tid lasix mg po bid fentanyl mcg patch transdermal qh calcium vitamin combination calcium carbonate mgvitamin units one tab po tid bactrim ds mg mg tablet one tablet qh x days levaquin mg one tablet po x daysthe medications listed one listed po administered via jtubefollowup patient instructed see dr x approximately five seven days given lab sheet cbc diff well cmp drawn prior appointment dr x instructed follow dr condition changes regarding colon cancer instructed follow dr z oncologist regarding positive lymph nodes unable contact dr z telephone number given patient instructed make followup appointment also instructed follow endocrinologist dr regarding insulin pump adjustments necessary also instructed follow dr b gastroenterologist regarding issues jtubecondition discharge stable

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES:,1. Seizure.,2. Hypoglycemia.,3. Anemia.,4. Hypotension.,5. Dyspnea.,6. Edema.,DISCHARGE DIAGNOSES:,1. Colon cancer, status post right hemicolectomy.,2. Anemia.,3. Hospital-acquired pneumonia.,4. Hypertension.,5. Congestive heart failure.,6. Seizure disorder.,PROCEDURES PERFORMED:,1. Colonoscopy.,2. Right hemicolectomy.,HOSPITAL COURSE: , The patient is a 59-year-old female with multiple medical problems including diabetes mellitus requiring insulin for 26 years, previous MI and coronary artery disease, history of seizure disorder, GERD, bipolar disorder, and anemia. She was admitted due to a seizure and myoclonic jerks as well as hypoglycemia and anemia. Regarding the seizure disorder, Neurology was consulted. Noncontrast CT of the head was negative. Neurology felt that the only necessary intervention at that time would be to increase her Lamictal to 150 mg in the morning and 100 mg in the evening with gradual increase of the dosage until she was on 200 mg b.i.d. Regarding the hypoglycemia, the patient has diabetic gastroparesis and was being fed on J-tube intermittent feedings throughout the night at the rate of 120 an hour. Her insulin pump had a basal rate of roughly three at night during the feedings. While in the hospital, the insulin pump rate was turned down to 1.5 and then subsequently decreased a few other times. She seemed to tolerate the insulin pump rate well throughout her hospital course. There were a few episodes of hypoglycemia as well as hyperglycemia, but the episode seem to be related to the patient's n.p.o. status and the changing rates of tube feedings throughout her hospital course.,At discharge, her endocrinologist was contacted. It was decided to change her insulin pump rate to 3 units per hour from midnight till 6 a.m., from 0.8 units per hour from 6 a.m. until 8 a.m., and then at 0.2 units per hour from 8 a.m. until 6 p.m. The insulin was to be NovoLog. Regarding the anemia, the gastroenterologists were consulted regarding her positive Hemoccult stools. A colonoscopy was performed, which found a mass at the right hepatic flexure. General Surgery was then consulted and a right hemicolectomy was performed on the patient. The patient tolerated the procedure well and tube feeds were slowly restarted following the procedure, and prior to discharge were back at her predischarge rates of 120 per hour. Regarding the cancer itself, it was found that 1 out of 53 nodes were positive for cancer. CT of the abdomen and pelvis revealed no metastasis, a CT of the chest revealed possible lung metastasis. Later in hospital course, the patient developed a septic-like picture likely secondary to hospital-acquired pneumonia. She was treated with Zosyn, Levaquin, and vancomycin, and tolerated the medications well. Her symptoms decreased and serial chest x-rays were followed, which showed some resolution of the illness. The patient was seen by the Infectious Disease specialist. The Infectious Disease specialist recommended vancomycin to cover MRSA bacteria, which was found at the J-tube site. At discharge, the patient was given three additional days of p.o. Levaquin 750 mg as well as three additional days of Bactrim DS every 12 hours. The Bactrim was used to cover the MRSA at the J-tube site. It was found that MRSA was sensitive to Bactrim. Throughout her hospital course, the patient continued to receive Coreg 12.5 mg daily and Lasix 40 mg twice a day for her congestive heart failure, which remains stable. She also received Lipitor for her high cholesterol. Her seizure disorder remained stable and she was discharged on a dose of 100 mg in the morning and 150 mg at night. The dosage increases can begin on an outpatient basis.,DISCHARGE INSTRUCTIONS/MEDICATIONS: , The patient was discharged to home. She was told to shy away from strenuous activity. Her discharge diet was to be her usual diet of isotonic fiber feeding through the J-tube at a rate of 120 per hour throughout the night. The discharge medications were as follows:,1. Coreg 12.5 mg p.o. b.i.d.,2. Lipitor 10 mg p.o. at bedtime.,3. Nitro-Dur patch 0.3 mg per hour one patch daily.,4. Phenergan syrup 6.25 mg p.o. q.4h. p.r.n.,5. Synthroid 0.175 mg p.o. daily.,6. Zyrtec 10 mg p.o. daily.,7. Lamictal 100 mg p.o. daily.,8. Lamictal 150 mg p.o. at bedtime.,9. Ferrous sulfate drops 325 mg, PEG tube b.i.d.,10. Nexium 40 mg p.o. at breakfast.,11. Neurontin 400 mg p.o. t.i.d.,12. Lasix 40 mg p.o. b.i.d.,13. Fentanyl 50 mcg patch transdermal q.72h.,14. Calcium and vitamin D combination, calcium carbonate 500 mg/vitamin D 200 units one tab p.o. t.i.d.,15. Bactrim DS 800mg/160 mg tablet one tablet q.12h. x3 days.,16. Levaquin 750 mg one tablet p.o. x3 days.,The medications listed above, one listed as p.o. are to be administered via the J-tube.,FOLLOWUP: ,The patient was instructed to see Dr. X in approximately five to seven days. She was given a lab sheet to have a CBC with diff as well as a CMP to be drawn prior to her appointment with Dr. X. She is instructed to follow up with Dr. Y if her condition changes regarding her colon cancer. She was instructed to follow up with Dr. Z, her oncologist, regarding the positive lymph nodes. We were unable to contact Dr. Z, but his telephone number was given to the patient and she was instructed to make a followup appointment. She was also instructed to follow up with her endocrinologist, Dr. A, regarding any insulin pump adjustments, which were necessary and she was also instructed to follow up with Dr. B, her gastroenterologist, regarding any issues with her J-tube.,CONDITION ON DISCHARGE: , Stable. ### Response: Cardiovascular / Pulmonary, Discharge Summary, Gastroenterology, General Medicine

ADMISSION DIAGNOSES:,1. Severe menometrorrhagia unresponsive to medical therapy.,2. Severe anemia.,3. Fibroid uterus.,DISCHARGE DIAGNOSES:,1. Severe menometrorrhagia unresponsive to medical therapy.,2. Severe anemia.,3. Fibroid uterus.,OPERATIONS PERFORMED:,1. Hysteroscopy.,2. Dilatation and curettage (D&C).,3. Myomectomy.,COMPLICATIONS: , Large endometrial cavity fibroid requiring careful dissection and excision.,BLOOD TRANSFUSIONS: , Two units of packed red blood cells.,INFECTION: , None.,SIGNIFICANT LAB AND X-RAY: , Posttransfusion of the 2nd unit showed her hematocrit of 25, hemoglobin of 8.3.,HOSPITAL COURSE AND TREATMENT: , The patient was admitted to the surgical suite and taken to the operating room where a dilatation and curettage (D&C) was performed. Hysteroscopy revealed a large endometrial cavity fibroid. Careful shaving and excision of this fibroid was performed with removal of the fibroid. Hemostasis was noted completely at the end of this procedure. Postoperatively, the patient has done well. The patient was given a 2nd unit of packed red blood cells because of intraoperative blood loss. The patient is now ambulating without difficulty and tolerating her diet. The patient desires to go home. The patient is discharged to home.,DISCHARGE CONDITION: , Stable.,DISCHARGE INSTRUCTIONS: ,Regular diet, bedrest for 1 week with slow return to normal activities over the ensuing 2 to 3 weeks, pelvic rest for 6 weeks. Vicodin tablets 1 tablet p.o. q.4-6 h. p.r.n. pain, multiple vitamin 1 tab p.o. daily, ferrous sulfate tablets 1 tablet p.o. daily. Ambulate with assistance at home only. The patient is to return to see Dr. X p.r.n. plus Tuesday, 6/16/2009 for further followup care. The patient was given full and complete postop and discharge instructions. All her questions were answered.

admission diagnoses severe menometrorrhagia unresponsive medical therapy severe anemia fibroid uterusdischarge diagnoses severe menometrorrhagia unresponsive medical therapy severe anemia fibroid uterusoperations performed hysteroscopy dilatation curettage dc myomectomycomplications large endometrial cavity fibroid requiring careful dissection excisionblood transfusions two units packed red blood cellsinfection nonesignificant lab xray posttransfusion nd unit showed hematocrit hemoglobin hospital course treatment patient admitted surgical suite taken operating room dilatation curettage dc performed hysteroscopy revealed large endometrial cavity fibroid careful shaving excision fibroid performed removal fibroid hemostasis noted completely end procedure postoperatively patient done well patient given nd unit packed red blood cells intraoperative blood loss patient ambulating without difficulty tolerating diet patient desires go home patient discharged homedischarge condition stabledischarge instructions regular diet bedrest week slow return normal activities ensuing weeks pelvic rest weeks vicodin tablets tablet po q h prn pain multiple vitamin tab po daily ferrous sulfate tablets tablet po daily ambulate assistance home patient return see dr x prn plus tuesday followup care patient given full complete postop discharge instructions questions answered

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES:,1. Severe menometrorrhagia unresponsive to medical therapy.,2. Severe anemia.,3. Fibroid uterus.,DISCHARGE DIAGNOSES:,1. Severe menometrorrhagia unresponsive to medical therapy.,2. Severe anemia.,3. Fibroid uterus.,OPERATIONS PERFORMED:,1. Hysteroscopy.,2. Dilatation and curettage (D&C).,3. Myomectomy.,COMPLICATIONS: , Large endometrial cavity fibroid requiring careful dissection and excision.,BLOOD TRANSFUSIONS: , Two units of packed red blood cells.,INFECTION: , None.,SIGNIFICANT LAB AND X-RAY: , Posttransfusion of the 2nd unit showed her hematocrit of 25, hemoglobin of 8.3.,HOSPITAL COURSE AND TREATMENT: , The patient was admitted to the surgical suite and taken to the operating room where a dilatation and curettage (D&C) was performed. Hysteroscopy revealed a large endometrial cavity fibroid. Careful shaving and excision of this fibroid was performed with removal of the fibroid. Hemostasis was noted completely at the end of this procedure. Postoperatively, the patient has done well. The patient was given a 2nd unit of packed red blood cells because of intraoperative blood loss. The patient is now ambulating without difficulty and tolerating her diet. The patient desires to go home. The patient is discharged to home.,DISCHARGE CONDITION: , Stable.,DISCHARGE INSTRUCTIONS: ,Regular diet, bedrest for 1 week with slow return to normal activities over the ensuing 2 to 3 weeks, pelvic rest for 6 weeks. Vicodin tablets 1 tablet p.o. q.4-6 h. p.r.n. pain, multiple vitamin 1 tab p.o. daily, ferrous sulfate tablets 1 tablet p.o. daily. Ambulate with assistance at home only. The patient is to return to see Dr. X p.r.n. plus Tuesday, 6/16/2009 for further followup care. The patient was given full and complete postop and discharge instructions. All her questions were answered. ### Response: Discharge Summary, Obstetrics / Gynecology

ADMISSION DIAGNOSES:,1. Severe menometrorrhagia unresponsive to medical therapy.,2. Severe anemia.,3. Symptomatic fibroid uterus.,DISCHARGE DIAGNOSES:,1. Severe menometrorrhagia unresponsive to medical therapy.,2. Severe anemia.,3. Symptomatic fibroid uterus.,4. Extensive adenomyosis by pathological report.,OPERATION PERFORMED: , On 6/10/2009 total abdominal hysterectomy (TAH).,COMPLICATIONS:, None.,BLOOD TRANSFUSIONS: , None.,INFECTIONS: , None.,SIGNIFICANT LAB AND X-RAY: , On admission hemoglobin and hematocrit was 10.5 and 32.8 respectively. On discharge, hemoglobin and hematocrit 7.9 and 25.2.,HOSPITAL COURSE AND TREATMENT: ,The patient was admitted to the surgical suite and taken to the operating room on 6/10/2009 where a total abdominal hysterectomy (TAH) with low intraoperative complication was performed. The patient tolerated all procedures well. On the 1st postoperative day, the patient was afebrile and all vital signs were stable. On the 3rd postoperative day, the patient was ambulating with difficulty and tolerating clear liquid diet. On the 4th postoperative day, the patient was complaining of pain in her back and abdomen as well as incisional wound tenderness. On the 5th postoperative day, the patient was afebrile. Vital signs were stable. The patient was tolerating a diet and ambulating without difficulty. The patient was desirous of going home. The patient denied any abdominal pain or flank pain. The patient had minimal incisional wound tenderness. The patient was desirous of going home and was discharged home.,DISCHARGE CONDITION: , Stable.,DISCHARGE INSTRUCTIONS:, Regular diet, bedrest x1 week with slow return to normal activity over the ensuing 4 to 6 weeks, pelvic rest for 6 weeks. Motrin 600 mg tablets 1 tablet p.o. q.8h. p.r.n. pain, Colace 100 mg tablets 1 tablet p.o. daily p.r.n. constipation and ferrous sulfate 60 mg tablets 1 tablet p.o. daily, and multiple vitamin 1 tablet p.o. daily. The patient is to return on Wednesday 6/17/2009 for removal of staples. The patient was given a full explanation of her clinical condition. The patient was given full and complete postoperative and discharge instructions. All her questions were answered.

admission diagnoses severe menometrorrhagia unresponsive medical therapy severe anemia symptomatic fibroid uterusdischarge diagnoses severe menometrorrhagia unresponsive medical therapy severe anemia symptomatic fibroid uterus extensive adenomyosis pathological reportoperation performed total abdominal hysterectomy tahcomplications noneblood transfusions noneinfections nonesignificant lab xray admission hemoglobin hematocrit respectively discharge hemoglobin hematocrit hospital course treatment patient admitted surgical suite taken operating room total abdominal hysterectomy tah low intraoperative complication performed patient tolerated procedures well st postoperative day patient afebrile vital signs stable rd postoperative day patient ambulating difficulty tolerating clear liquid diet th postoperative day patient complaining pain back abdomen well incisional wound tenderness th postoperative day patient afebrile vital signs stable patient tolerating diet ambulating without difficulty patient desirous going home patient denied abdominal pain flank pain patient minimal incisional wound tenderness patient desirous going home discharged homedischarge condition stabledischarge instructions regular diet bedrest x week slow return normal activity ensuing weeks pelvic rest weeks motrin mg tablets tablet po qh prn pain colace mg tablets tablet po daily prn constipation ferrous sulfate mg tablets tablet po daily multiple vitamin tablet po daily patient return wednesday removal staples patient given full explanation clinical condition patient given full complete postoperative discharge instructions questions answered

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES:,1. Severe menometrorrhagia unresponsive to medical therapy.,2. Severe anemia.,3. Symptomatic fibroid uterus.,DISCHARGE DIAGNOSES:,1. Severe menometrorrhagia unresponsive to medical therapy.,2. Severe anemia.,3. Symptomatic fibroid uterus.,4. Extensive adenomyosis by pathological report.,OPERATION PERFORMED: , On 6/10/2009 total abdominal hysterectomy (TAH).,COMPLICATIONS:, None.,BLOOD TRANSFUSIONS: , None.,INFECTIONS: , None.,SIGNIFICANT LAB AND X-RAY: , On admission hemoglobin and hematocrit was 10.5 and 32.8 respectively. On discharge, hemoglobin and hematocrit 7.9 and 25.2.,HOSPITAL COURSE AND TREATMENT: ,The patient was admitted to the surgical suite and taken to the operating room on 6/10/2009 where a total abdominal hysterectomy (TAH) with low intraoperative complication was performed. The patient tolerated all procedures well. On the 1st postoperative day, the patient was afebrile and all vital signs were stable. On the 3rd postoperative day, the patient was ambulating with difficulty and tolerating clear liquid diet. On the 4th postoperative day, the patient was complaining of pain in her back and abdomen as well as incisional wound tenderness. On the 5th postoperative day, the patient was afebrile. Vital signs were stable. The patient was tolerating a diet and ambulating without difficulty. The patient was desirous of going home. The patient denied any abdominal pain or flank pain. The patient had minimal incisional wound tenderness. The patient was desirous of going home and was discharged home.,DISCHARGE CONDITION: , Stable.,DISCHARGE INSTRUCTIONS:, Regular diet, bedrest x1 week with slow return to normal activity over the ensuing 4 to 6 weeks, pelvic rest for 6 weeks. Motrin 600 mg tablets 1 tablet p.o. q.8h. p.r.n. pain, Colace 100 mg tablets 1 tablet p.o. daily p.r.n. constipation and ferrous sulfate 60 mg tablets 1 tablet p.o. daily, and multiple vitamin 1 tablet p.o. daily. The patient is to return on Wednesday 6/17/2009 for removal of staples. The patient was given a full explanation of her clinical condition. The patient was given full and complete postoperative and discharge instructions. All her questions were answered. ### Response: Discharge Summary, Obstetrics / Gynecology

ADMISSION DIAGNOSES:,1. Syncope.,2. End-stage renal disease requiring hemodialysis.,3. Congestive heart failure.,4. Hypertension.,DISCHARGE DIAGNOSES:,1. Syncope.,2. End-stage renal disease requiring hemodialysis.,3. Congestive heart failure.,4. Hypertension.,CONDITION ON DISCHARGE: , Stable.,PROCEDURE PERFORMED: , None.,HOSPITAL COURSE: , The patient is a 44-year-old African-American male who was diagnosed with end-stage renal disease requiring hemodialysis three times per week approximately four to five months ago. He reports that over the past month, he has been feeling lightheaded when standing and has had three syncopal episodes during this time with return of consciousness after several minutes. He reportedly had this even while seated and denied overt dizziness. He reports this lightheadedness is made even worse when standing. He has had these symptoms almost daily over the past month. He does report some confusion when he awakens. He reports that he loses consciousness for two to three minutes. Denies any bowel or bladder loss, although he reports very little urine output secondary to his end-stage renal disease. He denied any palpitations, warmth, or diaphoresis, which is indicative of vasovagal syncope. There were no witnesses to his syncopal episodes. He also denied any clonic activity and no history of seizures. In the emergency room, the patient was given fluids and orthostatics were checked. At that time, orthostatics were negative; however, due to the fact that fluid had been given before, it is impossible to rule out orthostatic hypotension. The patient presented to the hospital on Coreg 12.5 mg b.i.d. and lisinopril 10 mg daily secondary to his hypertension, congestive heart failure with dilated cardiomyopathy and end-stage renal disease. Regarding his syncopal episodes, he was admitted with likely orthostatic hypotension. Cardiology was consulted and their recommendations were to reduce the lisinopril to 5 mg daily. At that time, the Coreg had been held secondary to hypotension. Cardiology also ordered a nuclear medicine myocardial perfusion stress test. Regarding the end-stage renal disease, Nephrology was consulted as the patient was due for hemodialysis treatment the day following admission. Nephrology was able to perform dialysis on the patient and Renal concurred that the presyncopal symptoms were likely due to decreased intravascular volume in the postdialytic time frame. Renal agreed with decreasing his lisinopril to 5 mg daily and decreasing the Coreg to 6.25 mg b.i.d. They reported that the Procrit should be continued. As previously indicated regarding the dilated cardiomyopathy, Cardiology ordered a nuclear medicine stress test to be performed. Also, regarding the patient's hypertension, he actually was noted to have hypotension on admission, and as previously stated, the Coreg was originally discontinued and then it was restarted at 6.25 mg b.i.d. and the patient tolerated this well. The patient's hospital course remained uncomplicated until September 17, 2007, the day the nuclear medicine stress test was scheduled. The patient stated that he was reluctant to proceed with the test and he was afraid of needles and the risks associated with the test although the procedure was explained to the patient and the risks of the procedure were quit low, the patient proceeded to discharge himself against medical advice.,DISCHARGE INSTRUCTIONS/MEDICATIONS:,The patient left AMA. No specific discharge instructions and medications were given. At the time of the patient leaving AMA, his medications were as follows:,1. Aspirin 81 mg p.o. daily.,2. Multivitamin, Nephrocaps one cap p.o. daily.,3. Fosrenol 500 mg chewable t.i.d.,4. Lisinopril 2.5 mg daily.,6. Coreg 3.125 mg p.o. b.i.d.,7. Procrit 10,000 units inject every Tuesday, Thursday, and Saturday.,8. Heparin 5000 units q.8h. subcutaneous for DVT prophylaxis.

admission diagnoses syncope endstage renal disease requiring hemodialysis congestive heart failure hypertensiondischarge diagnoses syncope endstage renal disease requiring hemodialysis congestive heart failure hypertensioncondition discharge stableprocedure performed nonehospital course patient yearold africanamerican male diagnosed endstage renal disease requiring hemodialysis three times per week approximately four five months ago reports past month feeling lightheaded standing three syncopal episodes time return consciousness several minutes reportedly even seated denied overt dizziness reports lightheadedness made even worse standing symptoms almost daily past month report confusion awakens reports loses consciousness two three minutes denies bowel bladder loss although reports little urine output secondary endstage renal disease denied palpitations warmth diaphoresis indicative vasovagal syncope witnesses syncopal episodes also denied clonic activity history seizures emergency room patient given fluids orthostatics checked time orthostatics negative however due fact fluid given impossible rule orthostatic hypotension patient presented hospital coreg mg bid lisinopril mg daily secondary hypertension congestive heart failure dilated cardiomyopathy endstage renal disease regarding syncopal episodes admitted likely orthostatic hypotension cardiology consulted recommendations reduce lisinopril mg daily time coreg held secondary hypotension cardiology also ordered nuclear medicine myocardial perfusion stress test regarding endstage renal disease nephrology consulted patient due hemodialysis treatment day following admission nephrology able perform dialysis patient renal concurred presyncopal symptoms likely due decreased intravascular volume postdialytic time frame renal agreed decreasing lisinopril mg daily decreasing coreg mg bid reported procrit continued previously indicated regarding dilated cardiomyopathy cardiology ordered nuclear medicine stress test performed also regarding patients hypertension actually noted hypotension admission previously stated coreg originally discontinued restarted mg bid patient tolerated well patients hospital course remained uncomplicated september day nuclear medicine stress test scheduled patient stated reluctant proceed test afraid needles risks associated test although procedure explained patient risks procedure quit low patient proceeded discharge medical advicedischarge instructionsmedicationsthe patient left ama specific discharge instructions medications given time patient leaving ama medications follows aspirin mg po daily multivitamin nephrocaps one cap po daily fosrenol mg chewable tid lisinopril mg daily coreg mg po bid procrit units inject every tuesday thursday saturday heparin units qh subcutaneous dvt prophylaxis

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSES:,1. Syncope.,2. End-stage renal disease requiring hemodialysis.,3. Congestive heart failure.,4. Hypertension.,DISCHARGE DIAGNOSES:,1. Syncope.,2. End-stage renal disease requiring hemodialysis.,3. Congestive heart failure.,4. Hypertension.,CONDITION ON DISCHARGE: , Stable.,PROCEDURE PERFORMED: , None.,HOSPITAL COURSE: , The patient is a 44-year-old African-American male who was diagnosed with end-stage renal disease requiring hemodialysis three times per week approximately four to five months ago. He reports that over the past month, he has been feeling lightheaded when standing and has had three syncopal episodes during this time with return of consciousness after several minutes. He reportedly had this even while seated and denied overt dizziness. He reports this lightheadedness is made even worse when standing. He has had these symptoms almost daily over the past month. He does report some confusion when he awakens. He reports that he loses consciousness for two to three minutes. Denies any bowel or bladder loss, although he reports very little urine output secondary to his end-stage renal disease. He denied any palpitations, warmth, or diaphoresis, which is indicative of vasovagal syncope. There were no witnesses to his syncopal episodes. He also denied any clonic activity and no history of seizures. In the emergency room, the patient was given fluids and orthostatics were checked. At that time, orthostatics were negative; however, due to the fact that fluid had been given before, it is impossible to rule out orthostatic hypotension. The patient presented to the hospital on Coreg 12.5 mg b.i.d. and lisinopril 10 mg daily secondary to his hypertension, congestive heart failure with dilated cardiomyopathy and end-stage renal disease. Regarding his syncopal episodes, he was admitted with likely orthostatic hypotension. Cardiology was consulted and their recommendations were to reduce the lisinopril to 5 mg daily. At that time, the Coreg had been held secondary to hypotension. Cardiology also ordered a nuclear medicine myocardial perfusion stress test. Regarding the end-stage renal disease, Nephrology was consulted as the patient was due for hemodialysis treatment the day following admission. Nephrology was able to perform dialysis on the patient and Renal concurred that the presyncopal symptoms were likely due to decreased intravascular volume in the postdialytic time frame. Renal agreed with decreasing his lisinopril to 5 mg daily and decreasing the Coreg to 6.25 mg b.i.d. They reported that the Procrit should be continued. As previously indicated regarding the dilated cardiomyopathy, Cardiology ordered a nuclear medicine stress test to be performed. Also, regarding the patient's hypertension, he actually was noted to have hypotension on admission, and as previously stated, the Coreg was originally discontinued and then it was restarted at 6.25 mg b.i.d. and the patient tolerated this well. The patient's hospital course remained uncomplicated until September 17, 2007, the day the nuclear medicine stress test was scheduled. The patient stated that he was reluctant to proceed with the test and he was afraid of needles and the risks associated with the test although the procedure was explained to the patient and the risks of the procedure were quit low, the patient proceeded to discharge himself against medical advice.,DISCHARGE INSTRUCTIONS/MEDICATIONS:,The patient left AMA. No specific discharge instructions and medications were given. At the time of the patient leaving AMA, his medications were as follows:,1. Aspirin 81 mg p.o. daily.,2. Multivitamin, Nephrocaps one cap p.o. daily.,3. Fosrenol 500 mg chewable t.i.d.,4. Lisinopril 2.5 mg daily.,6. Coreg 3.125 mg p.o. b.i.d.,7. Procrit 10,000 units inject every Tuesday, Thursday, and Saturday.,8. Heparin 5000 units q.8h. subcutaneous for DVT prophylaxis. ### Response: Discharge Summary

ADMISSION DIAGNOSIS (ES):,1. Chronic obstructive pulmonary disease.,2. Pneumonia.,3. Congestive heart failure.,4. Diabetes mellitus.,5. Neuropathy.,6. Anxiety.,7. Hypothyroidism.,8. Depression.,9. Hypertension.,DISCHARGE DIAGNOSIS (ES):,1. Severe chronic obstructive pulmonary disease.,2. Diabetes mellitus.,3. Hypothyroidism.,4. Altered mental status, less somnolent, likely secondary to medications, resolved.,5. Lower gastrointestinal bleed.,6. Status post episode of atrial fibrillation.,7. Status post diverticular bleed.,DISCHARGE MEDICATIONS:,1. Albuterol inhaler q.i.d.,2. Xanax 1 mg t.i.d.,3. Cardizem CD 120 mg daily.,4. Colace 100 mg b.i.d.,5. Iron sulfate 325 mg b.i.d.,6. NPH 10 units subcutaneous b.i.d.,7. Atrovent inhaler q.i.d.,8. Statin oral suspension p.o. q.i.d., swish and spit.,9. Paxil 10 mg daily.,10. Prednisone 20 mg daily.,11. Darvocet Darvocet-N 100, one q.4h PRN pain.,12. Metamucil one pack b.i.d.,13. Synthroid 50 mcg daily.,14. Nexium 40 mg daily.,HOSPITAL COURSE:, The patient was a 66-year-old who presented with complaints of shortness of breath and was found to have acute COPD exacerbation. She had previously been at outlying hospital and had left AMA after 10 sets of BiPAP use. Here she was able to be kept off BiPAP later and slowly improved her exacerbation of COPD with the assistance of pulmonary. She was thought to have bronchitis as well and was treated with antibiotics. During hospitalization she developed acute lower GI bleed and was transferred to intensive care unit and transfused packed red blood cells. GI was consulted, performed endoscopy, revealing diverticular disease of the sigmoid colon, with this being the suspected cause of hemorrhage. Plavix is being held for at least 10 days. Lovenox held as well. No further signs of bleeding. The patient's respiratory status did slowly improve to baseline. She is discharged and given the above noted medications. Followup with Dr. Pesce, of diagnostic pulmonary, in the outpatient setting. She will also followup with Dr. Pesce, in the outpatient setting.

admission diagnosis es chronic obstructive pulmonary disease pneumonia congestive heart failure diabetes mellitus neuropathy anxiety hypothyroidism depression hypertensiondischarge diagnosis es severe chronic obstructive pulmonary disease diabetes mellitus hypothyroidism altered mental status less somnolent likely secondary medications resolved lower gastrointestinal bleed status post episode atrial fibrillation status post diverticular bleeddischarge medications albuterol inhaler qid xanax mg tid cardizem cd mg daily colace mg bid iron sulfate mg bid nph units subcutaneous bid atrovent inhaler qid statin oral suspension po qid swish spit paxil mg daily prednisone mg daily darvocet darvocetn one qh prn pain metamucil one pack bid synthroid mcg daily nexium mg dailyhospital course patient yearold presented complaints shortness breath found acute copd exacerbation previously outlying hospital left ama sets bipap use able kept bipap later slowly improved exacerbation copd assistance pulmonary thought bronchitis well treated antibiotics hospitalization developed acute lower gi bleed transferred intensive care unit transfused packed red blood cells gi consulted performed endoscopy revealing diverticular disease sigmoid colon suspected cause hemorrhage plavix held least days lovenox held well signs bleeding patients respiratory status slowly improve baseline discharged given noted medications followup dr pesce diagnostic pulmonary outpatient setting also followup dr pesce outpatient setting

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSIS (ES):,1. Chronic obstructive pulmonary disease.,2. Pneumonia.,3. Congestive heart failure.,4. Diabetes mellitus.,5. Neuropathy.,6. Anxiety.,7. Hypothyroidism.,8. Depression.,9. Hypertension.,DISCHARGE DIAGNOSIS (ES):,1. Severe chronic obstructive pulmonary disease.,2. Diabetes mellitus.,3. Hypothyroidism.,4. Altered mental status, less somnolent, likely secondary to medications, resolved.,5. Lower gastrointestinal bleed.,6. Status post episode of atrial fibrillation.,7. Status post diverticular bleed.,DISCHARGE MEDICATIONS:,1. Albuterol inhaler q.i.d.,2. Xanax 1 mg t.i.d.,3. Cardizem CD 120 mg daily.,4. Colace 100 mg b.i.d.,5. Iron sulfate 325 mg b.i.d.,6. NPH 10 units subcutaneous b.i.d.,7. Atrovent inhaler q.i.d.,8. Statin oral suspension p.o. q.i.d., swish and spit.,9. Paxil 10 mg daily.,10. Prednisone 20 mg daily.,11. Darvocet Darvocet-N 100, one q.4h PRN pain.,12. Metamucil one pack b.i.d.,13. Synthroid 50 mcg daily.,14. Nexium 40 mg daily.,HOSPITAL COURSE:, The patient was a 66-year-old who presented with complaints of shortness of breath and was found to have acute COPD exacerbation. She had previously been at outlying hospital and had left AMA after 10 sets of BiPAP use. Here she was able to be kept off BiPAP later and slowly improved her exacerbation of COPD with the assistance of pulmonary. She was thought to have bronchitis as well and was treated with antibiotics. During hospitalization she developed acute lower GI bleed and was transferred to intensive care unit and transfused packed red blood cells. GI was consulted, performed endoscopy, revealing diverticular disease of the sigmoid colon, with this being the suspected cause of hemorrhage. Plavix is being held for at least 10 days. Lovenox held as well. No further signs of bleeding. The patient's respiratory status did slowly improve to baseline. She is discharged and given the above noted medications. Followup with Dr. Pesce, of diagnostic pulmonary, in the outpatient setting. She will also followup with Dr. Pesce, in the outpatient setting. ### Response: Discharge Summary, General Medicine

ADMISSION DIAGNOSIS: ,Adenocarcinoma of the prostate.,HISTORY:, The patient is a 71-year-old male whose personal physician, Dr. X identified a change in the patient's PSA from 7/2008 (4.2) to 4/2009 (10.5). The patient underwent a transrectal ultrasound and biopsy and was found to have a Gleason 3+4 for a score of 7, 20% of the tissue removed from the left base. The patient also had Gleason 6 in the right lobe, midportion, as well as the left apical portion. He underwent a bone scan which was normal and cystoscopy which was normal and renal ultrasound that was normal.,SURGICAL HISTORY: , Appendectomy.,MEDICAL HISTORY:, Atrial fibrillation.,MEDICATIONS:, Coumadin and lisinopril.,SOCIAL HISTORY: ,Smokes none. Alcohol none.,ALLERGIES:, NONE.,REVIEW OF SYSTEMS: , The patient relates no recent weight gain, weight loss, night sweats, fevers or chills. Eyes: No change in vision or diplopia. Ears: No tinnitus or vertigo. Mouth: No dysphagia. Pulmonary: No chronic cough or shortness of breath. Cardiac: No angina or palpitations. GI: No nausea, vomiting, diarrhea or constipation. Musculoskeletal: No arthritides or myalgias. Hematopoietic: No easy bleeding or bruising. Skin: No chronic ulcers or persistent itch.,PHYSICAL EXAMINATION:,GENERAL: The patient is well developed and well nourished.,HEENT: Head is normocephalic. Eyes, pupils are equal. Conjunctivae are pink. Sclerae are anicteric.,NECK: There is no adenopathy.,PULMONARY: Respirations are unlabored.,HEART: Regular rhythm.,ABDOMEN: Liver, spleen, kidney, and bladder are not palpable. There are no discernible masses. There are no peritoneal signs.,GENITALIA: The penis has no plaques. Meatus is on the glans. Scrotal skin is healthy. Testicles are fair consistency. Epididymides are nontender.,RECTAL: The prostate is +1 to 2/4. There are no areas that are suspicious for tumor. Consistency is even. Sidewalls are sharp. Seminal vesicles are not palpable.,MUSCULOSKELETAL: The upper and lower extremities are symmetric bilaterally.,NEUROLOGIC: There are no gross focal neurologic abnormalities.,IMPRESSION:,1. Adenocarcinoma of the prostate.,2. Atrial fibrillation.,PLAN: , The patient's wife and I have discussed his treatment options, which include primarily radiation and surgery. He has _________ surviving prostate cancer by Dr. Y. He is aware of incontinency, both total and partial. We discussed erectile dysfunction. We have discussed bleeding, infection, injury to the rectum, injury to vessels and nerves, deep vein thrombosis, pulmonary embolus, MI, stroke, and death. He had no questions at the conclusion of the conversation and he does know that in his age group, though a nerve-sparing procedure will be performed, preserving any erectile function is highly unlikely. He had no questions at the conclusion of our last conversation.

admission diagnosis adenocarcinoma prostatehistory patient yearold male whose personal physician dr x identified change patients psa patient underwent transrectal ultrasound biopsy found gleason score tissue removed left base patient also gleason right lobe midportion well left apical portion underwent bone scan normal cystoscopy normal renal ultrasound normalsurgical history appendectomymedical history atrial fibrillationmedications coumadin lisinoprilsocial history smokes none alcohol noneallergies nonereview systems patient relates recent weight gain weight loss night sweats fevers chills eyes change vision diplopia ears tinnitus vertigo mouth dysphagia pulmonary chronic cough shortness breath cardiac angina palpitations gi nausea vomiting diarrhea constipation musculoskeletal arthritides myalgias hematopoietic easy bleeding bruising skin chronic ulcers persistent itchphysical examinationgeneral patient well developed well nourishedheent head normocephalic eyes pupils equal conjunctivae pink sclerae anictericneck adenopathypulmonary respirations unlaboredheart regular rhythmabdomen liver spleen kidney bladder palpable discernible masses peritoneal signsgenitalia penis plaques meatus glans scrotal skin healthy testicles fair consistency epididymides nontenderrectal prostate areas suspicious tumor consistency even sidewalls sharp seminal vesicles palpablemusculoskeletal upper lower extremities symmetric bilaterallyneurologic gross focal neurologic abnormalitiesimpression adenocarcinoma prostate atrial fibrillationplan patients wife discussed treatment options include primarily radiation surgery _________ surviving prostate cancer dr aware incontinency total partial discussed erectile dysfunction discussed bleeding infection injury rectum injury vessels nerves deep vein thrombosis pulmonary embolus mi stroke death questions conclusion conversation know age group though nervesparing procedure performed preserving erectile function highly unlikely questions conclusion last conversation

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSIS: ,Adenocarcinoma of the prostate.,HISTORY:, The patient is a 71-year-old male whose personal physician, Dr. X identified a change in the patient's PSA from 7/2008 (4.2) to 4/2009 (10.5). The patient underwent a transrectal ultrasound and biopsy and was found to have a Gleason 3+4 for a score of 7, 20% of the tissue removed from the left base. The patient also had Gleason 6 in the right lobe, midportion, as well as the left apical portion. He underwent a bone scan which was normal and cystoscopy which was normal and renal ultrasound that was normal.,SURGICAL HISTORY: , Appendectomy.,MEDICAL HISTORY:, Atrial fibrillation.,MEDICATIONS:, Coumadin and lisinopril.,SOCIAL HISTORY: ,Smokes none. Alcohol none.,ALLERGIES:, NONE.,REVIEW OF SYSTEMS: , The patient relates no recent weight gain, weight loss, night sweats, fevers or chills. Eyes: No change in vision or diplopia. Ears: No tinnitus or vertigo. Mouth: No dysphagia. Pulmonary: No chronic cough or shortness of breath. Cardiac: No angina or palpitations. GI: No nausea, vomiting, diarrhea or constipation. Musculoskeletal: No arthritides or myalgias. Hematopoietic: No easy bleeding or bruising. Skin: No chronic ulcers or persistent itch.,PHYSICAL EXAMINATION:,GENERAL: The patient is well developed and well nourished.,HEENT: Head is normocephalic. Eyes, pupils are equal. Conjunctivae are pink. Sclerae are anicteric.,NECK: There is no adenopathy.,PULMONARY: Respirations are unlabored.,HEART: Regular rhythm.,ABDOMEN: Liver, spleen, kidney, and bladder are not palpable. There are no discernible masses. There are no peritoneal signs.,GENITALIA: The penis has no plaques. Meatus is on the glans. Scrotal skin is healthy. Testicles are fair consistency. Epididymides are nontender.,RECTAL: The prostate is +1 to 2/4. There are no areas that are suspicious for tumor. Consistency is even. Sidewalls are sharp. Seminal vesicles are not palpable.,MUSCULOSKELETAL: The upper and lower extremities are symmetric bilaterally.,NEUROLOGIC: There are no gross focal neurologic abnormalities.,IMPRESSION:,1. Adenocarcinoma of the prostate.,2. Atrial fibrillation.,PLAN: , The patient's wife and I have discussed his treatment options, which include primarily radiation and surgery. He has _________ surviving prostate cancer by Dr. Y. He is aware of incontinency, both total and partial. We discussed erectile dysfunction. We have discussed bleeding, infection, injury to the rectum, injury to vessels and nerves, deep vein thrombosis, pulmonary embolus, MI, stroke, and death. He had no questions at the conclusion of the conversation and he does know that in his age group, though a nerve-sparing procedure will be performed, preserving any erectile function is highly unlikely. He had no questions at the conclusion of our last conversation. ### Response: Consult - History and Phy., Urology

ADMISSION DIAGNOSIS: , Bilateral l5 spondylolysis with pars defects and spinal instability with radiculopathy.,SECONDARY DIAGNOSIS:, Chronic pain syndrome.,PRINCIPAL PROCEDURE: , L5 Gill procedure with interbody and posterolateral (360 degrees circumferential) arthrodesis using cages, bone graft, recombinant bone morphogenic protein, and pedicle fixation. This was performed by Dr. X on 01/08/08.,BRIEF HISTORY OF HOSPITAL COURSE: , The patient is a man with a history of longstanding back, buttock, and bilateral leg pain. He was evaluated and found to have bilateral pars defects at L5-S1 with spondylolysis and instability. He was admitted and underwent an uncomplicated surgical procedure as noted above. In the postoperative period, he was up and ambulatory. He was taking p.o. fluids and diet well. He was afebrile. His wounds were healing well. Subsequently, the patient was discharged home.,DISCHARGE MEDICATIONS: , Discharge medications included his usual preoperative pain medication as well as other medications.,FOLLOWUP: ,At this time, the patient will follow up with me in the office in six weeks' time. The patient understands discharge plans and is in agreement with the discharge plan. He will follow up as noted

admission diagnosis bilateral l spondylolysis pars defects spinal instability radiculopathysecondary diagnosis chronic pain syndromeprincipal procedure l gill procedure interbody posterolateral degrees circumferential arthrodesis using cages bone graft recombinant bone morphogenic protein pedicle fixation performed dr x brief history hospital course patient man history longstanding back buttock bilateral leg pain evaluated found bilateral pars defects ls spondylolysis instability admitted underwent uncomplicated surgical procedure noted postoperative period ambulatory taking po fluids diet well afebrile wounds healing well subsequently patient discharged homedischarge medications discharge medications included usual preoperative pain medication well medicationsfollowup time patient follow office six weeks time patient understands discharge plans agreement discharge plan follow noted

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSIS: , Bilateral l5 spondylolysis with pars defects and spinal instability with radiculopathy.,SECONDARY DIAGNOSIS:, Chronic pain syndrome.,PRINCIPAL PROCEDURE: , L5 Gill procedure with interbody and posterolateral (360 degrees circumferential) arthrodesis using cages, bone graft, recombinant bone morphogenic protein, and pedicle fixation. This was performed by Dr. X on 01/08/08.,BRIEF HISTORY OF HOSPITAL COURSE: , The patient is a man with a history of longstanding back, buttock, and bilateral leg pain. He was evaluated and found to have bilateral pars defects at L5-S1 with spondylolysis and instability. He was admitted and underwent an uncomplicated surgical procedure as noted above. In the postoperative period, he was up and ambulatory. He was taking p.o. fluids and diet well. He was afebrile. His wounds were healing well. Subsequently, the patient was discharged home.,DISCHARGE MEDICATIONS: , Discharge medications included his usual preoperative pain medication as well as other medications.,FOLLOWUP: ,At this time, the patient will follow up with me in the office in six weeks' time. The patient understands discharge plans and is in agreement with the discharge plan. He will follow up as noted ### Response: Discharge Summary, Orthopedic

ADMISSION DIAGNOSIS: , Left hip fracture.,CHIEF COMPLAINT: , Diminished function, secondary to the above.,HISTORY: , This pleasant 70-year-old gentleman had a ground-level fall at home on 05/05/03 and was brought into ABCD Medical Center, evaluated by Dr. X and brought in for orthopedic stay. He had left hip fracture identified on x-rays at that time. Pain and inability to ambulate brought him in. He was evaluated and then underwent medical consultation as well, where they found a history of resolving pneumonia, hypertension, chronic obstructive pulmonary disease, congestive heart failure, hypothyroidism, depression, anxiety, seizure and chronic renal failure, as well as anemia. His medical issues are under good control. The patient underwent left femoral neck fixation with hemiarthroplasty on that left side on 05/06/03. The patient has had some medical issues including respiratory insufficiency, perioperative anemia, pneumonia, and hypertension. Cardiology has followed closely, and the patient has responded well to medical treatment, as well as physical therapy and occupational therapy. He is gradually tolerating more activities with less difficulties, made good progress and tolerated more consistent and more prolonged interventions.,PAST MEDICAL HISTORY: , Positive for congestive heart failure, chronic renal insufficiency, azotemia, hyperglycemia, coronary artery disease, history of paroxysmal atrial fibrillation. Remote history of subdural hematoma precluding the use of Coumadin. History of depression, panic attacks on Doxepin. Perioperative anemia. Swallowing difficulties.,ALLERGIES:, Zyloprim, penicillin, Vioxx, NSAIDs.,CURRENT MEDICATIONS,1. Heparin.,2. Albuterol inhaler.,3. Combivent.,4. Aldactone.,5. Doxepin.,6. Xanax.,7. Aspirin.,8. Amiodarone.,9. Tegretol.,10. Synthroid.,11. Colace.,SOCIAL HISTORY: , Lives in a 1-story home with 1 step down; wife is there. Speech and language pathology following with current swallowing dysfunction. He is minimum assist for activities of daily living, bed mobility.,REVIEW OF SYSTEMS:, Currently negative for headache, nausea and vomiting, fevers, chills or shortness of breath or chest pain.,PHYSICAL EXAMINATION,HEENT: Oropharynx clear.,CV: Regular rate and rhythm without murmurs, rubs or gallops.,LUNGS: Clear to auscultation bilaterally.,ABDOMEN: Nontender, nondistended. Bowel sounds positive.,EXTREMITIES: Without clubbing, cyanosis, or edema.,NEUROLOGIC: There are no focal motor or sensory losses to the lower extremities. Bulk and tone normal in the lower extremities. Wound site has healed well with staples out.,IMPRESSION ,1. Status post left hip fracture and hemiarthroplasty.,2. History of panic attack, anxiety, depression.,3. Myocardial infarction with stent placement.,4. Hypertension.,5. Hypothyroidism.,6. Subdural hematoma.,7. Seizures.,8. History of chronic obstructive pulmonary disease. Recent respiratory insufficiency.,9. Renal insufficiency.,10. Recent pneumonia.,11. O2 requiring.,12. Perioperative anemia.,PLAN: , Rehab transfer as soon as medically cleared.

admission diagnosis left hip fracturechief complaint diminished function secondary abovehistory pleasant yearold gentleman groundlevel fall home brought abcd medical center evaluated dr x brought orthopedic stay left hip fracture identified xrays time pain inability ambulate brought evaluated underwent medical consultation well found history resolving pneumonia hypertension chronic obstructive pulmonary disease congestive heart failure hypothyroidism depression anxiety seizure chronic renal failure well anemia medical issues good control patient underwent left femoral neck fixation hemiarthroplasty left side patient medical issues including respiratory insufficiency perioperative anemia pneumonia hypertension cardiology followed closely patient responded well medical treatment well physical therapy occupational therapy gradually tolerating activities less difficulties made good progress tolerated consistent prolonged interventionspast medical history positive congestive heart failure chronic renal insufficiency azotemia hyperglycemia coronary artery disease history paroxysmal atrial fibrillation remote history subdural hematoma precluding use coumadin history depression panic attacks doxepin perioperative anemia swallowing difficultiesallergies zyloprim penicillin vioxx nsaidscurrent medications heparin albuterol inhaler combivent aldactone doxepin xanax aspirin amiodarone tegretol synthroid colacesocial history lives story home step wife speech language pathology following current swallowing dysfunction minimum assist activities daily living bed mobilityreview systems currently negative headache nausea vomiting fevers chills shortness breath chest painphysical examinationheent oropharynx clearcv regular rate rhythm without murmurs rubs gallopslungs clear auscultation bilaterallyabdomen nontender nondistended bowel sounds positiveextremities without clubbing cyanosis edemaneurologic focal motor sensory losses lower extremities bulk tone normal lower extremities wound site healed well staples outimpression status post left hip fracture hemiarthroplasty history panic attack anxiety depression myocardial infarction stent placement hypertension hypothyroidism subdural hematoma seizures history chronic obstructive pulmonary disease recent respiratory insufficiency renal insufficiency recent pneumonia requiring perioperative anemiaplan rehab transfer soon medically cleared

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSIS: , Left hip fracture.,CHIEF COMPLAINT: , Diminished function, secondary to the above.,HISTORY: , This pleasant 70-year-old gentleman had a ground-level fall at home on 05/05/03 and was brought into ABCD Medical Center, evaluated by Dr. X and brought in for orthopedic stay. He had left hip fracture identified on x-rays at that time. Pain and inability to ambulate brought him in. He was evaluated and then underwent medical consultation as well, where they found a history of resolving pneumonia, hypertension, chronic obstructive pulmonary disease, congestive heart failure, hypothyroidism, depression, anxiety, seizure and chronic renal failure, as well as anemia. His medical issues are under good control. The patient underwent left femoral neck fixation with hemiarthroplasty on that left side on 05/06/03. The patient has had some medical issues including respiratory insufficiency, perioperative anemia, pneumonia, and hypertension. Cardiology has followed closely, and the patient has responded well to medical treatment, as well as physical therapy and occupational therapy. He is gradually tolerating more activities with less difficulties, made good progress and tolerated more consistent and more prolonged interventions.,PAST MEDICAL HISTORY: , Positive for congestive heart failure, chronic renal insufficiency, azotemia, hyperglycemia, coronary artery disease, history of paroxysmal atrial fibrillation. Remote history of subdural hematoma precluding the use of Coumadin. History of depression, panic attacks on Doxepin. Perioperative anemia. Swallowing difficulties.,ALLERGIES:, Zyloprim, penicillin, Vioxx, NSAIDs.,CURRENT MEDICATIONS,1. Heparin.,2. Albuterol inhaler.,3. Combivent.,4. Aldactone.,5. Doxepin.,6. Xanax.,7. Aspirin.,8. Amiodarone.,9. Tegretol.,10. Synthroid.,11. Colace.,SOCIAL HISTORY: , Lives in a 1-story home with 1 step down; wife is there. Speech and language pathology following with current swallowing dysfunction. He is minimum assist for activities of daily living, bed mobility.,REVIEW OF SYSTEMS:, Currently negative for headache, nausea and vomiting, fevers, chills or shortness of breath or chest pain.,PHYSICAL EXAMINATION,HEENT: Oropharynx clear.,CV: Regular rate and rhythm without murmurs, rubs or gallops.,LUNGS: Clear to auscultation bilaterally.,ABDOMEN: Nontender, nondistended. Bowel sounds positive.,EXTREMITIES: Without clubbing, cyanosis, or edema.,NEUROLOGIC: There are no focal motor or sensory losses to the lower extremities. Bulk and tone normal in the lower extremities. Wound site has healed well with staples out.,IMPRESSION ,1. Status post left hip fracture and hemiarthroplasty.,2. History of panic attack, anxiety, depression.,3. Myocardial infarction with stent placement.,4. Hypertension.,5. Hypothyroidism.,6. Subdural hematoma.,7. Seizures.,8. History of chronic obstructive pulmonary disease. Recent respiratory insufficiency.,9. Renal insufficiency.,10. Recent pneumonia.,11. O2 requiring.,12. Perioperative anemia.,PLAN: , Rehab transfer as soon as medically cleared. ### Response: Consult - History and Phy., Orthopedic

ADMISSION DIAGNOSIS: , Microinvasive carcinoma of the cervix.,DISCHARGE DIAGNOSIS: , Microinvasive carcinoma of the cervix.,PROCEDURE PERFORMED: , Total vaginal hysterectomy.,HISTORY OF PRESENT ILLNESS: , The patient is a 36-year-old, white female, gravida 7, para 5, last period mid March, status post tubal ligation. She had an abnormal Pap smear in the 80s, which she failed to followup on until this year. Biopsy showed a microinvasive carcinoma of the cervix and a cone biopsy was performed on 02/12/2007 also showing microinvasive carcinoma with a 1 mm invasion. She has elected definitive therapy with a total vaginal hysterectomy. She is aware of the future need of Pap smears.,PAST MEDICAL HISTORY: , Past history is significant for seven pregnancies, five term deliveries, and significant past history of tobacco use.,PHYSICAL EXAMINATION: , Physical exam is within normal limits with a taut normal size uterus and a small cervix, status post cone biopsy.,LABORATORY DATA AND DIAGNOSTIC STUDIES: , Chest x-ray was clear. Discharge hemoglobin 10.8.,HOSPITAL COURSE: , She was taken to the operating room on 04/02/2007 where a total vaginal hysterectomy was performed under general anesthesia. There was an incidental cystotomy at the time of the creation of the bladder flap. This was repaired intraoperatively without difficulty. Postoperative, she did very well. Bowel and bladder function returned quickly. She is ambulating well and tolerating a regular diet.,Routine postoperative instructions given and understood. Followup will be in ten days for a cystogram and catheter removal with followup in the office at that time. ,DISCHARGE MEDICATIONS:, Vicodin, Motrin, and Macrodantin at bedtime for urinary tract infection suppression. ,DISCHARGE CONDITION: , Good.,Final pathology report was free of residual disease.

admission diagnosis microinvasive carcinoma cervixdischarge diagnosis microinvasive carcinoma cervixprocedure performed total vaginal hysterectomyhistory present illness patient yearold white female gravida para last period mid march status post tubal ligation abnormal pap smear failed followup year biopsy showed microinvasive carcinoma cervix cone biopsy performed also showing microinvasive carcinoma mm invasion elected definitive therapy total vaginal hysterectomy aware future need pap smearspast medical history past history significant seven pregnancies five term deliveries significant past history tobacco usephysical examination physical exam within normal limits taut normal size uterus small cervix status post cone biopsylaboratory data diagnostic studies chest xray clear discharge hemoglobin hospital course taken operating room total vaginal hysterectomy performed general anesthesia incidental cystotomy time creation bladder flap repaired intraoperatively without difficulty postoperative well bowel bladder function returned quickly ambulating well tolerating regular dietroutine postoperative instructions given understood followup ten days cystogram catheter removal followup office time discharge medications vicodin motrin macrodantin bedtime urinary tract infection suppression discharge condition goodfinal pathology report free residual disease

### Instruction: find the medical speciality for this medical test. ### Input: ADMISSION DIAGNOSIS: , Microinvasive carcinoma of the cervix.,DISCHARGE DIAGNOSIS: , Microinvasive carcinoma of the cervix.,PROCEDURE PERFORMED: , Total vaginal hysterectomy.,HISTORY OF PRESENT ILLNESS: , The patient is a 36-year-old, white female, gravida 7, para 5, last period mid March, status post tubal ligation. She had an abnormal Pap smear in the 80s, which she failed to followup on until this year. Biopsy showed a microinvasive carcinoma of the cervix and a cone biopsy was performed on 02/12/2007 also showing microinvasive carcinoma with a 1 mm invasion. She has elected definitive therapy with a total vaginal hysterectomy. She is aware of the future need of Pap smears.,PAST MEDICAL HISTORY: , Past history is significant for seven pregnancies, five term deliveries, and significant past history of tobacco use.,PHYSICAL EXAMINATION: , Physical exam is within normal limits with a taut normal size uterus and a small cervix, status post cone biopsy.,LABORATORY DATA AND DIAGNOSTIC STUDIES: , Chest x-ray was clear. Discharge hemoglobin 10.8.,HOSPITAL COURSE: , She was taken to the operating room on 04/02/2007 where a total vaginal hysterectomy was performed under general anesthesia. There was an incidental cystotomy at the time of the creation of the bladder flap. This was repaired intraoperatively without difficulty. Postoperative, she did very well. Bowel and bladder function returned quickly. She is ambulating well and tolerating a regular diet.,Routine postoperative instructions given and understood. Followup will be in ten days for a cystogram and catheter removal with followup in the office at that time. ,DISCHARGE MEDICATIONS:, Vicodin, Motrin, and Macrodantin at bedtime for urinary tract infection suppression. ,DISCHARGE CONDITION: , Good.,Final pathology report was free of residual disease. ### Response: Discharge Summary, Obstetrics / Gynecology