TigerResearch/tigerbot-mt-note-generation-en huggingface dataset:
CHIEF COMPLAINT:  Right distal ureteral calculus. HISTORY OF PRESENT ILLNESS: The patient had hematuria and a CT urogram at ABC Radiology on 01/04/07 showing a 1 cm non-obstructing calcification in the right distal ureter. He had a KUB also showing a teardrop shaped calcification apparently in the right lower ureter. He comes in now for right ureteroscopy, Holmium laser lithotripsy, right ureteral stent placement. PAST MEDICAL HISTORY: 1. Prostatism. 2. Coronary artery disease. PAST SURGICAL HISTORY: 1. Right spermatocelectomy. 2. Left total knee replacement in 1987. 3. Right knee in 2005. MEDICATIONS: 1. Coumadin 3 mg daily. 2. Fosamax. 3. Viagra p.r.n. ALLERGIES:  NONE. REVIEW OF SYSTEMS:   CARDIOPULMONARY: No shortness of breath or chest pain. GI: No nausea, vomiting, diarrhea or constipation. GU: Voids well. MUSCULOSKELETAL: No weakness or strokes. FAMILY HISTORY:  Noncontributory. PHYSICAL EXAMINATION: GENERAL APPEARANCE: An alert male in no distress. HEENT: Grossly normal. NECK: Supple. LUNGS: Clear. HEART: Normal sinus rhythm. No murmur or gallop. ABDOMEN: Soft. No masses. GENITALIA: Normal penis. Testicles descended bilaterally. RECTAL: Examination benign. EXTREMITIES: No edema. IMPRESSION:  Right distal ureteral calculus. PLAN:  Right ureteroscopy, ureteral lithotripsy. Risks and complications discussed with the patient. He signed a true informed consent. No guarantees or warrantees were given.
CHIEF COMPLAINT:   Foul-smelling urine and stomach pain after meals. HISTORY OF PRESENT ILLNESS:   Stomach pain with most meals x one and a half years and urinary symptoms for same amount of time. She was prescribed Reglan, Prilosec, Pepcid, and Carafate at ED for her GI symptoms and Bactrim for UTI. This visit was in July 2010. REVIEW OF SYSTEMS:   HEENT: No headaches. No visual disturbances, no eye irritation. No nose drainage or allergic symptoms. No sore throat or masses. Respiratory: No shortness of breath. No cough or wheeze. No pain. Cardiac: No palpitations or pain. Gastrointestinal: Pain and cramping. Denies nausea, vomiting, or diarrhea. Has some regurgitation with gas after meals. Genitourinary: "Smelly" urine. Musculoskeletal: No swelling, pain, or numbness. MEDICATION ALLERGIES:   No known drug allergies. PHYSICAL EXAMINATION: General: Unremarkable. HEENT: PERRLA. Gaze conjugate. Neck: No nodes. No thyromegaly. No masses. Lungs: Clear. Heart: Regular rate without murmur. Abdomen: Soft, without organomegaly, without guarding or tenderness. Back: Straight. No paraspinal spasm. Extremities: Full range of motion. No edema. Neurologic: Cranial nerves II-XII intact. Deep tendon reflexes 2+ bilaterally. Skin: Unremarkable. LABORATORY STUDIES:   Urinalysis was done, which showed blood due to her period and moderate leukocytes. ASSESSMENT: 1. UTI. 2. GERD. 3. Dysphagia. 4. Contraception consult. PLAN: 1. Cipro 500 mg b.i.d. x five days. Ordered BMP, CBC, and urinalysis with microscopy. 2. Omeprazole 20 mg daily and famotidine 20 mg b.i.d. 3. Prescriptions same as #2. Also referred her for a barium swallow series to rule out a stricture. 4. Ortho Tri-Cyclen Lo.
CHIEF COMPLAINT:  Left flank pain and unable to urinate. HISTORY:  The patient is a 46-year-old female who presented to the emergency room with left flank pain and difficulty urinating. Details are in the history and physical. She does have a vague history of a bruised left kidney in a motor vehicle accident. She feels much better today. I was consulted by Dr. X. MEDICATIONS:   Ritalin 50 a day. ALLERGIES:  To penicillin. PAST MEDICAL HISTORY:  ADHD. SOCIAL HISTORY:   No smoking, alcohol, or drug abuse. PHYSICAL EXAMINATION:  She is awake, alert, and quite comfortable. Abdomen is benign. She points to her left flank, where she was feeling the pain. DIAGNOSTIC DATA:  Her CAT scan showed a focal ileus in left upper quadrant, but no thickening, no obstruction, no free air, normal appendix, and no kidney stones. LABORATORY WORK:  Showed white count 6200, hematocrit 44.7. Liver function tests and amylase were normal. Urinalysis 3+ bacteria. IMPRESSION: 1. Left flank pain, question etiology. 2. No evidence of surgical pathology. 3. Rule out urinary tract infection. PLAN: 1. No further intervention from my point of view. 2. Agree with discharge and followup as an outpatient. Further intervention will depend on how she does clinically. She fully understood and agreed.
CHIEF COMPLAINT:   Recurrent bladder tumor. HISTORY OF PRESENT ILLNESS:  The patient is a 79-year-old woman, the patient of Dr. X, who on recent followup cystoscopy for transitional cell carcinomas of the bladder neck was found to have a 5-cm area of papillomatosis just above the left ureteric orifice. The patient underwent TUR of several transitional cell carcinomas of the bladder on the bladder neck in 2006. This was followed by bladder instillation of BCG. At this time, the patient denies any voiding symptoms or hematuria. The patient opting for TUR and electrofulguration of the recurrent tumors. ALLERGIES:  None known. MEDICATIONS:  Atenolol 5 mg daily. OPERATIONS:  Status post bilateral knee replacements and status post TUR of bladder tumors. REVIEW OF SYSTEMS:  Other than some mild hypertension, the patient is in very, very good health. No history of diabetes, shortness of breath or chest pain. PHYSICAL EXAMINATION:  Well-developed and well-nourished woman, alert and oriented. Her lungs are clear. Heart, regular sinus rhythm. Back, no CVA tenderness. Abdomen, soft and nontender. No palpable masses. IMPRESSION:  Recurrent bladder tumors. PLAN:  The patient to have CBC, chem-6, PT, PTT, EKG, and chest x-ray beforehand.
CHIEF COMPLAINT:   Non-healing surgical wound to the left posterior thigh. HISTORY OF PRESENT ILLNESS:  This is a 49-year-old white male who sustained a traumatic injury to his left posterior thighthis past year while in ABCD. He sustained an injury from the patellar from a boat while in the water. He was air lifted actually up to XYZ Hospital and underwent extensive surgery. He still has an external fixation on it for the healing fractures in the leg and has undergone grafting and full thickness skin grafting closure to a large defect in his left posterior thigh, which is nearly healed right in the gluteal fold on that left area. In several areas right along the graft site and low in the leg, the patient has several areas of hypergranulation tissue. He has some drainage from these areas. There are no signs and symptoms of infection. He is referred to us to help him get those areas under control. PAST MEDICAL HISTORY:   Essentially negative other than he has had C. difficile in the recent past. ALLERGIES:   None. MEDICATIONS:  Include Cipro and Flagyl. PAST SURGICAL HISTORY:  Significant for his trauma surgery noted above. FAMILY HISTORY:  His maternal grandmother had pancreatic cancer. Father had prostate cancer. There is heart disease in the father and diabetes in the father. SOCIAL HISTORY:   He is a non-cigarette smoker and non-ETOH user. He is divorced. He has three children. He has an attorney. REVIEW OF SYSTEMS: CARDIAC: He denies any chest pain or shortness of breath. GI: As noted above. GU: As noted above. ENDOCRINE: He denies any bleeding disorders. PHYSICAL EXAMINATION: GENERAL: He presents as a well-developed, well-nourished 49-year-old white male who appears to be in no significant distress. HEENT: Unremarkable. NECK: Supple. There is no mass, adenopathy, or bruit. CHEST: Normal excursion. LUNGS: Clear to auscultation and percussion. COR: Regular. There is no S3, S4, or gallop. There is no murmur. ABDOMEN: Soft. It is nontender. There is no mass or organomegaly. GU: Unremarkable. RECTAL: Deferred. EXTREMITIES: His right lower extremity is unremarkable. Peripheral pulse is good. His left lower extremity is significant for the split thickness skin graft closure of a large defect in the posterior thigh, which is nearly healed. The open areas that are noted above __________ hypergranulation tissue both on his gluteal folds on the left side. There is one small area right essentially within the graft site, and there is one small area down lower on the calf area. The patient has an external fixation on that comes out laterally on his left thigh. Those pin sites look clean. NEUROLOGIC: Without focal deficits. The patient is alert and oriented. IMPRESSION:  Several multiple areas of hypergranulation tissue on the left posterior leg associated with a sense of trauma to his right posterior leg. PLAN:   Plan would be for chemical cauterization of these areas. Series of treatment with chemical cauterization till these are closed.
CHIEF COMPLAINT:   The patient comes for three-week postpartum checkup, complaining of allergies. HISTORY OF PRESENT ILLNESS:   She is doing well postpartum. She has had no headache. She is breastfeeding and feels like her milk is adequate. She has not had much bleeding. She is using about a mini pad twice a day, not any cramping or clotting and the discharge is turned from red to brown to now slightly yellowish. She has not yet had sexual intercourse. She does complain that she has had a little pain with the bowel movement, and every now and then she notices a little bright red bleeding. She has not been particularly constipated but her husband says she is not eating her vegetables like she should. Her seasonal allergies have back developed and she is complaining of extremely itchy watery eyes, runny nose, sneezing, and kind of a pressure sensation in her ears. MEDICATIONS:   Prenatal vitamins. ALLERGIES:   She thinks to Benadryl. FAMILY HISTORY:  Mother is 50 and healthy. Dad is 40 and healthy. Half-sister, age 34, is healthy. She has a sister who is age 10 who has some yeast infections. PHYSICAL EXAMINATION: VITALS: Weight: 124 pounds. Blood pressure 96/54. Pulse: 72. Respirations: 16. LMP: 10/18/03. Age: 39. HEENT: Head is normocephalic. Eyes: EOMs intact. PERRLA. Conjunctiva clear. Fundi: Discs flat, cups normal. No AV nicking, hemorrhage or exudate. Ears: TMs intact. Mouth: No lesion. Throat: No inflammation. She has allergic rhinitis with clear nasal drainage, clear watery discharge from the eyes. Abdomen: Soft. No masses. Pelvic: Uterus is involuting. Rectal: She has one external hemorrhoid which has inflamed. Stool is guaiac negative and using anoscope, no other lesions are identified. ASSESSMENT/PLAN:   Satisfactory three-week postpartum course, seasonal allergies. We will try Patanol eyedrops and Allegra 60 mg twice a day. She was cautioned about the possibility that this may alter her milk supply. She is to drink extra fluids and call if she has problems with that. We will try ProctoFoam HC. For the hemorrhoids, also increase the fiber in her diet. That prescription was written, as well as one for Allegra and Patanol. She additionally will be begin on Micronor because she would like to protect herself from pregnancy until her husband get scheduled in and has a vasectomy, which is their ultimate plan for birth control, and she anticipates that happening fairly soon. She will call and return if she continues to have problems with allergies. Meantime, rechecking in three weeks for her final six-week postpartum checkup.
CHIEF COMPLAINT:   Essential thrombocytosis. HISTORY OF PRESENT ILLNESS:  This is an extremely pleasant 64-year-old gentleman who I am following for essential thrombocytosis. He was first diagnosed when he first saw a hematologist on 07/09/07. At that time, his platelet count was 1,240,000. He was initially started on Hydrea 1000 mg q.d. On 07/11/07, he underwent a bone marrow biopsy, which showed essential thrombocytosis. He was positive for the JAK-2 mutation. On 11/06/07, his platelets were noted to be 766,000. His current Hydrea dose is now 1500 mg on Mondays and Fridays and 1000 mg on all other days. He moved to ABCD in December 2009 in an attempt to improve his wife's rheumatoid arthritis. Overall, he is doing well. He has a good energy level, and his ECOG performance status is 0. He denies any fevers, chills, or night sweats. No lymphadenopathy. No nausea or vomiting. No change in bowel or bladder habits. CURRENT MEDICATIONS:  Hydrea 1500 mg on Mondays and Fridays and 1000 mg the other days of the week,  Flomax q.d.  vitamin D q.d, saw palmetto q.d.  aspirin 81 mg q.d.  and vitamin C q.d. ALLERGIES:  No known drug allergies. REVIEW OF SYSTEMS:   As per the HPI, otherwise negative. PAST MEDICAL HISTORY: 1. He is status post an appendectomy. 2. Status post a tonsillectomy and adenoidectomy. 3. Status post bilateral cataract surgery. 4. BPH. SOCIAL HISTORY: He has a history of tobacco use, which he quit at the age of 37. He has one alcoholic drink per day. He is married. He is a retired lab manager. FAMILY HISTORY: There is no history of solid tumor or hematologic malignancies in his family. PHYSICAL EXAM: VIT:
CHIEF COMPLAINT:  Polycythemia rubra vera. HISTORY OF PRESENT ILLNESS:  The patient is an 83-year-old female with a history of polycythemia vera. She comes in to clinic today for followup. She has not required phlebotomies for several months. The patient comes to clinic unaccompanied. CURRENT MEDICATIONS:  Levothyroxine 200 mcg q.d.  Nexium 40 mg q.d.  Celebrex 200 mg q.d.  vitamin D3 2000 IU q.d.  aspirin 81 mg q.d.  selenium 200 mg q.d.  Aricept 10 mg q.d.  Skelaxin 800 mg q.d.  ropinirole 1 mg q.d.  vitamin E 1000 IU q.d.  vitamin C 500 mg q.d.  flaxseed oil 100 mg daily, fish oil 100 units q.d.  Vicodin q.h.s.  and stool softener q.d. ALLERGIES: Penicillin. REVIEW OF SYSTEMS: The patient's chief complaint is her weight. She brings in a packet of information on HCZ Diovan and also metabolic assessment that was done at the key. She has questions as to whether or not there would be any contra indications to her going on the diet. Otherwise, she feels great. She had family reunion in Iowa once in four days out there. She continues to volunteer Hospital and is walking and enjoying her summer. She denies any fevers, chills, or night sweats. She has some mild constipation problem but has had under control. The rest of her review of systems is negative. PHYSICAL EXAM: VITALS:
DIAGNOSIS:   Polycythemia vera with secondary myelofibrosis. REASON FOR VISIT:  Followup of the above condition. CHIEF COMPLAINT:  Left shin pain. HISTORY OF PRESENT ILLNESS:  A 55-year-old white male who carries a diagnosis of polycythemia vera with secondary myelofibrosis. Diagnosis was made some time in 2005/2006. Initially, he underwent phlebotomy. He subsequently transferred his care here. In the past, he has been on hydroxyurea and interferon but did not tolerate both of them. He is JAK-2 positive. He does not have any siblings for a match-related transplant. He was seen for consideration of a MUD transplant, but was deemed not to be a candidate because of the social support as well as his reasonably good health. At our institution, the patient received a trial of lenalidomide and prednisone for a short period. He did well with the combination. Subsequently, he developed intolerance to lenalidomide. He complained of severe fatigue and diarrhea. This was subsequently stopped. The patient reports some injury to his left leg last week. His left leg apparently was swollen. He took steroids for about 3 days and stopped. Left leg swelling has disappeared. The patient denies any other complaints at this point in time. He admits to smoking marijuana. He says this gives him a great appetite and he has actually gained some weight. Performance status in the ECOG scale is 1. PHYSICAL EXAMINATION: VITAL SIGNS: He is afebrile. Blood pressure 144/85, pulse 86, weight 61.8 kg, and respiratory rate 18 per minute. GENERAL: He is in no acute distress. HEENT: There is no pallor, icterus or cervical adenopathy that is noted. Oral cavity is normal to exam. CHEST: Clear to auscultation. CARDIOVASCULAR: S1 and S2 normal with regular rate and rhythm. ABDOMEN: Soft and nontender with no hepatomegaly. Spleen is palpable 4 fingerbreadths below the left costal margin. There is no guarding, tenderness, rebound or rigidity noted. Bowel sounds are present. EXTREMITIES: Reveal no edema. Palpation of the left tibia revealed some mild tenderness. However, I do not palpate any bony abnormalities. There is no history of deep venous thrombosis. LABORATORY DATA:  CBC from today is significant for a white count of 41,900 with an absolute neutrophil count of 34,400, hemoglobin 14.8 with an MCV of 56.7, and platelet count 235,000. ASSESSMENT AND PLAN: 1. JAK-2 positive myeloproliferative disorder. The patient has failed pretty much all available options. He is not a candidate for chlorambucil or radioactive phosphorus because of his young age and the concern for secondary malignancy. I have e-mailed Dr. X to see whether he will be a candidate for the LBH trial. Hopefully, we can get a JAK-2 inhibitor trial quickly on board. 2. I am concerned about the risk of thrombosis with his elevated white count. He is on aspirin prophylaxis. The patient has been told to call me with any complaints. 3. Left shin pain. I have ordered x-rays of the left tibia and knee today. The patient will return to the clinic in 3 weeks. He is to call me in the interim for any problems.
CHIEF COMPLAINT:  Right knee. ,HISTORY OF THE PRESENT ILLNESS:  The patient presents today for follow up of osteoarthritis Grade IV of the bilateral knees and flexion contracture, doing great. Physical therapy is helping. The subjective pain is on the bilateral knees right worse than left. Pain: Localized to the bilateral knees right worse than left. Quality: There is no swelling, no redness, or warmth. The pain is described as aching occasionally. There is no burning. ,Duration: Months. Associated symptoms: Includes stiffness and weakness. There is no sleep loss and no instability. ,Hip Pain: None. ,Back pain: None. ,Radicular type pain: None. ,Modifying factors: Includes weight bearing pain and pain with ambulation. There is no sitting, and no night pain. There is no pain with weather change. VISCOSUPPLEMENTATION IN PAST:   No Synvisc. VAS PAIN SCORE:  10 bilaterally. WOMAC SCORE:  8,A-1 WOMAC SCORE:  0,See the enclosed WOMAC osteoarthritis index, which accompanies the patient's chart, for complete details of the patient's limitations to activities of daily living. ,REVIEW OF SYSTEMS:   No change. Constitutional: Good appetite and energy. No fever. No general complaints. HEENT: No headaches, no difficulty swallowing, no change in vision, no change in hearing. CV - RESP: No shortness of breath at rest or with exertion. No paroxysmal nocturnal dyspnea, orthopnea, and without significant cough, hemoptysis, or sputum. No chest pain on exertion. GI:
CHIEF COMPLAINT:  MGUS. HISTORY OF PRESENT ILLNESS:   This is an extremely pleasant 86-year-old gentleman, who I follow for his MGUS. I initially saw him for thrombocytopenia when his ANC was 1300. A bone marrow biopsy was obtained. Interestingly enough, at the time of his bone marrow biopsy, his hemoglobin was 13.0 and his white blood cell count was 6.5 with a platelet count of 484,000. His bone marrow biopsy showed a normal cellular bone marrow; however, there were 10% plasma cells and we proceeded with the workup for a plasma cell dyscrasia. All his tests came back as consistent with an MGUS. Overall, he is doing well. Since I last saw him, he tells me that he has had onset of atrial fibrillation. He has now started going to the gym two times per week, and has lost over 10 pounds. He has a good energy level and his ECOG performance status is 0. He denies any fever, chills, or night sweats. No lymphadenopathy. No nausea or vomiting. No change in bowel or bladder habits. CURRENT MEDICATIONS:  Multivitamin q.d.  aspirin one tablet q.d.  Lupron q. three months, Flomax  0.4 mg q.d.  and Warfarin 2.5 mg q.d. ALLERGIES: No known drug allergies. REVIEW OF SYSTEMS:  As per the HPI, otherwise negative. PAST MEDICAL HISTORY: 1. He is status post left inguinal hernia repair. 2. Prostate cancer diagnosed in December 2004, which was a Gleason 3+4. He is now receiving Lupron. SOCIAL HISTORY:  He has a very remote history of tobacco use. He has one to two alcoholic drinks per day. He is married. FAMILY HISTORY:  His brother had prostate cancer. PHYSICAL EXAM: VIT:
CHIEF COMPLAINT:   Follicular non-Hodgkin's lymphoma. HISTORY OF PRESENT ILLNESS:  This is an extremely pleasant 69 year-old gentleman, who I follow for his follicular lymphoma. His history is that in February of 1988 he had a biopsy of a left posterior auricular lymph node and pathology showed follicular non-Hodgkin's lymphoma. From 03/29/88 to 08/02/88, he received six cycles of CHOP chemotherapy. In 1990, his CT scan showed retroperitoneal lymphadenopathy. Therefore from 04/02/90 to 08/20/90, he received seven cycles of CVP. In 1999, he was treated with m-BACOD. He also received radiation to his pelvis. On 03/21/01, he had a right cervical lymph node biopsy, which again showed follicular lymphoma. His most recent PET scan dated 12/31/08 showed resolution of previously described hypermetabolic lymph nodes in the right lower neck. Overall, he is doing well. He has a good energy level, his ECOG performance status is 0. He denies any fever, chills or night sweats. No lymphadenopathy. No nausea or vomiting. No change in bowel or bladder habits. CURRENT MEDICATIONS:  Avelox 400 mg q.d. p.r.n.  cefuroxime 200 mg q.d. to be altered monthly with doxycycline 100 mg q.d.  Coumadin 5 mg on Monday and 2.5 mg on all other days, dicyclomine 10 mg q.d.  Coreg 6.25 mg b.i.d.  Vasotec 2.5 mg b.i.d.  Zantac 150 mg q.d.  Claritin D q.d.  Centrum q.d.  calcium q.d.  omega-3 b.i.d.  Metamucil q.d.  and Lasix 40 mg t.i.d. ALLERGIES:  No known drug allergies. REVIEW OF SYSTEMS: As per the HPI, otherwise negative. PAST MEDICAL HISTORY: 1. He has chronic lymphedema of the bilateral lower extremities secondary to his pelvic radiation. 2. He had bilateral ureteral obstruction and is status post a stent placement. The obstruction was secondary to his pelvic radiation. 3. History of congestive heart failure. 4. History of schwannoma resection. It was resected from T12 to L1 in 1991. 5. He has chronic obstruction of his inferior vena cava. 6. Recurrent lower extremity cellulitis. SOCIAL HISTORY: He has no tobacco use. No alcohol use. He is married. He is a retired Methodist minister. FAMILY HISTORY:  His mother just died two days ago. There is no history of solid tumors or hematologic malignancies in his family. PHYSICAL EXAM: VIT:
CHIEF COMPLAINT: 1. Extensive stage small cell lung cancer. 2. Chemotherapy with carboplatin and etoposide. 3. Left scapular pain status post CT scan of the thorax. HISTORY OF PRESENT ILLNESS:  The patient is a 67-year-old female with extensive stage small cell lung cancer. She is currently receiving treatment with carboplatin and etoposide. She completed her fifth cycle on 08/12/10. She has had ongoing back pain and was sent for a CT scan of the thorax. She comes into clinic today accompanied by her daughters to review the results. CURRENT MEDICATIONS:  Levothyroxine 88 mcg daily, Soriatane 25 mg daily, Timoptic 0.5% solution b.i.d.  Vicodin 5/500 mg one to two tablets q.6 hours p.r.n. ALLERGIES:  No known drug allergies. REVIEW OF SYSTEMS: The patient continues to have back pain some time she also take two pain pill. She received platelet transfusion the other day and reported mild fever. She denies any chills, night sweats, chest pain, or shortness of breath. The rest of her review of systems is negative. PHYSICAL EXAM: VITALS: