TigerResearch/tigerbot-mt-note-generation-en huggingface dataset:
CHIEF COMPLAINT:   Leg pain. HISTORY OF PRESENT ILLNESS:   This is a 56-year-old female who has pain in her legs at nighttime and when she gets up it comes and goes, radiates from her buttocks to her legs, sometimes it is her ankle. She has noticed it since she has been on Lipitor. She has had some night sweats occasionally. She has had a little bit of fever and nausea. She has noticed her blood sugars have been low. She has lost over 30 pounds after exercising doing water aerobics at Genesis in Wichita. She has noticed her fasting blood sugars have been ranging from 100 to 120. Blood sugars one and a half hours after meals have been 185. She is coming in for a diabetic checkup in one month and wants lab prior to that time. She has been eating more meat recently and has not been on a diet for cholesterol. CURRENT MEDICATIONS:   Include Lipitor 80 mg q.d. discontinued today, Vioxx 25 mg q.d.  Maxzide 37/25 q.d.  Protonix 40 mg q.d.  hydroxyzine pamoate 50 mg at h.s.  aspirin 81 mg q.d.  Glucovance 1.25/250 b.i.d. decreased to one a day today, Monopril 20 mg q.d.  estradiol one mg q.d.  and glucosamine 1000 mg q.d. ALLERGIES:   Cipro, sulfa, Bactrim, and Demerol. OBJECTIVE: Vital Signs: Weight is 248 pounds which is a 12-pound drop from January. Blood pressure 120/70. Pulse 68. General: This is a well-developed adult female, awake, alert, and in no acute distress. HEENT: Oropharynx and HEENT are within normal limits. Lungs: Clear. Heart: Regular rhythm and rate. Abdomen: Soft, nontender, and nondistended without organomegaly. GU: Palpation of femurs do not cause pain, rotation of hips do not cause pain, and compression of the hips do not cause pain. Neurologic: Deep tendon reflexes are normal. Extremities: Pulses in lower extremities are normal. Straight leg lifts are normal. ASSESSMENT/PLAN: 1. Leg pain/bone pain, I am going to check her CMP. I think this possibly is a side effect from Lipitor. We will stop Lipitor, have her follow up in one month which she has already got planned for diabetes appointment and check symptoms at that time. Certainly if her pain improves might consider something like Crestor, which is more water soluble, which may cause less adverse effects. We will check her comprehensive metabolic panel to make sure the alkaline phosphatase is okay, may need an x-ray of back, hip, and legs at that time if symptoms are not gone. 2. Hypercholesterolemia, this is somewhat bothersome as she is a diabetic. Did discuss with her that we need to stick to the diet especially after going off of Lipitor. We will see how she does with her bone pain/leg pain off of Lipitor. If she has improvement may consider Crestor in one month. I am going to check her lipid panel and a CMP. Apparently, she is going to get this at a different site, Mapleridge in Wichita. 3. Type II diabetes. We will decrease her Glucovance because she is having frequent low blood sugars. Her previous hemoglobin A1c was 5.6 so we will see if this improves her symptoms. I am also going to check a hemoglobin A1c at Mapleridge in Wichita and have a followup here in one month for that diabetes appointment.
CHIEF COMPLAINT:   Followup on hypertension and hypercholesterolemia. SUBJECTIVE:   This is a 78-year-old male who recently had his right knee replaced and also back surgery about a year and a half ago. He has done well with that. He does most of the things that he wants to do. He travels at every chance he has, and he just got back from a cruise. He denies any type of chest pain, heaviness, tightness, pressure, shortness of breath with stairs only, cough or palpitations. He sees Dr. Ferguson. He is known to have Crohn's and he takes care of that for him. He sees Dr. Roszhart for his prostate check. He is a nonsmoker and denies swelling in his ankles. MEDICATIONS:  Refer to chart. ALLERGIES:  Refer to chart. PHYSICAL EXAMINATION:  ,Vitals: Wt; 172 lbs, up 2 lbs,  B/P; 150/60, T; 96.4, P; 72 and regular. ,General: A 78-year-old male who does not appear to be in any acute distress. Glasses. Good dentition. CV: Distant S1, S2 without murmur or gallop. No carotid bruits. P: 2+ all around. Lungs: Diminished with increased AP diameter. ,Abdomen: Soft, bowel sounds active x 4 quadrants. No tenderness, no distention, no masses or organomegaly noted. Extremities: Well-healed surgical scar on the right knee. No edema. Hand grasps are strong and equal. Back: Surgical scar on the lower back. Neuro: Intact. A&O. Moves all four with no focal motor or sensory deficits. IMPRESSION: 1. Hypertension. 2. Hypercholesterolemia. 3. Osteoarthritis. 4. Fatigue. PLAN:   We will check a BMP, lipid, liver profile, CPK, and CBC. Refill his medications x 3 months. I gave him a copy of Partners in Prevention. Increase his Altace to 5 mg day for better blood pressure control. Diet, exercise, and weight loss, and we will see him back in three months and p.r.n.
CHIEF COMPLAINT:  Followup on diabetes mellitus, hypercholesterolemia, and sinusitis. ,SUBJECTIVE:   A 70-year-old female who was diagnosed with diabetes mellitus last fall. She has been checking her Accu-Cheks generally once a day, and they range from 82 to a high of 132. She feels well. She walks 1-2 miles most days. If the weather is bad, they go to a local mall. Otherwise they walk outside. She does complain of some sinus congestion and drainage for the last several days. She is up-to-date on her mammogram that she had at the Baylis Building. She sees Dr. Cheng for her gynecological care. She is a nonsmoker. Denies abdominal pain, nausea, vomiting, diarrhea, constipation, blood in her urine, blood in her stools. She has nocturia x 1. Denies swelling in her ankles. She checks her feet regularly.  ,PAST MEDICAL HISTORY:   Refer to chart. MEDICATIONS:  Refer to chart. ALLERGIES:  Refer to chart. PHYSICAL EXAMINATION: Vitals: Wt: 185 B/P: 142/70. When she checks it at the mall and other places, it is usually about 120/56. T: 96.5 P: 84 and regular. General: A 70-year-old female who does not appear to be in acute distress. ,HEENT: She has frontal and maxillary sinus tenderness on the right to palpation. The right TM is slightly dull.
CHIEF COMPLAINT:   Followup on diabetes mellitus, status post cerebrovascular accident. SUBJECTIVE:   This is a 70-year-old male who has no particular complaints other than he has just discomfort on his right side. We have done EMG studies. He has noticed it since his stroke about five years ago. He has been to see a neurologist. We have tried different medications and it just does not seem to help. He checks his blood sugars at home two to three times a day. He kind of adjusts his own insulin himself. Re-evaluation of symptoms is essentially negative. He has a past history of heavy tobacco and alcohol usage. MEDICATIONS:  Refer to chart. ALLERGIES:  Refer to chart. PHYSICAL EXAMINATION: Vitals: Wt; 118 lbs, B/P; 108/72, T; 96.5, P; 80 and regular. ,General: A 70-year-old male who does not appear to be in acute distress but does look older than his stated age. He has some missing dentition. Skin: Dry and flaky. ,CV: Heart tones are okay, adequate carotid pulsations. He has 2+ pedal pulse on the left and 1+ on the right. Lungs: Diminished but clear. Abdomen: Scaphoid. Rectal: His prostate check was normal per Dr. Gill. Neuro: Sensation with monofilament testing is better on the left than it is on the right. IMPRESSION: 1. Diabetes mellitus. 2. Neuropathy. 3. Status post cerebrovascular accident. PLAN:   Refill his medications x 3 months. We will check an A1c and BMP. I have talked to him several times about a colonoscopy, which he has refused, and so we have been doing stools for occult blood. We will check a PSA. Continue with yearly eye exams, foot exams, Accu-Cheks, and we will see him in three months and p.r.n.
CHIEF COMPLAINT: 1. Stage IIIC endometrial cancer. 2. Adjuvant chemotherapy with cisplatin, Adriamycin, and Abraxane. HISTORY OF PRESENT ILLNESS:  The patient is a 47-year-old female who was noted to have abnormal vaginal bleeding in the fall of 2009. In March 2010, she had an abnormal endometrial ultrasound with thickening of the endometrium and an enlarged uterus. CT scan of the abdomen on 03/22/2010 showed an enlarged uterus, thickening of the endometrium, and a mass structure in the right and left adnexa that was suspicious for ovarian metastasis. On 04/01/2010, she had a robotic modified radical hysterectomy with bilateral salpingo-oophorotomy and appendectomy with pelvic and periaortic lymphadenectomy. The pathology was positive for grade III endometrial adenocarcinoma, 9.5 cm in size with 2 cm of invasion. Four of 30 lymph nodes were positive for disease. The left ovary was positive for metastatic disease. Postsurgical PET/CT scan showed left lower pelvic side wall seroma and hypermetabolic abdominal and right pelvic retroperitoneal lymph nodes suspicious for metastatic disease. The patient has completed five of planned six cycles of chemotherapy and comes in to clinic today for followup. Of note, we had sent off genetic testing which was denied back in June. I have been trying to get this testing completed. CURRENT MEDICATIONS:  Synthroid q.d.  ferrous sulfate 325 mg b.i.d.  multivitamin q.d.  Ativan 0.5 mg q.4 hours p.r.n. nausea and insomnia, gabapentin one tablet at bedtime. ALLERGIES:
CHIEF COMPLAINT: Followup diabetes mellitus, type 1.  ,SUBJECTIVE:   Patient is a 34-year-old male with significant diabetic neuropathy. He has been off on insurance for over a year. Has been using NPH and Regular insulin to maintain his blood sugars. States that he is deathly afraid of having a low blood sugar due to motor vehicle accident he was in several years ago. Reports that his blood sugar dropped too low which caused the accident. Since this point in time, he has been unwilling to let his blood sugars fall within a normal range, for fear of hypoglycemia. Also reports that he regulates his blood sugars with how he feels, rarely checking his blood sugar with a glucometer.  ,Reports that he has been worked up extensively at hospital and was seeing an Endocrinologist at one time. Reports that he had some indications of kidney damage when first diagnosed. His urine microalbumin today is 100. His last hemoglobin A1C drawn at the end of December is 11.9. Reports that at one point, he was on Lantus which worked well and he did not worry about his blood sugars dropping too low. While using Lantus, he was able to get his hemoglobin A1C down to 7. His last CMP shows an elevated alkaline phosphatase level of 168. He denies alcohol or drug use and is a non smoker. Reports he quit drinking 3 years ago. I have discussed with patient that it would be appropriate to do an SGGT and hepatic panel today. Patient also has a history of gastroparesis and impotence. Patient requests Nexium and Viagra, neither of which are covered under the Health Plan. , ,Patient reports that he was in a scooter accident one week ago, fell off his scooter, hit his head. Was not wearing a helmet. Reports that he did not go to the emergency room and had a headache for several days after this incident. Reports that an ambulance arrived at the scene and he was told he had a scalp laceration and to go into the emergency room. Patient did not comply. Reports that the headache has resolved. Denies any dizziness, nausea, vomiting, or other neurological abnormalities.  ,PHYSICAL EXAMINATION:  WD, WN. Slender, 34-year-old white male. VITAL SIGNS: Blood sugar 145, blood pressure 120/88, heart rate 104, respirations 16. Microalbumin 100. SKIN: There appears to be 2 skin lacerations on the left parietal region of the scalp, each approximately 1 inch long. No signs of infection. Wound is closed with new granulation tissue. Appears to be healing well. HEENT: Normocephalic. PERRLA. EOMI. TMs pearly gray with landmarks present. Nares patent. Throat with no redness or swelling. Nontender sinuses. NECK: Supple. Full ROM. No LAD. CARDIAC:
CHIEF COMPLAINT:  Septal irritation. HISTORY OF PRESENT ILLNESS:  The patient is a 39-year-old African-American female status post repair of septal deviation but unfortunately, ultimately ended with a large septal perforation. The patient has been using saline nasal wash 2-3 times daily, however, she states that she still has discomfort in her nose with a "stretching" like pressure. She says her nose is frequently dry and she occasionally has nosebleeds due to the dry nature of her nose. She has no other complaints at this time. PHYSICAL EXAM: GENERAL: This is a pleasant African-American female resting in the examination room chair in no apparent distress. ENT: External auditory canals are clear. Tympanic membrane shows no perforation, is intact. NOSE: The patient has a slightly deviated right septum. Septum has a large perforation in the anterior 2/3rd of the septum. This appears to be well healed. There is no sign of crusting in the nose. ORAL CAVITY: No lesions or sores. Tonsils show no exudate or erythema. NECK: No cervical lymphadenopathy. VITAL SIGNS: Temperature 98 degrees Fahrenheit, pulse 77, respirations 18, blood pressure 130/73. ASSESSMENT AND PLAN: The patient is a 40-year-old female with a past medical history of repair of deviated septum with complication of a septal perforation. At this time, the patient states that her septal perforation bothers her as she feels that she has very dry air through her nose as well as occasional epistaxis. At this time, I counseled the patient on the risks and benefits of surgery. She will consider surgery but at this time, would like to continue using the saline nasal wash as well as occasional Bactroban to the nose if there is occasional irritation or crusting, which she will apply with the edge of a Q-tip. We will see her back in 3 weeks and if the patient does not feel relieved from the Bactroban as well as saline nasal spray wash, we will consider setting the patient for surgery at that time.
CHIEF COMPLAINT: 1. Metastatic breast cancer. 2. Enrolled is clinical trial C40502. 3. Sinus pain. HISTORY OF PRESENT ILLNESS:  She is a very pleasant 59-year-old nurse with a history of breast cancer. She was initially diagnosed in June 1994. Her previous treatments included Zometa, Faslodex, and Aromasin. She was found to have disease progression first noted by rising tumor markers. PET/CT scan revealed metastatic disease and she was enrolled in clinical trial of CTSU/C40502. She was randomized to the ixabepilone plus Avastin. She experienced dose-limiting toxicity with the fourth cycle. The Ixempra was skipped on day 1 and day 8. She then had a dose reduction and has been tolerating treatment well with the exception of progressive neuropathy. Early in the month she had concerned about possible perforated septum. She was seen by ENT urgently. She was found to have nasal septum intact. She comes into clinic today for day eight Ixempra. CURRENT MEDICATIONS: Zometa monthly, calcium with Vitamin D q.d.  multivitamin q.d.  Ambien 5 mg q.h.s.  Pepcid AC 20 mg q.d.  Effexor 112 mg q.d.  Lyrica 100 mg at bedtime, Tylenol p.r.n.  Ultram p.r.n.  Mucinex one to two tablets b.i.d.  Neosporin applied to the nasal mucosa b.i.d. nasal rinse daily. ALLERGIES: Compazine. REVIEW OF SYSTEMS:  The patient is comfort in knowing that she does not have a septal perforation. She has progressive neuropathy and decreased sensation in her fingertips. She makes many errors when keyboarding. I would rate her neuropathy as grade 2. She continues to have headaches respond to Ultram which she takes as needed. She occasionally reports pain in her right upper quadrant as well as right sternum. He denies any fevers, chills, or night sweats. Her diarrhea has finally resolved and her bowels are back to normal. The rest of her review of systems is negative. PHYSICAL EXAM: VITALS:
CHIEF COMPLAINT:   Stage IIA right breast cancer. HISTORY OF PRESENT ILLNESS: This is an extremely pleasant 58-year-old woman, who I am following for her stage IIA right breast cancer. She noticed a lump in the breast in November of 2007. A mammogram was obtained dated 01/28/08, which showed a mass in the right breast. On 02/10/08, she underwent an ultrasound-guided biopsy. The pathology showed an infiltrating ductal carcinoma Nottingham grade II. The tumor was ER positive, PR positive and HER-2/neu negative. On 02/22/08, she underwent a lumpectomy and sentinel lymph node biopsy. The pathology showed a 3.3 cm infiltrating ductal carcinoma grade I, one sentinel lymph node was negative. Therefore it was a T2, N0, M0 stage IIA breast cancer. Of note, at that time she was taking hormone replacement therapy and that was stopped. She underwent radiation treatment ending in May 2008. She then started on Arimidex, but unfortunately she did not tolerate the Arimidex and I changed her to Femara. She also did not tolerate the Femara and I changed it to tamoxifen. She did not tolerate the tamoxifen and therefore when I saw her on 11/23/09, she decided that she would take no further antiestrogen therapy. She met with me again on 02/22/10, and decided she wants to rechallenge herself with tamoxifen. When I saw her on 04/28/10, she was really doing quite well with tamoxifen. She tells me 2 weeks after that visit, she developed toxicity from the tamoxifen and therefore stopped it herself. She is not going take to any further tamoxifen. Overall, she is feeling well. She has a good energy level and her ECOG performance status is 0. She denies any fevers, chills, or night sweats. No lymphadenopathy. No nausea or vomiting. No change in bowel or bladder habits. CURRENT MEDICATIONS:   Avapro 300 mg q.d.  Pepcid q.d.  Zyrtec p.r.n.  and calcium q.d. ALLERGIES:   Sulfa, Betadine, and IV contrast. REVIEW OF SYSTEMS:  As per the HPI, otherwise negative. PAST MEDICAL HISTORY: 1. Asthma. 2. Hypertension. 3. GERD. 4. Eczema. 5. Status post three cesarean sections. 6. Status post a hysterectomy in 1981 for fibroids. They also removed one ovary. 7. Status post a cholecystectomy in 1993. 8. She has a history of a positive TB test. 9. She is status post repair of ventral hernia in November 2008. SOCIAL HISTORY:  She has no tobacco use. Only occasional alcohol use. She has no illicit drug use. She has two grown children. She is married. She works as a social worker dealing with adult abuse and neglect issues. Her husband is a high school chemistry teacher. FAMILY HISTORY: Her father had prostate cancer. Her maternal uncle had Hodgkin's disease, melanoma, and prostate cancer. PHYSICAL EXAM: VIT:
CHIEF COMPLAINT:  Aplastic anemia. HISTORY OF PRESENT ILLNESS:  This is a very pleasant 72-year-old woman, who I have been following for her pancytopenia. After several bone marrow biopsies, she was diagnosed with aplastic anemia. She started cyclosporine and prednisone on 03/30/10. She was admitted to the hospital from 07/11/10 to 07/14/10 with acute kidney injury. Her cyclosporine level was 555. It was thought that her acute kidney injury was due to cyclosporine toxicity and therefore that was held. Overall, she tells me that now she feels quite well since leaving the hospital. She was transfused 2 units of packed red blood cells while in the hospital. Repeat CBC from 07/26/10 showed white blood cell count of 3.4 with a hemoglobin of 10.7 and platelet count of 49,000. CURRENT MEDICATIONS:   Folic acid, Aciphex, MiraLax, trazodone, prednisone for 5 days every 4 weeks, Bactrim double strength 1 tablet b.i.d. on Mondays, Wednesdays and Fridays. ALLERGIES: No known drug allergies. REVIEW OF SYSTEMS:  As per the HPI, otherwise negative. PAST MEDICAL HISTORY: 1. Hypertension. 2. GERD. 3. Osteoarthritis. 4. Status post tonsillectomy. 5. Status post hysterectomy. 6. Status post bilateral cataract surgery. 7. Esophageal stricture status post dilatation approximately four times. SOCIAL HISTORY: She has no tobacco use. She has rare alcohol use. She has three children and is a widow. Her husband died after they were married only eight years. She is retired. FAMILY HISTORY:  Her sister had breast cancer. PHYSICAL EXAM: VIT:
CHIEF COMPLAINT: 1. Chronic lymphocytic leukemia (CLL). 2. Autoimmune hemolytic anemia. 3. Oral ulcer. HISTORY OF PRESENT ILLNESS:  The patient is a 72-year-old gentleman who was diagnosed with chronic lymphocytic leukemia in May 2008. He was noted to have autoimmune hemolytic anemia at the time of his CLL diagnosis. He has been on chronic steroids to control his hemolysis and is currently on prednisone 5 mg every other day. He comes in to clinic today for follow-up and complete blood count. At his last office visit we discontinued this prophylactic antivirals and antibacterial. CURRENT MEDICATIONS:   Prilosec 20 mg b.i.d.  levothyroxine 50 mcg q.d.  Lopressor 75 mg q.d.  vitamin C 500 mg q.d.  multivitamin q.d.  simvastatin 20 mg q.d.  and prednisone 5 mg q.o.d. ALLERGIES: Vicodin. REVIEW OF SYSTEMS: The patient reports ulcer on his tongue and his lip. He has been off of Valtrex for five days. He is having some difficulty with his night vision with his left eye. He has a known cataract. He denies any fevers, chills, or night sweats. He continues to have headaches. The rest of his review of systems is negative. PHYSICAL EXAM: VITALS:
CHIEF COMPLAINT:   Rule out obstructive sleep apnea syndrome. Sample Patient is a pleasant, 61-year-old, obese, African-American male with a past medical history significant for hypertension, who presents to the Outpatient Clinic with complaints of loud snoring and witnessed apnea episodes by his wife for at least the past five years. He denies any gasping, choking, or coughing episodes while asleep at night. His bedtime is between 10 to 11 p.m.  has no difficulty falling asleep, and is usually out of bed around 7 a.m. feeling refreshed. He has two to three episodes of nocturia per night. He denies any morning symptoms. He has mild excess daytime sleepiness manifested by dozing off during boring activities. PAST MEDICAL HISTORY:   Hypertension, gastritis, and low back pain. PAST SURGICAL HISTORY:   TURP. MEDICATIONS:   Hytrin, Motrin, Lotensin, and Zantac. ALLERGIES:   None. FAMILY HISTORY:   Hypertension. SOCIAL HISTORY:   Significant for about a 20-pack-year tobacco use, quit in 1991. No ethanol use or illicit drug use. He is married. He has one dog at home. He used to be employed at Budd Automotors as a die setter for about 37 to 40 years. REVIEW OF SYSTEMS:   His weight has been steady over the years. Neck collar size is 17½". He denies any chest pain, cough, or shortness of breath. Last chest x-ray within the past year, per his report, was normal. PHYSICAL EXAM:   A pleasant, obese, African-American male in no apparent respiratory distress. T: 98. P: 90. RR: 20. BP: 156/90. O2 saturation: 97% on room air. Ht: 5' 5". Wt: 198 lb. HEENT: A short thick neck, low-hanging palate, enlarged scalloped tongue, narrow foreshortened pharynx, clear nares, and no JVD. CARDIAC: Regular rate and rhythm without any adventitious sounds. CHEST: Clear lungs bilaterally. ABDOMEN: An obese abdomen with active bowel sounds. EXTREMITIES: No cyanosis, clubbing, or edema. NEUROLOGIC: Non-focal. IMPRESSION: 1. Probable obstructive sleep apnea syndrome. 2. Hypertension. 3. Obesity. 4. History of tobacco use. PLAN: 1. We will schedule an overnight sleep study to evaluate obstructive sleep apnea syndrome. 2. Encouraged weight loss. 3. Check TSH. 4. Asked not to drive and engage in any activity that could endanger himself or others while sleepy. 5. Asked to return to the clinic one week after sleep the study is done.