harishnair04/mtsamples huggingface dataset:
Pneumothorax & Subcutaneous Emphysema 
Medical specialty:  Consult - History and Phy.
 Consult for subcutaneous emphysema and a small right-sided pneumothorax secondary to trauma.

REASON FOR CONSULTATION:,  Pneumothorax and subcutaneous emphysema.,HISTORY OF PRESENT ILLNESS: , The patient is a 48-year-old male who was initially seen in the emergency room on Monday with complaints of scapular pain.  The patient presented the following day with subcutaneous emphysema and continued complaints of pain as well as change in his voice.  The patient was evaluated with a CT scan of the chest and neck which demonstrated significant subcutaneous emphysema, a small right-sided pneumothorax, but no other findings.  The patient was admitted for observation.,PAST SURGICAL HISTORY: , Hernia repair and tonsillectomy.,ALLERGIES: , Penicillin.,MEDICATIONS: , Please see chart.,REVIEW OF SYSTEMS:,  Not contributory.,PHYSICAL EXAMINATION:,GENERAL:  Well developed, well nourished, lying on hospital bed in minimal distress.,HEENT:  Normocephalic and atraumatic.  Pupils are equal, round, and reactive to light.  Extraocular muscles are intact.,NECK:  Supple.  Trachea is midline.,CHEST:  Clear to auscultation bilaterally.,CARDIOVASCULAR:  Regular rate and rhythm.,ABDOMEN:  Soft, nontender, and nondistended.  Normoactive bowel sounds.,EXTREMITIES:  No clubbing, edema, or cyanosis.,SKIN:  The patient has significant subcutaneous emphysema of the upper chest and anterior neck area although he states that the subcutaneous emphysema has improved significantly since yesterday.,DIAGNOSTIC STUDIES:,  As above.,IMPRESSION: , The patient is a 48-year-old male with subcutaneous emphysema and a small right-sided pneumothorax secondary to trauma.  These are likely a result of either a parenchymal lung tear versus a small tracheobronchial tree rend.,RECOMMENDATIONS:,  At this time, the CT Surgery service has been consulted and has left recommendations.  The patient also is awaiting bronchoscopy per the Pulmonary Service.  At this time, there are no General Surgery issues.
Postop Medical Management 
Medical specialty:  Consult - History and Phy.
 Post-surgical medical management; right total knee replacement.

REASON FOR CONSULTATION: , Post-surgical medical management.,PROCEDURE DONE: , Right total knee replacement.,MEDICAL HISTORY:,1.  Arthritis of the right knee.,2.  Hypertension.,PAST SURGICAL HISTORY: , Hysterectomy, Cesarean section, left hip arthroplasty, and breast biopsy.,MEDICATIONS: , Hyzaar 12.5 mg p.o. daily, Femara 2.5 mg p.o. daily, Fosamax 70 mg p.o. every week, aspirin 81 mg p.o. daily, and vitamin.,ALLERGIES: , MORPHINE.,HISTORY OF PRESENT COMPLAINT: , This 84-year-old patient with history of arthritis underwent right total knee replacement yesterday.  The patient is admitted today to the surgical floor for postoperative management.  The patient tolerated the procedure well.,REVIEW OF SYSTEMS:,CONSTITUTIONAL:  No fever, chills, or malaise.,ENT:  Unremarkable.,RESPIRATORY:  The patient denies shortness of breath, cough, or wheezing.,CARDIOVASCULAR:  No known heart problems.  No orthopnea, palpitations, syncopal episode, or pedal swelling.,GASTROINTESTINAL:  She denies nausea or vomiting.  No history of GI bleed.,GENITOURINARY:  No dysuria, no hematuria.,ENDOCRINE:  Negative for diabetes or thyroid problems.,NEUROLOGICAL:  No history of seizure or TIA.  Cognitive function is intact.,SOCIAL HISTORY:  ,The patient does not smoke.  She consumes alcohol moderately.,FAMILY HISTORY:  ,Positive for cancer.,PHYSICAL EXAMINATION:,GENERAL:  This is an 84-year-old lady who looks young for her age.,VITAL SIGNS:  Blood pressure of 138/53, pulse is 73, respiratory rate of 20, and O2 saturation is 95% on room air.  She is afebrile.,HEAD AND NECK:  Face is symmetrical.  Cranial nerves are intact.  No distended neck veins.  No palpable neck masses.,CHEST:  Clear to auscultation.  No wheezing.  No crepitations.,CARDIOVASCULAR:  First and second heart sounds were heard.  No murmur is appreciated.,ABDOMEN:  Soft and nontender.  Bowel sounds are positive.,EXTREMITIES:  There is no pedal swelling.,LABORATORY DATA:  ,Hemoglobin has dropped from 12.6 to 10.2.  Hematocrit is 30.  Glucose is 125.  BUN is 15.9, creatinine is 0.6, sodium is 134, and potassium is 3.8.,ASSESSMENT AND PLAN:,1.  Right knee arthritis status post right total knee replacement.  The patient tolerated the procedure well.,2.  Anemia due to stated operative blood loss, would not require transfusion at this point.,3.  Hypertension, under control.  Continue current home medications.,4.  Deep vein thrombosis risk, prophylaxis as per surgeon.,5.  Gastrointestinal prophylaxis.,6.  Debility.  Continue physical therapy and occupational therapy.
Perioperative Elevated Blood Pressure 
Medical specialty:  Consult - History and Phy.
 Before surgery, the patient's blood pressure was 181/107.  The patient received IV labetalol.  Blood pressure improved, but postsurgery, the patient's blood pressure went up again to 180/100. 

REASON FOR CONSULTATION:,  Perioperative elevated blood pressure.,PAST MEDICAL HISTORY:,1.  Graves disease.,2.  Paroxysmal atrial fibrillation, has been in normal sinus rhythm for several months, off medication.,3.  Diverticulosis.,4.  GERD.,5.  High blood pressure.,6.  Prostatic hypertrophy, status post transurethral resection of the prostate.,PAST SURGICAL HISTORY: , Bilateral inguinal hernia repair, right shoulder surgery with reconstruction, both shoulders rotator cuff repair, left knee arthroplasty, and transurethral resection of prostate.,HISTORY OF PRESENTING COMPLAINT:  ,This 71-year-old gentleman with the above history, underwent laser surgery for the prostate earlier today.  Before surgery, the patient's blood pressure was 181/107.  The patient received IV labetalol.  Blood pressure improved, but postsurgery, the patient's blood pressure went up again to 180/100.  Currently, blood pressure is 158/100, goes up to 155 systolic when he is talking.  On further questioning, the patient denies shortness of breath, chest pain, palpitations, or dizziness.,REVIEW OF SYSTEMS:,CONSTITUTIONAL:  No recent fever or general malaise.,ENT:  Unremarkable.,RESPIRATORY:  No cough or shortness of breath.,CARDIOVASCULAR:  No chest pain.,GASTROINTESTINAL:  No nausea or vomiting.,GENITOURINARY:  The patient has prostatic hypertrophy, had laser surgery earlier today.,ENDOCRINE:  Negative for diabetes, but positive for Graves disease.,MEDICATIONS:  ,The patient takes Synthroid and aspirin.  Aspirin had been discontinued about 1 week ago.  He used to be on atenolol, lisinopril, and terazosin, both of which have been discontinued by his cardiologist, Dr. X several months ago.,PHYSICAL EXAMINATION:,GENERAL:  A 71-year-old gentleman, not in acute distress.,CHEST:  Clear to auscultation.,CARDIOVASCULAR:  First and second heart sounds were heard.  No murmur was appreciated.,ABDOMEN:  Benign.,EXTREMITIES:  There is no swelling.,NEUROLOGICAL:  The patient is alert and oriented x3.  Examination is nonfocal.,ASSESSMENT AND PLAN:,1.  Perioperative hypertension.  We will restart lisinopril at half the previous dose.  He will be on 20 mg p.o. daily.  If blood pressure remains above systolic of 150 within 3 days, the patient should increase lisinopril to 40 mg p.o. daily.  The patient should see his primary physician, Dr. Y in 2 weeks' time.  If blood pressure, however, remains above 150 systolic despite 40 mg of lisinopril, the patient should make an appointment to see his primary physician in a week's time.,2.  Prostatic hypertrophy, status post laser surgery.  The patient tolerated the procedure well.,3.  History of Graves disease.,4.  History of atrial fibrillation.  The patient is in normal sinus rhythm.,DISPOSITION:  ,The patient is stable to be discharged to home.  Nurse should observe for 1 hour after lisinopril to make sure the blood pressure does not go too low.
Peripheral Effusion - Consult 
Medical specialty:  Consult - History and Phy.
 Peripheral effusion on the CAT scan.  The patient is a 70-year-old Caucasian female with prior history of lung cancer, status post upper lobectomy.  She was recently diagnosed with recurrent pneumonia and does have a cancer on the CAT scan, lung cancer with metastasis. 

REASON FOR CONSULT: , Peripheral effusion on the CAT scan.,HISTORY OF PRESENT ILLNESS: , The patient is a 70-year-old Caucasian female with prior history of lung cancer, status post upper lobectomy.  She was recently diagnosed with recurrent pneumonia and does have a cancer on the CAT scan, lung cancer with metastasis.  The patient had a visiting nurse for Christmas and started having abdominal pain, nausea and vomiting for which, she was admitted.  She had a CAT scan of the abdomen done, showed moderate pericardial effusion for which cardiology consult was requested.  She had an echo done, which shows moderate pericardial effusion with early tamponade.  The patient has underlying shortness of breath because of COPD, emphysema and chronic cough.  However, denies any dizziness, syncope, presyncope, palpitation.  Denies any prior history of coronary artery disease.,ALLERGIES: , No known drug allergies.,MEDICATIONS: , At this time, she is on hydromorphone p.r.n., erythromycin, ceftriaxone, calcium carbonate, Ambien.  She is on oxygen and nebulizer.,PAST MEDICAL HISTORY: , History of COPD, emphysema, pneumonia, and lung cancer.,PAST SURGICAL HISTORY:  ,Hip surgery and resection of the lung cancer 10 years ago.,SOCIAL HISTORY:,  Still smokes, but less than before.  Drinks socially.,FAMILY HISTORY:,  Noncontributory.,REVIEW OF SYSTEMS: , Denies any syncope, presyncope, palpitations, shortness of breath, cough, nausea, vomiting, or diarrhea.,PHYSICAL EXAMINATION:,GENERAL:  The patient is comfortable not in any distress.,VITAL SIGNS:  Blood pressure 121/79, Pulse rate 94, respiratory rate 19, and temperature 97.6.,HEENT:  Atraumatic and normocephalic.,NECK:  Supple.  No JVD.  No carotid bruit.,CHEST:  Breath sounds vesicular.  Clear on auscultation.,HEART:  PMI could not be localized.  S2 and S2 regular.  No S3, no S4.  No murmur.,ABDOMEN:  Soft and nontender.  Positive bowel sounds.,EXTREMITIES:  No cyanosis, clubbing, or edema.  Pulse 2+.,CNS:  Alert, awake, and oriented x3.,EKG shows normal sinus rhythm, low voltage.,LABORATORY DATA: , White cell count 7.3, hemoglobin 12.9, hematocrit 38.1, and platelet at 322,000.  Sodium 135, potassium 5, BUN 6, creatinine 1.2, glucose 71, alkaline phosphatase 263, total protein 5.3, lipase 414, and amylase 57.,DIAGNOSTIC STUDIES:,  Chest x-ray shows left upper lobe airspace disease consistent with pneumonia _______.  CT abdomen showed diffuse replacement of the _______ metastasis, hepatomegaly, perihepatic ascites, moderate pericardial effusion, small left _______ sigmoid diverticulosis.,ASSESSMENT:,1.  Moderate peripheral effusion with early tamponade, probably secondary to lung cancer.,2.  Lung cancer with metastasis most likely.,3.  Pneumonia.,4.  COPD.,PLAN: , We will get CT surgery consult for pericardial window.  Continue present medication.
Pain Management Consult - 2 
Medical specialty:  Consult - History and Phy.
 Entrapment of the Superior Gluteal Nerve in the aponeurosis of the Gluteus Medius-Left.

HPI - WORKERS COMP:, The current problem began on or about 2/10/2000. The symptoms were sudden in onset. According to the patient, the current problem is a result of a work injury involving lifting approximately 40 pounds. Pain location (lower body): left hip. The patient describes the pain as dull, aching and stabbing. The severity of the pain ranges from mild to severe. The pain is severe occasionally. It is present constantly. The pain is made worse by sitting, riding in a car, twisting and lifting. The pain is made better by rest. The patient's symptoms appear to be soft tissue (spine), myofascial (spine) and musculoskeletal (spine) in origin. Sleep alteration because of pain: positive and wakes up after getting to sleep nightly. Systemic signs/symptoms relevant or potentially relevant to the spine: none. Patient reports the following symptoms: depressed mood, loss of interest or pleasure in all or most activities, insomnia, inability to concentrate, fatigue and loss of energy.,WORK STATUS:,
Orthopedic Consult - 4 
Medical specialty:  Consult - History and Phy.
 Patient with chronic pain plus lumbar disk replacement with radiculitis and myofascial complaints. 

CHIEF COMPLAINT: , Chronic low back, left buttock and leg pain.,HISTORY OF PRESENT ILLNESS: , This is a pleasant 49-year-old gentleman post lumbar disc replacement from January 2005.  Unfortunately, the surgery and interventional procedures have not been helpful in alleviating his pain.  He has also tried acupuncture, TENS unit, physical therapy, chiropractic treatment and multiple neuropathic medications including Elavil, Topamax, Cymbalta, Neurontin, and Lexapro, which he discontinued either due to side effects or lack of effectiveness in decreasing his pain.  Most recently, he has had piriformis injections, which did give him a brief period of relief; however, he reports that the Botox procedure that was done on March 8, 2006 has not given him any relief from his buttock pain.  He states that approximately 75% of his pain is in his buttock and leg and 25% in his back.  He has tried to increase in his activity with walking and does note increased spasm with greater activity in the low back.  He rated his pain today as 6/10, describing it is shooting, sharp and aching.  It is increased with lifting, prolonged standing or walking and squatting, decreased with ice, reclining and pain medication.  It is constant but variable in degree.  It continues to affect activities and sleep at night as well as mood at times.  He is currently not satisfied completely with his level of pain relief.,MEDICATIONS: , Kadian 30 mg b.i.d., Zanaflex one-half to one tablet p.r.n. spasm, and Advil p.r.n.,ALLERGIES:,  No known drug allergies.,REVIEW OF SYSTEMS:,  Complete multisystem review was noted and signed in the chart.,SOCIAL HISTORY:,  Unchanged from prior visit.,PHYSICAL EXAMINATION: , Blood pressure 123/87, pulse 89, respirations 18, and weight 220 lbs.  He is a well-developed obese male in no acute distress.  He is alert and oriented x3, and displays normal mood and affect with no evidence of acute anxiety or depression.  He ambulates with normal gait and has normal station.  He is able to heel and toe walk.  He denies any sensory changes.,ASSESSMENT & PLAN: , This is a pleasant 49-year-old with chronic pain plus lumbar disk replacement with radiculitis and myofascial complaints.  We discussed treatment options at length and he is willing to undergo a trial of Lyrica.,He is sensitive to medications based on his past efforts and is given a prescription for 150 mg that he will start at bedtime.  We discussed the up taper schedule and he understands that he will have to be on this for some time before we can decide whether or not it is helpful to him.  We also briefly touched on the possibility of a spinal cord stimulator trial if this medication is not helpful to him.  He will call me if there are any issues with the new prescription and follow in four weeks for reevaluation.
Pain from Hernia - ER Consult 
Medical specialty:  Consult - History and Phy.
 This is a 53-year-old man, who presented to emergency room with multiple complaints including pain from his hernia, some question of blood in his stool, nausea, and vomiting, and also left lower extremity pain. 

HISTORY OF PRESENT ILLNESS:  ,This is a 53-year-old man, who presented to emergency room with multiple complaints including pain from his hernia, some question of blood in his stool, nausea, and vomiting, and also left lower extremity pain.  At the time of my exam, he states that his left lower extremity pain has improved considerably.  He apparently had more significant paresthesias in the past and now he feels that the paresthesias have improved considerably.  He does have a history of multiple medical problems including atrial fibrillation, he is on Coumadin, which is currently subtherapeutic, multiple CVAs in the past, peripheral vascular disease, and congestive heart failure.  He has multiple chronic history of previous ischemia of his large bowel in the past.,PHYSICAL EXAM,VITAL SIGNS:  Currently his temperature is 98.2, pulse is 95, and blood pressure is 138/98.,HEENT:  Unremarkable.,LUNGS:  Clear.,CARDIOVASCULAR:  An irregular rhythm.,ABDOMEN:  Soft.,EXTREMITIES:  His upper extremities are well perfused.  He has palpable radial and femoral pulses.  He does not have any palpable pedal pulses in either right or left lower extremity.  He does have reasonable capillary refill in both feet.  He has about one second capillary refill on both the right hand and left lower extremities and his left foot is perhaps little cool, but it is relatively warm.  Apparently, this was lot worst few hours ago.  He describes significant pain and pallor, which he feels has improved and certainly clinically at this point does not appear to be as significant.,IMPRESSION AND PLAN: , This gentleman with a history of multiple comorbidities as detailed above had what sounds clinically like acute exacerbation of chronic peripheral vascular disease, essentially related to spasm versus a small clot, which may have been lysed to some extent.  He currently has a viable extremity and viable foot, but certainly has significant making compromised flow.  It is unclear to me whether this is chronic or acute, and whether he is a candidate for any type of intervention.  He certainly would benefit from an angiogram to better to define his anatomy and anticoagulation in the meantime.  Given his potential history of recent lower GI bleeding, he has been evaluated by GI to see whether or not he is a candidate for heparinization.  We will order an angiogram for the next few hours and followup on those results to better define his anatomy and to determine whether or not if any interventions are appropriate.  Again, at this point, he has no pain, relatively rapid capillary refill, and relatively normal motor function suggesting a viable extremity.  We will follow him along closely.
Oligoarticular Arthritis - 2 
Medical specialty:  Consult - History and Phy.
 A lady with symptoms consistent with possible oligoarticular arthritis of her knees.

HISTORY: , A is a young lady, who came here with a diagnosis of seizure disorder and history of Henoch-Schonlein purpura with persistent proteinuria.  A was worked up for collagen vascular diseases and is here to find out the results.  Also was recommended to take 7.5 mg of Mobic every day for her joint pains.  She states that she continues with some joint pain and feeling tired all the time.  Mother states that also her seizure has continued without any control so far.  She is having some studies in the next few days.  She is mostly stiff on her legs, neck, and also on her hands.  The rest of the review of systems is in the chart.,PHYSICAL EXAMINATION: , ,VITAL SIGNS:  Temperature today is 99.2 degrees Fahrenheit, weight is 45.9 kg, blood pressure is 123/59, height is 149.5 cm, and pulse is 94.,HEENT:  She has no facial rashes, no lymphadenopathy, no alopecia, no oral ulcerations.  Pupils are reactive to accommodation.  Funduscopic examination is within normal limits.,NECK:  No neck masses.,CHEST:  Clear to auscultation.,HEART:  Regular rhythm with no murmur.,ABDOMEN:  Soft, nontender with no visceromegaly.,SKIN:  No rashes today.,MUSCULOSKELETAL:  Examination shows good range of motion with no swelling or tenderness in any of her joints of the upper extremities, but she does have minus/plus swelling of her knees with flexion contracture bilaterally on both.,LABORATORY DATA: , Laboratories were not done recently, but we have some lab results from the previous evaluation that basically is negative for any collagen vascular disease, but shows some evidence of decreased calcium and vitamin D levels.,ASSESSMENT: , This is a patient, who today presents with symptoms consistent with possible oligoarticular arthritis of her knees with also arthralgias and deficiency in vitamin D.  She also has chronic proteinuria and seizure disorder.  My recommendation is to start her on vitamin D and calcium supplements, and also increase the Mobic to 50 mg, which is one of the few things she can tolerate with all the medication she is taking.  We are going to refer her to physical therapy and see her back in 2 months for followup.  The plan was discussed with A and her parents and they have no further questions.
Onychomycosis - H&P 
Medical specialty:  Consult - History and Phy.
 Toenails are discolored, thickened, and painful - Onychomycosis

CHIEF COMPLAINT (1/1):, This 59 year old female presents today complaining that her toenails are discolored, thickened, and painful. Duration: Condition has existed for 6 months. Severity: Severity of condition is worsening.,ALLERGIES: ,Patient admits allergies to dairy products, penicillin.,MEDICATION HISTORY:, None.,PAST MEDICAL HISTORY:, Past medical history is unremarkable.,PAST SURGICAL HISTORY:, Patient admits past surgical history of eye surgery in 1999.,SOCIAL HISTORY:, Patient denies alcohol use, Patient denies illegal drug use, Patient denies STD history, Patient denies tobacco use.,FAMILY HISTORY:, Unremarkable.,REVIEW OF SYSTEMS:, Psychiatric: (+) poor sleep pattern, Respiratory: (+) breathing difficulties, respiratory symptoms.,PHYSICAL EXAM:, Patient is a 59 year old female who appears well developed, well nourished and with good attention to hygiene and body habitus. Toenails 1-5 bilateral appear crumbly, discolored - yellow, friable and thickened.,Cardiovascular: DP pulses palpable bilateral. PT pulses palpable bilateral. CFT immediate. No edema observed.  Varicosities are not observed.,Skin: Skin temperature of the lower extremities is warm to cool, proximal to distal. No skin rash, subcutaneous nodules, lesions or ulcers observed.,Neurological: Touch, pin, vibratory and proprioception sensations are normal. Deep tendon reflexes normal.,Musculoskeletal: Muscle strength is 5/5 for all groups tested. Muscle tone is normal. Inspection and palpation of bones, joints and muscles is unremarkable.,TEST RESULTS:, No tests to report at this time.,IMPRESSION:, Onychomycosis.,PLAN:, Debrided 10 nails.,PRESCRIPTIONS:, Penlac Dosage: 8% Topical Solution Sig: