harishnair04/mtsamples huggingface dataset:
Q-Fever Endocarditis 
Medical specialty:  SOAP / Chart / Progress Notes
 A 16-year-old male with Q-fever endocarditis.

HISTORY OF PRESENT ILLNESS: , This is a follow-up visit on this 16-year-old male who is currently receiving doxycycline 150 mg by mouth twice daily as well as hydroxychloroquine 200 mg by mouth three times a day for Q-fever endocarditis.  He is also taking digoxin, aspirin, warfarin, and furosemide.  Mother reports that he does have problems with 2-3 loose stools per day since September, but tolerates this relatively well.  This has not increased in frequency recently.,Mark recently underwent surgery at Children's Hospital and had on 10/15/2007, replacement of pulmonary homograft valve, resection of a pulmonary artery pseudoaneurysm, and insertion of Gore-Tex membrane pericardial substitute.  He tolerated this procedure well.  He has been doing well at home since that time.,PHYSICAL EXAMINATION:,VITAL SIGNS:  Temperature is 98.5, pulse 84, respirations 19, blood pressure 101/57, weight 77.7 kg, and height 159.9 cm.,GENERAL APPEARANCE:  Well-developed, well-nourished, slightly obese, slightly dysmorphic male in no obvious distress.,HEENT:  Remarkable for the badly degenerated left lower molar.  Funduscopic exam is unremarkable.,NECK:  Supple without adenopathy.,CHEST:  Clear including the sternal wound.,CARDIOVASCULAR:  A 3/6 systolic murmur heard best over the upper left sternal border.,ABDOMEN:  Soft.  He does have an enlarged spleen, however, given his obesity, I cannot accurately measure its size.,GU:  Deferred.,EXTREMITIES:  Examination of extremities reveals no embolic phenomenon.,SKIN:  Free of lesions.,NEUROLOGIC:  Grossly within normal limits.,LABORATORY DATA: , Doxycycline level obtained on 10/05/2007 as an outpatient was less than 0.5.  Hydroxychloroquine level obtained at that time was undetectable.  Of note is that doxycycline level obtained while in the hospital on 10/21/2007 was 6.5 mcg/mL.  Q-fever serology obtained on 10/05/2007 was positive for phase I antibodies in 1/2/6 and phase II antibodies at 1/128, which is an improvement over previous elevated titers.  Studies on the pulmonary valve tissue removed at surgery are pending.,IMPRESSION: , Q-fever endocarditis.,PLAN:  ,1.  Continue doxycycline and hydroxychloroquine.  I carefully questioned mother about compliance and concomitant use of dairy products while taking these medications.  She assures me that he is compliant with his medications.  We will however repeat his hydroxychloroquine and doxycycline levels.,2.  Repeat Q-fever serology.,3.  Comprehensive metabolic panel and CBC.,4.  Return to clinic in 4 weeks.,5.  Clotting times are being followed by Dr. X.
Prostate Adenocarcinoma - 3 
Medical specialty:  SOAP / Chart / Progress Notes
 Moderately differentiated adenocarcinoma, 1+ enlarged prostate with normal seminal vesicles.

PHYSICAL EXAMINATION: , The patient is a 63-year-old executive who was seen by his physician for a company physical.  He stated that he was in excellent health and led an active life.  His physical examination was normal for a man of his age.  Chest x-ray and chemical screening blood work were within normal limits.  His PSA was elevated.,IMAGING:,Chest x-ray:  Normal.,CT scan of abdomen and pelvis:  No abnormalities.,LABORATORY:,  PSA 14.6.,PROCEDURES: , Ultrasound guided sextant biopsy of prostate:  Digital rectal exam performed at the time of the biopsy showed a 1+ enlarged prostate with normal seminal vesicles.,PATHOLOGY:  ,Prostate biopsy:  Left apex:  adenocarcinoma, moderately differentiated, Gleason's score 3 + 4 = 7/10.  Maximum linear extent in apex of tumor was 6 mm.  Left mid region prostate:  moderately differentiated adenocarcinoma, Gleason's 3 + 2 = 5/10.  Left base, right apex, and right mid-region and right base:  negative for carcinoma.,TREATMENT:,  The patient opted for low dose rate interstitial prostatic implants of I-125.  It was performed as an outpatient on 8/10.
Prostate Adenocarcinoma - 2 
Medical specialty:  SOAP / Chart / Progress Notes
 Moderate to poorly differentiated adenocarcinoma in the right lobe and poorly differentiated tubular adenocarcinoma in the left lobe of prostate.

PHYSICAL EXAMINATION:,  This 71-year-old man went to his primary care physician for a routine physical.  His only complaints were nocturia times two and a gradual "slowing down" feeling.  The physical examination on 1/29 was within normal limits except for the digital rectal exam which revealed an asymmetric prostate gland with nodularity, R>L.  PSA was elevated.  The differential diagnosis for the visit was abnormal prostate, suggestive of CA.,IMAGING:  ,CT pelvis:  Irregular indentation of bladder.  Seminal vesicles enlarged.  Streaky densities in periprostatic fat consistent with transcapular spread to periprostatic plexus.  Impression:  prostatic malignancy with extracapsular extension and probable regional node metastasis.,Bone scan:  Negative for distant metastasis.,LABORATORY:,  PSA 32.1,PROCEDURES:,  Transrectal needle biopsy of prostate.  Pelvic lymphadenectomy and radical prostatectomy.,PATHOLOGY:  ,Prostate biopsy:  Moderate to poorly differentiated adenocarcinoma in the right lobe and poorly differentiated tubular adenocarcinoma in the left lobe of prostate.,Lymphadenectomy and prostatectomy:  Frozen section of removed pelvic lymph nodes demonstrated metastatic adenocarcinoma in one lymph node in the right obturator fossa.  Therefore, the radical prostatectomy was canceled.  ,Final pathology diagnosis:  Pelvic lymphadenectomy; left obturator fossa, single negative lymph node.  Right obturator fossa; metastatic adenocarcinoma in 1/5 lymph nodes.  Largest involved node 1.5 cm.,TREATMENT: , Patient began external beam radiation therapy to the pelvis.
Prostate Adenocarcinoma - 4 
Medical specialty:  SOAP / Chart / Progress Notes
 Prostate gland showing moderately differentiated infiltrating adenocarcinoma - Excised prostate including capsule, pelvic lymph nodes, seminal vesicles, and small portion of bladder neck.

PHYSICAL EXAMINATION:,  Patient is a 46-year-old white male seen for annual physical exam and had an incidental PSA elevation of 4.0.  All other systems were normal.,PROCEDURES:  ,Sextant biopsy of the prostate.,Radical prostatectomy:  Excised prostate including capsule, pelvic lymph nodes, seminal vesicles, and small portion of bladder neck.,PATHOLOGY:,Prostate biopsy:  Right lobe, negative.  Left lobe, small focus of adenocarcinoma, Gleason's 3 + 3 in approximately 5% of the tissue.,Radical prostatectomy:  Negative lymph nodes.  Prostate gland showing moderately differentiated infiltrating adenocarcinoma, Gleason 3 + 2 extending to the apex involving both lobes of the prostate, mainly right.  Tumor overall involved less than 5% of the tissue.  Surgical margin was reported and involved at the apex.  The capsule and seminal vesicles were free.,DISCHARGE NOTE:,  Patient has made good post-op recovery other than mild urgency incontinence.  His post-op PSA is 0.1 mg/ml.
Prostate Adenocarcinoma - 1 
Medical specialty:  SOAP / Chart / Progress Notes
 Complete urinary obstruction, underwent a transurethral resection of the prostate - adenocarcinoma of the prostate.

HISTORY:,  This 75-year-old man was transferred from the nursing home where he lived to the hospital late at night on 4/11 through the Emergency Department in complete urinary obstruction.  After catheterization, the patient underwent cystoscopy on 4/13.  On 4/14 the patient underwent a transurethral resection of the prostate and was discharged back to the nursing home later that day with voiding improved.  Final diagnosis was adenocarcinoma of the prostate.  Because of his mental status and general debility, the patient's family declined additional treatment.,LABORATORY:,  None,PROCEDURES:,Cystoscopy:  Blockage of the urethra by a markedly enlarged prostate.,Transurethral resection of prostate:  45 grams of tissue were sent to the Pathology Department for analysis.,PATHOLOGY: , Well differentiated adenocarcinoma, microacinar type, in 1 of 25 chips of prostatic tissue.
Prostate Fossa Irradiation - Followup 
Medical specialty:  SOAP / Chart / Progress Notes
 The patient returns for followup evaluation 21 months after undergoing prostate fossa irradiation for recurrent Gleason 8 adenocarcinoma.    Concerning slow ongoing rise in PSA.

HISTORY OF PRESENT ILLNESS: , The patient returns for followup evaluation 21 months after undergoing prostate fossa irradiation for recurrent Gleason 8 adenocarcinoma.  His urinary function had been stable until 2 days ago.  Over the past couple of days he has been waking every 1 to 1-1/2 hours and has had associated abdominal cramping, as well as a bit of sore throat (his wife has had a cold for about 2 weeks).  His libido remains intact (but he has not been sexually functional), but his erections have been dysfunctional.  The bowel function is stable with occasional irritative hemorrhoidal symptoms.  He has had no hematochezia.  The PSA has been slowly rising in recent months.  This month it reached 1.2.,PAIN ASSESSMENT: , Abdominal cramping in the past 2 days.  No more than 1 to 2 of 10 in intensity.,PERFORMANCE STATUS: , Karnofsky score 100.  He continues to work full-time.,NUTRITIONAL STATUS: , Appetite has been depressed over the past couple of days, and he has lost about 5 pounds.  (Per him, mostly this week.),PSYCHIATRIC: , Some stress regarding upcoming IRS audits of clients.,REVIEW OF SYSTEMS: , Otherwise noncontributory.,MEDICATIONS,1.  NyQuil.,2.  Timolol eye drops.,3.  Aspirin.,4.  Advil.,5.  Zinc.,PHYSICAL EXAMINATION,GENERAL:  Pleasant, well-developed, gentleman in no acute distress.  Weight is 197 pounds.,HEENT:  Sclerae and conjunctivae are clear.  Extraocular movement are intact.  Hearing is grossly intact.  The oral cavity is without thrush.  There is minor pharyngitis.,LYMPH NODES:  No palpable lymphadenopathy.,SKELETAL:  No focal skeletal tenderness.,LUNGS:  Clear to auscultation bilaterally.,CARDIOVASCULAR:  Regular rate and rhythm.,ABDOMEN:  Soft, nontender without palpable mass or organomegaly.,DIGITAL RECTAL EXAMINATION:  There are external hemorrhoids.  The prostate fossa is flat without suspicious nodularity.  There is no blood on the examining glove.,EXTREMITIES:  Without clubbing, cyanosis, or edema.,NEUROLOGIC:  Without focal deficit.,IMPRESSION:,  Concerning slow ongoing rise in PSA.,PLAN: , Discussed significance of this in detail with the patient.  He understands the probability that there may be residual cancer although the location is unknown.  For now there is no good evidence that early management affects the ultimate prognosis.  Accordingly, he is comfortable with careful monitoring, and I have asked him to return here in 3 months with an updated PSA.  I also suggested that he reestablish contact with Dr. X at his convenience.
Progress Note - Supraglottitis 
Medical specialty:  SOAP / Chart / Progress Notes
 Acute supraglottitis with airway obstruction and parapharyngeal cellulitis and peritonsillar cellulitis.

HISTORY: , A 59-year-old male presents in followup after being evaluated and treated as an in-patient by Dr. X for acute supraglottitis with airway obstruction and parapharyngeal cellulitis and peritonsillar cellulitis, admitted on 05/23/2008, discharged on 05/24/2008.  Please refer to chart for history and physical and review of systems and medical record.,PROCEDURES PERFORMED:  ,Fiberoptic laryngoscopy identifying about 30% positive Muller maneuver.  No supraglottic edema; +2/4 tonsils with small tonsil cyst, mid tonsil, left.,IMPRESSION:  ,1.  Resolving acute supraglottic edema secondary to pharyngitis and tonsillar cellulitis.,2.  Possible obstructive sleep apnea; however, the patient describes no known history of this phenomenon.,3.  Hypercholesterolemia.,4.  History of anxiety.,5.  History of coronary artery disease.,6.  Hypertension.,RECOMMENDATIONS: , Recommend continuing on Augmentin and tapered prednisone as prescribed by Dr. X.  Cultures are still pending and follow up with Dr. X in the next few weeks for re-evaluation.  I did discuss with the patient whether or not a sleep study would be beneficial and the patient denies any history of obstructive sleep apnea and wishes not to pursue this, but we will leave this open for him to talk with Dr. X on his followup, and he will pay more attention on his sleep pattern.
Polycythemia Rubra Vera 
Medical specialty:  SOAP / Chart / Progress Notes
 Polycythemia rubra vera.  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.

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:
Postop Parathyroid Exploration & Parathyroidectomy 
Medical specialty:  SOAP / Chart / Progress Notes
 This patient is one-day postop open parathyroid exploration with subtotal parathyroidectomy and intraoperative PTH monitoring for parathyroid hyperplasia.  She has had an uneventful postoperative night. 

SUMMARY:  ,This patient is one-day postop open parathyroid exploration with subtotal parathyroidectomy and intraoperative PTH monitoring for parathyroid hyperplasia.  She has had an uneventful postoperative night.  She put out 1175 mL of urine since surgery.  Her incision looks good.  IV site and extremities are unremarkable.,LABORATORY DATA:  ,Her calcium level was 7.5 this morning.  She has been on three Tums orally b.i.d. and I am increasing three Tums orally q.i.d. before meals and at bedtime.,PLAN:,  I will heparin lock her IV, advance her diet, and ambulate her.  I have asked her to increase her prednisone when she goes home.  She will double her regular dose for the next five days.  I will advance her diet.  I will continue to monitor her calcium levels throughout the day.  If they stabilize, I am hopeful that she will be ready for discharge either later today or tomorrow.  She will be given Lortab Elixir 2 to 4 teaspoons orally every four hours p.r.n. pain, dispensed #240 mL with one refill.  Her final calcium dosage will be determined prior to discharge.  I will plan to see her back in the office on the 12/30/08, and she has been instructed to call or return sooner for any problems.
Podiatry - Progress Note 
Medical specialty:  SOAP / Chart / Progress Notes
 Plantar fascitis/heel spur syndrome.  The patient was given injections of 3 cc 2:1 mixture of 1% lidocaine plain with dexamethasone phospate.

SUBJECTIVE:,  Mr. Sample Patient returns to the Sample Clinic with the chief complaint of painful right heel.  The patient states that the heel has been painful for approximately two weeks, it is starts with the first step in the morning and gets worse with activity during the day.  The patient states that he is currently doing no treatment for it.  He states that most of his pain is along medial tubercle of the right calcaneus and extends to the medial arch.  The patient states that he has no change in the past medical history since his last visit and denies any fever, chills, vomiting, headache, chest, or shortness of breath.,OBJECTIVE:,  Upon removal of shoes and socks bilaterally, neurovascular status remains unchanged since the last visit.  There is tenderness to palpation to the medial tubercle of the right foot.  The pain is elicited along the medial arch as well.  There are no open areas or signs of infection noted.,ASSESSMENT:,  Plantar fascitis/heel spur syndrome, right foot.,PLAN:,  The patient was given injections of 3 cc 2:1 mixture of 1% lidocaine plain with dexamethasone phospate.  He was given a low dye strapping and a heel lift was placed in his right shoe.  The patient will be seen back in approximately one month for further evaluation if necessary.  He was told to call if anything should occur before that.  The patient was told to continue with the good work on his diabetic control.
Plantar Fasciitis 
Medical specialty:  SOAP / Chart / Progress Notes
 A 44-year-old, 250-pound male presents with extreme pain in his left heel.

S -, A 44-year-old, 250-pound male presents with extreme pain in his left heel.  This is his chief complaint.  He says that he has had this pain for about two weeks.  He works on concrete floors.  He says that in the mornings when he gets up or after sitting, he has extreme pain and great difficulty in walking.  He also has a macular blotching of skin on his arms, face, legs, feet and the rest of his body that he says is a pigment disorder that he has had since he was 17 years old.  He also has redness and infection of the right toes.,O -, The patient apparently has a pigmentation disorder, which may or may not change with time, on his arms, legs and other parts of his body, including his face.  He has an erythematous moccasin-pattern tinea pedis of the plantar aspects of both feet.  He has redness of the right toes 2, 3 and 4.  Extreme exquisite pain can be produced by direct pressure on the plantar aspect of his left heel.,A -, 1.  Plantar fasciitis.,
Physical Therapy - Outpatient Rehab 
Medical specialty:  SOAP / Chart / Progress Notes
 Outpatient rehabilitation physical therapy progress note.  A 52-year-old male referred to physical therapy secondary to chronic back pain, weakness, and debilitation secondary to chronic pain. 

SUMMARY:  ,The patient has attended physical therapy from 11/16/06 to 11/21/06.  The patient has 3 call and cancels and 3 no shows.  The patient has been sick for several weeks due to a cold as well as food poisoning, so has missed many appointments.,SUBJECTIVE:  ,The patient states pain still significant, primarily 1st seen in the morning.  The patient was evaluated 1st thing in the morning and did not take his pain medications, so objective findings may reflect that.  The patient states overall functionally he is improving where he is able to get out in the house and visit and do activities outside the house more.  The patient does feel like he is putting on more muscle girth as well.  The patient states he is doing well with his current home exercise program and feels like pool therapy is also helping as well.,OBJECTIVE: , Physical therapy has consisted of:,1.  Pool therapy incorporating endurance and general lower and upper extremity strengthening.,2.  Clinical setting incorporating core stabilization and general total body strengthening and muscle wasting.,3.  The patient has just begun this, so it is on a very beginners level at this time.,ASSESSMENT, DONE ON 12/21/06,STRENGTH,Activities
PAF - 6-Month Followup 
Medical specialty:  SOAP / Chart / Progress Notes
 Six-month follow-up visit for paroxysmal atrial fibrillation (PAF).  She reports that she is getting occasional chest pains with activity.  Sometimes she feels that at night when she is lying in bed and it concerns her.

REASON FOR VISIT:,  Six-month follow-up visit for paroxysmal atrial fibrillation (PAF).,She reports that she is getting occasional chest pains with activity.  Sometimes she feels that at night when she is lying in bed and it concerns her.,She is frustrated by her inability to lose weight even though she is hyperthyroid.,MEDICATIONS: , Tapazole 10 mg b.i.d., atenolol/chlorthalidone 50/25 mg b.i.d., Micro-K 10 mEq q.d., Lanoxin 0.125 mg q.d., spironolactone 25 mg q.d., Crestor 10 mg q.h.s., famotidine 20 mg, Bayer Aspirin 81 mg q.d., Vicodin p.r.n., and Nexium 40 mg-given samples of this today.,REVIEW OF SYSTEMS:,  No palpitations.  No lightheadedness or presyncope.  She is having mild pedal edema, but she drinks a lot of fluid.,PEX: , BP:  112/74.  PR:  70.  WT:  223 pounds (up three pounds).  Cardiac:  Regular rate and rhythm with a 1/6 murmur at the upper sternal border.  Chest:  Nontender.  Lungs:  Clear.  Abdomen:  Moderately overweight.  Extremities:  Trace edema.,EKG: , Sinus bradycardia at 58 beats per minute, mild inferolateral ST abnormalities.,IMPRESSION:,1.  Chest pain-Mild.  Her EKG is mildly abnormal.  Her last stress echo was in 2001.  I am going to have her return for one just to make sure it is nothing serious.  I suspect; however, that is more likely due to her weight and acid reflux.  I gave her samples of Nexium.,2.  Mild pedal edema-Has to cut down on fluid intake, weight loss will help as well, continue with the chlorthalidone.,3.  PAF-Due to hypertension, hyperthyroidism and hypokalemia.  Staying in sinus rhythm.,4.  Hyperthyroidism-Last TSH was mildly suppressed, she had been out of her Tapazole for a while, now back on it.,5.  Dyslipidemia-Samples of Crestor given.,6.  LVH.,7.  Menometrorrhagia.,PLAN:,1.  Return for stress echo.,2.  Reduce the fluid intake to help with pedal edema.,3.  Nexium trial.
Pain Management Progress Note 
Medical specialty:  SOAP / Chart / Progress Notes
 Pain management sample progress note.

DIAGNOSES:,1.  Cervical dystonia.,2.  Post cervical laminectomy pain syndrome.,Ms. XYZ states that the pain has now shifted to the left side.  She has noticed a marked improvement on the right side, which was subject to a botulinum toxin injection about two weeks ago.  She did not have any side effects on the Botox injection and she feels that her activities of daily living are increased, but she is still on the oxycodone and methadone.  The patient's husband confirms the fact that she is doing a lot better, that she is more active, but there are still issues yet regarding anxiety, depression, and frustration regarding the pain in her neck.,PHYSICAL EXAMINATION:,  The patient is appropriate.  She is well dressed and oriented x3.  She still smells of some cigarette smoke.  Examination of the neck shows excellent reduction in muscle spasm on the right paraspinals, trapezius and splenius capitis muscles.  There are no trigger points felt and her range of motion of the neck is still somewhat guarded, but much improved.  On the left side, however, there is significant muscle spasm with tight bands involving the multifidus muscle with trigger point activity and a lot of tenderness and guarding.  This extends down into the trapezius muscle, but the splenius capitis seems to be not involved.,TREATMENT PLAN:,  After a long discussion with the patient and the husband, we have decided to go ahead and do botulinum toxin injection into the left multifidus/trapezius muscles.  A total of 400 units of Botox is anticipated.  The procedure is being scheduled.  The patient's medications are refilled.  She will continue to see Dr. Berry and continue her therapy with Mary Hotchkinson in Victoria.