Datasets:

rwik04

/

med_transcript

like 0

<s>[INST] <<SYS>> Father with HTN and h/o strokes at ages 45 and 80; now 82 years old. Mother has DM and is age 80. <</SYS>> Hello [/INST] Are there any known disease running in your family? [INST] My dad has high blood pressure, and he takes medication for it. He is now eighty two years old. He had a stroke around two years ago. This was his second stroke. First one he had when he was forty five. [/INST] What about your mom? How old is she? [INST] My mom is eighty years old. She does have sugar issues. [/INST]</s>

<s>[INST] <<SYS>> Denies any tobacco or alcohol use. She is divorced with 2 children. She lives with her son. <</SYS>> Hello [/INST] So, are you married, ma'am? [INST] Well, no I'm not. My husband and I got a divorce. [/INST] I'm sorry to hear that, do you have any children? [INST] It's okay, it was for the best. Yes, I have two. [/INST] Do you live with either of them? [INST] Yeah, um, I live with my son right now. [/INST] Do you smoke or drink? [INST] No I do not. [/INST]</s>

<s>[INST] <<SYS>> HEENT: No history of headaches, migraines, vertigo, syncope, visual loss, tinnitus, sinusitis, sore in the mouth, hoarseness, swelling or goiter. <</SYS>> Hello [/INST] Are you experiencing any headaches, or do you have any history of migraine? [INST] No. [/INST] Any temporary loss of consciousness? [INST] No. [/INST] Any feeling of being off balance or fainting? [INST] No. [/INST] Any continuous sound you may hear? [INST] No. [/INST] Okay so no tinnitus. Any mouth sores or ulcers? [INST] Um, no. [/INST] Do you notice any change in your voice, any hoarseness? [INST] No, nothing like that. [/INST] Did you notice any swelling in and around your mouth? [INST] No, I did not. [/INST] Any history of goiter or swelling of your thyroid gland? [INST] Nope. [/INST] Okay.</s>

<s>[INST] <<SYS>> General: No fevers, chills, or sweats. No weight loss or weight gain. Cardiovascular: No exertional chest pain, orthopnea, PND, or pedal edema. No palpitations. Neurologic: No paresis, paresthesias, or syncope. Eyes: No double vision or blurred vision. Ears: No tinnitus or decreased auditory acuity. ENT: No allergy symptoms, such as rhinorrhea or sneezing. GI: No indigestion, heartburn, or diarrhea. No blood in the stools or black stools. No change in bowel habits. GU: No dysuria, hematuria, or pyuria. No polyuria or nocturia. Denies slow urinary stream. Psych: No symptoms of depression or anxiety. Pulmonary: No wheezing, cough, or sputum production. Skin: No skin lesions or nonhealing lesions. Musculoskeletal: No joint pain, bone pain, or back pain. No erythema at the joints. Endocrine: No heat or cold intolerance. No polydipsia. Hematologic: No easy bruising or easy bleeding. No swollen lymph nodes. <</SYS>> Hello [/INST] Let me examine you. Tell me, did you have any fever or chills, any sweating or that sort of thing? [INST] Um no. [/INST] How about abnormal weight loss or weight gain? [INST] No. [/INST] Are you experiencing any chest pain on exertion or shortness of breath normally or when you try to sleep? [INST] No, no chest pain and shortness of breath. [/INST] Let me see your legs. They look good I don't see any pedal edema. Usually that happens due to excess water retention. Any palpitations? [INST] No. [/INST] Any feeling of numbness or tingling? Did you faint or lose consciousness anytime? [INST] No and no. [/INST] Okay, good! Any double and or blurred vision? [INST] No. [/INST] Any difficulty hearing or any wired continuous sound you may hear? [INST] No. [/INST] Okay, um tell me if you had any um, allergies, or sneezing, or runny nose? [INST] No, no really. [/INST] Okay, got it. Any indigestion, or heart burn? Did you notice any blood in stool or black stool? [INST] No. [/INST] Any diarrhea or vomiting? [INST] Nope. [/INST] Are you feeling thirsty frequently? [INST] No, just normal. [/INST] Okay. And I see you got a urine test, so no pus cells or blood present. [INST] Yes. [/INST] Any pain while passing urine though? Any blood? [INST] No. [/INST] And how is the urine frequency? Do you have to wake up at night to urinate? [INST] Well, my frequency is normal. I don't have to wake up at night for urinating. [/INST] How bout the stream while passing urine? You think it's normal or somewhat slow? [INST] No, it's absolutely normal. [/INST] Okay, so any cough or cold like symptoms any sputum? [INST] Nope. [/INST] No wheezing, right? [INST] Yes, no wheezing. [/INST] I don't see any lesions, that's good. Any mood swings, feeling depressed or have anxiety? [INST] No. [/INST] Any joint pain in the legs, back or anywhere? [INST] Um no. [/INST] Okay, so no erythema in the joints. Any heat or cold intolerance? [INST] No. [/INST] Okay, any difficulty swallowing? Let me check here, lymph nodes look fine. And do you bleed easily and does the bleeding stop normally? [INST] Oh yes! [/INST] Do you bruise easy? [INST] No, not really. [/INST] Okay. Any abnormal skin lesions? [INST] No. [/INST]</s>

<s>[INST] <<SYS>> The patient seeks evaluation for a second opinion concerning cataract extraction. She tells me cataract extraction has been recommended in each eye; however, she is nervous to have surgery. Past ocular surgery history is significant for neurovascular age-related macular degeneration. She states she has had laser four times to the macula on the right and two times to the left, she sees Dr. X for this. <</SYS>> Hello [/INST] Hello, miss. The nurse who seated you tells me you are here for a second opinion on surgery. [INST] Hello, doctor. Yes, I have been told that both eyes need cataract extraction. I came for a second opinion because I will only have surgery if necessary. I am nervous. [/INST] What is the reason for the extraction? [INST] I am not exactly sure because the other doctors said a bunch of medical terms. I have had laser in my eyes though. That was for macular degeneration. Doctor X said I had neurovascular age-related macular degeneration. [/INST] Do you know what laser you had on your eyes? [INST] No. I just know laser was done by Doctor X four times to the macula on the right and two times on the left. [/INST]</s>

<s>[INST] <<SYS>> The patient lives with his wife. <</SYS>> Hello [/INST] Is there anyone that lives with you at home? You are going to need someone to help you care for your wound. [INST] My wife lives at home with me. She can help me change my bandages. [/INST]</s>

<s>[INST] <<SYS>> None Past Psychological History: None <</SYS>> Hello [/INST] Do you have a history of mental illness or psychological disease? [INST] No. [/INST]</s>

<s>[INST] <<SYS>> No history of any smoking, alcohol, or drug abuse. The patient is a registered nurse by profession. <</SYS>> Hello [/INST] What do you do? [INST] I am a registered nurse. [/INST] That's nice. And do you smoke or drink? [INST] No sir. [/INST] Any history of drug abuse or anything? [INST] Absolutely not! [/INST] Okay, good.</s>

<s>[INST] <<SYS>> The patient lives locally. She is a widow. She does not smoke cigarettes or use illicit drugs. <</SYS>> Hello [/INST] So, do you live in the area? [INST] Yes, my husband and I have lived here for a long time. He died a few years back. [/INST] I'm sorry to hear that. [INST] It's alright. [/INST] Do you smoke or drink? [INST] No, I don't. [/INST] Do you use any illicit drugs or substances? [INST] No, I don't do anything like that. [/INST]</s>

<s>[INST] <<SYS>> Family history is positive for asthma and diabetes. There is also positive family history of renal disease on the father's side of the family. <</SYS>> Hello [/INST] What is your family medical history? [INST] My uncle on my dad's side of the family had kidney failure. I lot of my family members have diabetes and asthma. [/INST]</s>

<s>[INST] <<SYS>> None. <</SYS>> Hello [/INST] Any past medical history I should be aware of? [INST] Nope. [/INST]</s>

<s>[INST] <<SYS>> As in HPI. Patient and daughter also deny weight loss, fevers, chills, sweats, nausea, vomiting, abdominal pain. She has had some difficulty expressing herself, but seems to comprehend speech as above. The patient has had a history of chronic urinary tract infections and her drainage is similar to past episodes when she has had such infection. <</SYS>> Hello [/INST] Have you lost weight? [INST] No, I haven't, you can ask my daughter. [/INST] How about anything like fever, nausea, vomiting, pain? [INST] No. [/INST] And as we discussed you have problem talking and comprehending. [INST] Yes. [/INST] And you get urine infections too? [INST] Yes. [/INST] And as discussed, your drainage is similar to past episodes when you had such infection? [INST] Yes. [/INST]</s>

<s>[INST] <<SYS>> Her father died from leukemia. Her mother died from kidney and heart failure. She has two brothers; five sisters, one with breast cancer; two sons; and a daughter. She describes cancer, hypertension, nervous condition, kidney disease, high cholesterol, and depression in her family. <</SYS>> Hello [/INST] Can you tell me more about your family history, ma'am? How is your father doing? [INST] Well, doctor, my father passed away from leukemia a while back. [/INST] I'm so sorry to hear that. What about your mother? How is she doing? [INST] She died too. She had kidney and heart failure. [/INST] I'm sorry, ma'am. [INST] Oh, it's okay doctor, thank you. [/INST] Do you have any siblings? [INST] Yes, I have two brothers and five sisters. [/INST] That's a big family, do they have any conditions that you know about? [INST] One of my sisters has breast cancer. [/INST] Okay, thank you. Do you have any children? [INST] Yeah, I have two sons and a daughter. [/INST] That's great. Do you have any other conditions I should know about? [INST] Well, in addition to all of that, there's some high cholesterol, um, depression, and a nervous condition. [/INST]</s>

<s>[INST] <<SYS>> Noncontributory. <</SYS>> Hello [/INST] Do you have any orthopedic conditions that run in your family that I should know about? [INST] What, like arthritis? [/INST] Yeah, does anything like that sound familiar? [INST] No, not that I know of. [/INST]</s>

<s>[INST] <<SYS>> Appendectomy 1988. Cholecystectomy. 1992 <</SYS>> Hello [/INST] Have you had any surgeries in the past? [INST] Actually, yes, I had my gallbladder removed in nineteen ninety two. [/INST] Great, any other surgeries? Think back a little further? [INST] Oh yeah, I had my appendix out in nineteen eighty eight. [/INST]</s>

<s>[INST] <<SYS>> Unknown. <</SYS>> Hello [/INST] Do you have patient's family history? Hm, okay.</s>

<s>[INST] <<SYS>> Includes chronic diarrhea as I mentioned before and chronic obstructive pulmonary disease secondary to heavy smoking. <</SYS>> Hello [/INST] Do you have any medical conditions that I should know about? [INST] Yeah, I have chronic diarrhea, and C O P D. [/INST] Are you a smoker? [INST] Yes, I have been for a long time. [/INST] How would you characterize your smoking level? [INST] Um, I'd say it's pretty heavy. [/INST]</s>

<s>[INST] <<SYS>> Negative. <</SYS>> Hello [/INST] Do you have any medical conditions that I should know about? [INST] No, not that I know of. [/INST] So, there's no history of depression, or cancer, or high blood pressure? [INST] No, it's not ringing any bells. [/INST]</s>

<s>[INST] <<SYS>> This is a 79-year-old female who has disabling bilateral knee degenerative arthritis. She has been unresponsive to conservative measures. All risks, complications, anticipated benefits, and postoperative course were discussed. The patient has agreed to proceed with surgery as described below. <</SYS>> Hello [/INST] Good morning, ma'am. Before we begin today, can you confirm your age for me? [INST] Good morning, doctor. Sure, I'm seventy nine years old. [/INST] Great, thank you. What seems to be the problem today, ma'am? [INST] Well, I have this arthritis, as you know. [/INST] Yes, how would you describe your arthritis? [INST] Well, at this point I'd say it's debilitating. [/INST] I see, so the antiinflammatories and rest haven't helped at all? [INST] No, I haven't had any improvement, doctor. It's still so bad. [/INST] I see, I believe you'd be a good candidate for a knee replacement. [INST] Yes, I thought so. What are the risks of infection for the surgery? [/INST] Um, it's less than one percent, we use prophylactic antibiotics to control for infection the entire time. [INST] That's great, what about anesthesia, will I be asleep for this? [/INST] Yes, you won't feel a thing. [INST] Great, yes, I'd like to do the surgery, doctor. [/INST]</s>

<s>[INST] <<SYS>> Significant for partial oophorectomy, appendectomy, and abdominoplasty. <</SYS>> Hello [/INST] Did you have any surgeries in the past? [INST] Yes, I had a partial removal of my ovaries and then I also had my appendix removed. [/INST] Okay anything else? [INST] Yeah, I also got my tummy tucked. [/INST] Okay.</s>

<s>[INST] <<SYS>> Actually quite limited, includes that of dementia, asthma, anemia which is chronic, hypothyroidism, schizophrenia, positive PPD in the past. <</SYS>> Hello [/INST] And you are- So, do you know about her past medical history? Oh, I see. Yeah, that will be nice. Let me check her reports quickly. She has a history schizophrenia, chronic anemia and hypothyroidism and she also suffers from asthma. Oh, I also see here she tested positive for P P D, was she diagnosed with tuberculosis? Okay.</s>

<s>[INST] <<SYS>> Unremarkable. <</SYS>> Hello [/INST] I will ask you a few questions about your past medical history. Were you ever diagnosed with anything medically related? [INST] No. [/INST] Were you ever diagnosed with diabetes or any heart conditions? [INST] No. [/INST] Did you ever take medications for any long-term disease? [INST] No. [/INST] Did you ever have any surgery? [INST] No. [/INST]</s>

<s>[INST] <<SYS>> He has no known drug allergies. <</SYS>> Hello [/INST] Are you allergic to anything? [INST] No. [/INST]</s>

<s>[INST] <<SYS>> Ms. ABC returns today for followup regarding her left shoulder pain and left upper extremity C6 radiculopathy. I had last seen her on 06/21/07. At that time, she had been referred to me Dr. X and Dr. Y for evaluation of her left-sided C6 radiculopathy. She also had a significant rotator cuff tear and is currently being evaluated for left-sided rotator cuff repair surgery, I believe on, approximately 07/20/07. At our last visit, I only had a report of her prior cervical spine MRI. I did not have any recent images. I referred her for cervical spine MRI and she returns today. She states that her symptoms are unchanged. She continues to have significant left-sided shoulder pain for which she is being evaluated and is scheduled for surgery with Dr. Y. She also has a second component of pain, which radiates down the left arm in a C6 distribution to the level of the wrist. She has some associated minimal weakness described in detail in our prior office note. No significant right upper extremity symptoms. No bowel, bladder dysfunction. No difficulty with ambulation. <</SYS>> Hello [/INST] Welcome back to the clinic, Miss A B C. [INST] Thank you. [/INST] It looks like we last saw you June twenty first, this year. Doctor X and Y referred you for the evaluation of your pinched nerve in the C six regain on the left side. I also see that we are following up on the significant rotator cuff tear on the left side. Did you get scheduled for the surgery with Doctor Yen yet? [INST] Yes. I believe the surgery is scheduled for July twentieth. [/INST] How is your shoulder feeling? [INST] My shoulder is the same. I am still in a significant amount of pain. [/INST] I am sorry to hear that. Your surgery is coming up soon and that should help. [INST] I hope so. [/INST] We are also following up the pinched nerve in your upper left extremity C six. How are you feeling? [INST] I have had some pain starting in that same spot, and it goes down the left arm into my wrist. [/INST] Have you had any weakness associated with your upper extremities on the left side? [INST] It is mild and it is about the same as the last time. [/INST] Is it about the same as the last time you were here? We have it noted in the last note that it was mild as well. [INST] Yes. It has been the same. [/INST] Any weakness or symptoms on the right side? [INST] No, not really. [/INST] Any difficulty with mobility or moving around on either side? [INST] No. [/INST] Have you been experiencing any bowel or, bladder dysfunction. [INST] No. [/INST] I see in the chart for our last visit, I only had a report of a prior cervical spine M R I. I don't have any recent images. I going to refer you for a cervical spine M R I. Are you able to get the imaging done today and I will have you return to the clinic at the end of today? [INST] Yes. I can do that. I took the whole day off of work today. [/INST] Great! I will put the order in right now.</s>

<s>[INST] <<SYS>> Circumcision. <</SYS>> Hello [/INST] He had circumcision? [INST] Yes. [/INST] Do you remember the date? [INST] No I do not. But it should be in the chart. [/INST]</s>

<s>[INST] <<SYS>> She is married. She lives with her spouse. <</SYS>> Hello [/INST] How are you? I haven't seen you in a long time. [INST] I'm doing fine. I hurt my hand the other day. [/INST] How did that happen? [INST] My husband and I moved into our new home, and we were building a desk. I tried to nail something in, and I hammered my hand. [/INST] Oh, no. So, you and your husband live together now? [INST] Yeah. We do. We just got married. [/INST]</s>

<s>[INST] <<SYS>> 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. <</SYS>> Hello [/INST] Good morning, ma'am. I just need a few pieces of information before we get started today. [INST] Good morning, doctor. Absolutely, that's not a problem at all. [/INST] Do you smoke or drink, ma'am? [INST] I don't smoke, and I drink, um, I'd say on occasionally. [/INST] What about harder drugs, do you use any of those? [INST] No, I don't. [/INST] Are you married? [INST] Yes, to my wonderful husband. [/INST] That's great, what do you two do for a living? [INST] I'm a social worker, and my husband is a high school chemistry teacher. [/INST] What great work both of you are doing. What kinds of people do you work with as a social worker? [INST] I love it, I work with adult abuse and neglect issues. [/INST] Yes, that's great. Do you have any children? [INST] Yes, we have two sons. [/INST] Do they live at home? [INST] No, they're both grown and on their own now. [/INST]</s>

<s>[INST] <<SYS>> No known drug allergies. <</SYS>> Hello [/INST] Any known drug allergies? [INST] Nope, none whatsoever. [/INST]</s>

<s>[INST] <<SYS>> The patient stopped smoking 27 years ago, he smoked approximately two packs a day with combined cigarettes and cigars. He has not smoked for the past 27 years. He hardly ever uses alcohol. He is currently retired. <</SYS>> Hello [/INST] Are you working these days? [INST] No, sir. I've been retired for a couple years now. [/INST] Congratulations. I hope you're enjoying your time off. [INST] You bet. [/INST] You mentioned having a smoking history. When did you quit and approximately how much did you smoke? [INST] Uh I quit about twenty seven years ago. If I had to guess, I smoked about two packs a day. [/INST] Did you smoke only cigarettes? [INST] Cigars, too. [/INST] How about alcohol? [INST] Hardly ever. [/INST] Great.</s>

<s>[INST] <<SYS>> Bilateral tubal ligation in 2001, colon polyp removed at 14 years old. <</SYS>> Hello [/INST] Have you undergone any surgeries? [INST] I had both my tubes tied in O one and I had a polyp removed when I was fourteen. [/INST] And that was a- [INST] Oh, sorry I didn't mean to interrupt. [/INST] It's alright. I just wanted to know if that polyp was found in your colon? [INST] Yes, it was. [/INST]</s>

<s>[INST] <<SYS>> He had a history of surgery for an undescended testicle. <</SYS>> Hello [/INST] Have you had any surgeries in the past? [INST] Yeah, I have, I actually had it to repair an undescended testicle. [/INST] Oh, wow, do you remember it at all? [INST] No, nothing about it, I had that done when I was a baby. [/INST]</s>

<s>[INST] <<SYS>> The patient has been followed elsewhere, and we reviewed his records. Essentially, he has had a trigger finger and a mucocyst, and he has had injections. This has been going on for several months. He is now here for active treatment because the injections were not helpful, nonoperative treatment has not worked, and he would like to move forward in order to prevent this from keeping on locking and causing his pain. He is referred over here for evaluation regarding that. <</SYS>> Hello [/INST] How long has your finger been in pain, sir? [INST] Well, at this point, it's been more than a few months. [/INST] Have you seen another doctor for this pain? [INST] Yeah, I saw another guy a little while ago. [/INST] Do you have the records from the visit? [INST] Yeah, actually, they're right here. [/INST] Okay, so I see you have a trigger finger, and a mucous cyst, and this other doctor gave you injections. Is that correct? [INST] Yes sir. [/INST] Did the injections help at all? [INST] No sir, honestly, they did nothing. [/INST] So, your finger is still locking today? [INST] Yes sir, the other doctor referred me over here to see if there was anything more we could do. I'd like to try surgery. [/INST]</s>

<s>[INST] <<SYS>> Only occasionally drinks alcohol and he is a nonsmoker. He currently is working as a nurse aid, second shift, at a nursing home. He states that he did not enroll in Wichita State this semester. Stating he just was tired and wanted to take some time off. He states he is in a relationship with one partner and denies any specific stress in the relationship. <</SYS>> Hello [/INST] So, do you drink or smoke, sir? [INST] I'd say I have the occasional drink, but I don't smoke. [/INST] What do you do for a living? [INST] I'm a nursing aid in a nursing home right now. [/INST] Do you work the normal day shift? [INST] No, I work the second shift, so I work some late nights and early mornings. [/INST] Are you back at Wichita State this semester? [INST] No, I decided to take some time off. [/INST] Is everything okay? [INST] Yeah, I'm just really tired, so I decided to step away for a little. [/INST] That's understandable. Are you dating right now? [INST] Yes, I've been dating my boyfriend for a while now. [/INST] Is there any significant stress in your relationship? [INST] No, everything is going really well. [/INST]</s>

<s>[INST] <<SYS>> LYMPH: Cervical lymph nodes. No lymphadenopathy. <</SYS>> Hello [/INST] Doctor Shami, can you please take down the notes as I examine the patient? Can you put the heading as cervical lymph nodes. I am going to check for any swelling in your neck okay? Can you look down? [INST] Okay. [/INST] Alright, I do not feel anything here. Can you look up? [INST] Sure. [/INST] No palpable nodes here. None of the lymph nodes are enlarged or have any swellings. Yeah.</s>

<s>[INST] <<SYS>> The patient is a 59-year-old gentleman who is now approximately 4 months status post percutaneous screw fixation of Schatzker IV tibial plateau fracture and nonoperative management of second through fifth metatarsal head fractures. He is currently at home and has left nursing home facility. He states that his pain is well controlled. He has been working with physical therapy two to three times a week. He has had no drainage or fever. He has noticed some increasing paresthesias in his bilateral feet but has a history of spinal stenosis with lower extremity neuropathy. <</SYS>> Hello [/INST] Hello, sir. So, remind me, how long ago was your procedure? [INST] Let me think. Now, it's been about four months. I just turned fifty nine. [/INST] Okay, and just to refresh your memory, we did a percutaneous screw fixation of a Schatzker I V tibial plateau fracture, and we've managed those toe fractures nonoperatively. [INST] Which toes did I break? [/INST] You broke your second and fifth toes. [INST] Do you have the x rays? Can I see where the breaks are? [/INST] Absolutely, if you look here, right here is where the breaks are. These are called the metatarsal heads. [INST] Wow, that's right where it hurts. [/INST] Yep, and where are you living now? [INST] Thankfully, I left the nursing home, and I'm back in my own house now. [/INST] That's really good. Are you in any pain today? [INST] No, not today. [/INST] Great, have you been going to P T? [INST] Yeah, I've been going about two or three times a week. [/INST] Are there any signs of infection, like drainage from the incision? [INST] Nope, the wound healed up nicely. I'll be able to wear shorts again. [/INST] Great, are you having any fever symptoms, like cough, runny nose, sore throat, fatigue, anything like that? [INST] No, but I have had some tingling in both my feet. I don't know if its related to surgery. If I'm remembering the names right, um, I have a history of spinal stenosis and neuropathy in my legs. [/INST] With your history of spinal stenosis, the broken toes, and the surgery, that's a pretty normal side effect.</s>

<s>[INST] <<SYS>> Also up-to-date. <</SYS>> Hello [/INST] Did you have your vaccines? [INST] Yeah. [/INST] Did you skip any? [INST] No, I had all of them and am up to date with my immunizations. [/INST]</s>

<s>[INST] <<SYS>> This is a 29-year-old male who has had multiple problems with his teeth due to extensive dental disease and has had many of his teeth pulled. Complains of new tooth pain. The patient states his current toothache is to both upper and lower teeth on the left side for approximately three days. The patient states that he would have gone to see his regular dentist but he has missed so many appointments that they now do not allow him to schedule regular appointments, he has to be on standby appointments only. The patient denies any other problems or complaints. The patient denies any recent illness or injuries. The patient does have OxyContin and Vicodin at home which he uses for his knee pain but he wants more pain medicines because he does not want to use up that medicine for his toothache when he wants to say this with me. <</SYS>> Hello [/INST] What is up with your teeth man? It's been giving you problems huh? [INST] Yes, yes, many, many problems. Firstly, they pulled out so many teeth and now I have this bad tooth problem. [/INST] Oh, so this is new? [INST] Yes, it's a new pain. Right now it has been going on for three days on left side's upper and lower teeth. [/INST] Then why didn't you go and visit your regular dentist? [INST] I would have but I have missed so many appointments that they now do not allow me to schedule regular appointments. So they put me on a standby appointment now. [/INST] Oh I am sorry. [INST] It is okay. [/INST] Okay any other problems or any other complaints? [INST] No. [/INST] How about any recent illnesses or injuries? [INST] No, no illness whatsoever. [/INST] Do you have any medicine at home for pain? [INST] Yes I have OxyContin and Vicodin at home. I use it for my knee pain. But I want more pain medicines. I do not want to use up that medicine for my toothache. [/INST] Okay I understand. How old are you again? [INST] I am twenty nine. [/INST]</s>

<s>[INST] <<SYS>> CARDIOVASCULAR: No history of palpitations, irregular rhythm, chest pain, hypertension, hyperlipidemia, diaphoresis, congestive heart failure, heart catheterization, stress test or recent cardiac tests. <</SYS>> Hello [/INST] I just quickly wanted to check few things, let's go over them together? [INST] Sure. [/INST] Any heart condition like heart failure or anything? [INST] No. [/INST] Any heart catheterization? [INST] Um, no. [/INST] Any history of chest pain, palpitation, or irregular heartbeat? [INST] No. [/INST] Do you have high blood pressure? [INST] No. [/INST] Any history of high cholesterol? [INST] No. [/INST] Any excessive or abnormal sweating? [INST] Not really, no. [/INST] Any stress test or heart tests done recently? [INST] No. [/INST] Okay, thank you for answering these questions. [INST] No problem. [/INST]</s>

<s>[INST] <<SYS>> No known drug allergies. <</SYS>> Hello [/INST] Do you have any allergies? [INST] No I do not. [/INST] Are you sure? [INST] Yes I am. [/INST]</s>

<s>[INST] <<SYS>> The patient returns to the Pulmonary Medicine Clinic for followup evaluation of interstitial disease secondary to lupus pneumonitis. She was last seen in the Pulmonary Medicine Clinic in January 2004. Since that time, her respiratory status has been quite good. She has had no major respiratory difficulties; however, starting yesterday she began with increasing back and joint pain and as a result a deep breath has caused some back discomfort. She denies any problems with cough or sputum production. No fevers or chills. Recently, she has had a bit more problems with fatigue. For the most part, she has had no pulmonary limitations to her activity. <</SYS>> Hello [/INST] Thanks, nurse. How are you feeling today, miss? Welcome back to the Pulmonary Medicine Clinic. What happened yesterday? [INST] Well, I was doing fine since last time. My respiratory issues have been great and I have had no major difficulties breathing. [/INST] That's good to hear. What happened yesterday that caused you to want to come in so urgently? [INST] Yesterday I noticed that I have some back and joint pain. When I breathe deep my back hurts. [/INST] Are you experiencing any coughing? [INST] No, coughing at this moment. [/INST] Have you been producing any mucus the times that you do cough? [INST] No, I already said I didn't cough. [/INST] Okay. Any fevers or chills? [INST] Nothing so far. [/INST] Do you have any other symptoms currently? [INST] I do notice that I am more tired than usual. [/INST] During physical activity do you seem out of breath or more tired than usual? I want to see if your pulmonary system is inhibited. [INST] No. I don't have issues with breathing when I do daily activities. [/INST]</s>

<s>[INST] <<SYS>> lives with parents and sisters. <</SYS>> Hello [/INST] Are you studying? [INST] Yes. I'm doing my major in computer science. [/INST] Do you live alone? [INST] No, I live in my family. Mainly my parents and my sisters. [/INST]</s>

<s>[INST] <<SYS>> Noncontributory. <</SYS>> Hello [/INST] Do you smoke cigarettes? [INST] Yes. [/INST] Do you drink alcohol or use recreational drugs? [INST] Yes, I have been in and out of treatment. I am not doing so well with staying clean. [/INST] What substances do you use? [INST] I drink, and I did some coke today. I have been in treatment for heroin and alcohol. [/INST]</s>

<s>[INST] <<SYS>> works as a metal grinder and was engaged to be married. She denied any tobacco or illicit drug use. She consumed 1 alcoholic drink per month. <</SYS>> Hello [/INST] Do you use tobacco products, alcohol, or recreational drugs, miss? [INST] I have a drink every once and a while. [/INST] How many drinks do you consume in a week? [INST] I don't even drink that often. I probably have one drink per month. [/INST] Are you married? [INST] I was engaged but that is not happening anymore. It is a long story. [/INST] I am sorry the hear that. What do you do for work? [INST] I am a metal grinder. [/INST]</s>

<s>[INST] <<SYS>> He lives with his wife. He works at Shepherd Pratt doing network engineering. He smokes a pack of cigarettes a day and is working on quitting. He drinks four alcoholic beverages per night. Prior to that, he drank significantly more. He denies illicit drug use. He was athletic growing up. <</SYS>> Hello [/INST] Welcome to the clinic, sir. I am Doctor Jones. [INST] Thank you. It is nice to meet you. [/INST] Do you use tobacco products? [INST] Yes. I smoke cigarettes. I am working on quitting. [/INST] I am glad you are attempting to quit. We have a lot of tools now to help with cravings. How much do you smoke per day now? [INST] I smoke about a pack a day. [/INST] Do you drink alcohol or use recreational drugs? [INST] I drink but I don't do any drugs. [/INST] How many alcoholic drinks do you consume per week? [INST] I drink about four drinks per night. I used to drink a lot more than that. I have cut back on my drinking. [/INST] Are you physically active? Do you exercise? [INST] I was very athletic when I was growing up. Now I don't exercise on a regular basis. [/INST] What do you do for employment? [INST] I am a network engineer. I work for Shepherd Pratt. [/INST] Are you married? [INST] Yes. I have been married to my wife for five years now. [/INST] Do you live at home with your wife and or is there anyone else living in your home? [INST] No. Just me and the wife. [/INST]</s>

<s>[INST] <<SYS>> No previous surgeries. <</SYS>> Hello [/INST] Have you ever had surgery before? [INST] No, not that I know of. [/INST] So, no gallbladder removal, or joint replacements? [INST] Unless they did it while I was sleeping, but none that I can remember. [/INST]</s>

<s>[INST] <<SYS>> As tolerated. <</SYS>> Hello [/INST] How did the patient do on the activity test?</s>

<s>[INST] <<SYS>> She states her brother died of an MI suddenly in his 50s. <</SYS>> Hello [/INST] Do you have any related family history? [INST] You mean like heart issues in the family? [/INST] Yeah, something like that. [INST] My brother died of heart attack. It was sudden everyone was shocked. [/INST] How old was he? [INST] He was not that old; he was just in his fifties. [/INST]</s>

<s>[INST] <<SYS>> HTN, Colon CA, and a daughter with unknown type of "dystonia." <</SYS>> Hello [/INST] What is your family medical history? [INST] My family has a high blood pressure. I have a family member that had colon cancer. My daughter has a twitch. They don't know what caused it? [/INST] Okay.</s>

<s>[INST] <<SYS>> The patient is originally from Maine. She has lived in Arizona for 4 years. She has had 2 children; however, only one is living. She had one child died from complications of ulcerative colitis. She has been predominantly a homemaker during her life, but has done some domestic cleaning work in the past. <</SYS>> Hello [/INST] I understand that you are new to the clinic. Welcome. [INST] Yes, I am new here. I have lived in Arizona for the last four years. I am from Maine. That is where I grow up and most of my family still lives there. [/INST] What line of work are you in? [INST] I am a homemaker. I used to clean house, a while back. [/INST] Do you have children? [INST] I have two children but only one of them is still with us. My oldest son passed away from ulcerative colitis complications three years ago. [/INST] I am so sorry to hear that!</s>

<s>[INST] <<SYS>> 1. A D and C. 2. Bone fragment removed from her right arm. 3. Ovarian cancer staging. <</SYS>> Hello [/INST] Do you have a history of surgeries? [INST] I had a bone fragment removed from my right arm. I had a D and C done a long time ago. It was a treatment for H P V. More recently I had an ovarian cancer staging biopsy done. I have not heard back with the results yet. I only had it done less then a week ago. [/INST] How are you feeling after the biopsy? [INST] I had a significant amount of pain for two to three days after. I feel better now. [/INST]</s>

<s>[INST] <<SYS>> Denied Tobacco/ETOH/illicit drug use. <</SYS>> Hello [/INST] Do you use tobacco, alcohol, or recreational drugs? [INST] No. [/INST]</s>

<s>[INST] <<SYS>> Significant for degenerative disc disease in the back. <</SYS>> Hello [/INST] Do you have any other problems? [INST] I do actually, I have back disc degeneration. [/INST] Oh really? [INST] Yeah. [/INST] When were you diagnosed with it? [INST] Maybe twenty ten? [/INST]</s>

<s>[INST] <<SYS>> Insulin, metformin, Glucotrol, and Lipitor. <</SYS>> Hello [/INST] Are you on insulin? [INST] Yes. [/INST] Are you on metformin as well? [INST] Yes. [/INST] How about glucotrol? [INST] Yes I take that. [/INST] Are you on lipitor? [INST] Yes. [/INST]</s>

<s>[INST] <<SYS>> Her father died with heart disease in his 60s and her mother died of colon cancer. She has a sister who she believes is probably healthy. She has had two sons one who died of a blood clot after having been a heavy smoker and another who is healthy. She has two normal vaginal deliveries. <</SYS>> Hello [/INST] Can you tell me about your family? [INST] I have or had two sons both born normally without any complications. [/INST] Why did you say had? [INST] One of my sons was a heavy smoker, he uses to smoke a whole packet or more in a day. We tried everything possible, but he just couldn't quit. He died of clots. [/INST] Does anyone in your family like parents or siblings had any medical issues? [INST] Yes, my father had heart related issues, he died in his sixties, my mother died of colon cancer. I also have a sister but I don't think she has any issues. [/INST]</s>

<s>[INST] <<SYS>> This 67y/o RHF was diagnosed with Parkinson's Disease in 9/1/95, by a local physician. For one year prior to the diagnosis, the patient experienced staggering gait, falls and episodes of lightheadedness. She also noticed that she was slowly "losing" her voice, and that her handwriting was becoming smaller and smaller. Two months prior to diagnosis, she began experienced bradykinesia, but denied any tremor. She noted no improvement on Sinemet, which was started in 9/95. At the time of presentation, 2/13/96, she continued to have problems with coordination and staggering gait. She felt weak in the morning and worse as the day progressed. She denied any fever, chills, nausea, vomiting, HA, change in vision, seizures or stroke like events, or problems with upper extremity coordination. <</SYS>> Hello [/INST] You recently turned sixty seven, correct? [INST] Yes. Sixty seven years young. [/INST] Are you right or left handed? [INST] Right. [/INST] When were you first diagnosed with Parkinson's? [INST] September first of nineteen ninety five. [/INST] Do you remember who diagnosed you? [INST] A local doctor I was seeing at the time. A year before my diagnosis, I had a few falls and episodes of lightheadedness. I also noticed that I was staggering a lot more when walking. [/INST] Did you lose consciousness during any of your falls? [INST] Not that I know of. I had noticed that I was losing my normal voice to a degree. On top of losing my normal voice, my handwriting became smaller and smaller. I don't ever remember writing so small. Something seemed really off to me. [/INST] I'm sure that was difficult to experience. [INST] It was very difficult. Two months prior to being diagnosed, I started to move much slower than before. [/INST] By slower, do you mean the movements of your arms and legs were slower and impaired? [INST] Yes. I was prescribed Sinemet back in September of nineteen ninety five. [/INST] Did you notice any improvement while taking it? [INST] None. I was pretty disappointed and discouraged as a result. I have problems with coordination and walking without staggering even today. [/INST] Noting that it's February thirteenth nineteen ninety six. [INST] I felt weak in the morning and worse as the day went on. [/INST] Are you experiencing any other symptoms, such as stroke like events, vision changes, seizures, or problems with moving and coordinating your arms? [INST] No. [/INST] Any headache, nausea, vomiting, chills, or fever? [INST] No. [/INST]</s>

<s>[INST] <<SYS>> Patient is a 76-year-old white male who presents with his wife stating that he was stung by a bee on his right hand, left hand, and right knee at approximately noon today. He did not note any immediate reaction. Since that time, he has noted some increasing redness and swelling to his left hand, but he denies any generalized symptoms such as itching, hives, or shortness of breath. He denies any sensation of tongue swelling or difficulty swallowing. The patient states he was stung approximately one month ago without any serious reaction. He did windup taking Benadryl at that time. He has not taken anything today for his symptoms, but he is on hydrochlorothiazide and metoprolol for hypertension as well as a baby aspirin each day. <</SYS>> Hello [/INST] Oh wow, you got stung quite a few times. [INST] Yeah, you're right about that. In my seventy six years this i have never gotten stung. This is new. [/INST] [INST] Yeah, they got both my hands and right knee. Those little monsters. [/INST] Did you notice redness and swelling right away? [INST] Um not right away. [/INST] How long did it take for your body to react? [INST] Bout thirty minutes or so. [/INST] Did you experience any shortness of breath, itching, or hives? [INST] No, surprisingly. [/INST] And no tongue swelling or trouble swallowing? [INST] No. [/INST] Have you gotten stung in the past? Or is this your first time? [INST] I got stung about a month ago. No redness or swelling like I do now. I guess it could've been due to the Benadryl I took as soon as it happened. [/INST] Did you take Benadryl again today? [INST] No, I figured I'd be okay. [/INST] [INST] And a baby Aspirin in the mornings. [/INST] Did you take your daily medications today? [INST] Yeah." [/INST]</s>

<s>[INST] <<SYS>> Pressure decubitus, right hip. <</SYS>> Hello [/INST] Hi, how are you? [INST] I am good, how about you? [/INST] Well, I am good too, thank you for asking. So, what brings you here? [INST] Um, I have developed this painful ulcer on my hip. [/INST] Oh, let me take a look. Which side? [INST] On my right hip. [/INST] Okay, I see it. Looks like you have developed pressure ulcer.</s>

<s>[INST] <<SYS>> Mother died age 89 of "old age." Father died age 89 of stroke. Brother, age 74 with CAD, Sister died age 30 of cancer. <</SYS>> Hello [/INST] What is your family medical history? [INST] My mom was healthy all her life. She died of old age. She was eighty nine years old. My dad died of a stroke. He was eighty nine as well. [/INST] Do you have siblings? [INST] Yes I had a brother and a sister. My sister died way too young. She was only thirty when she passed away from cancer. My brother lasted until he was seventy four. He had coronary artery disease. [/INST]</s>

<s>[INST] <<SYS>> 1. Hypoglycemia due to not eating her meals on a regular basis. 2. Hypertension. 3. Renal insufficiency, may be dehydration, or diabetic nephropathy. <</SYS>> Hello [/INST] Poor renal sufficiency, possibly due to dehydration or diabetic nephropathy. She also has high blood pressure and low blood sugar as a result of missing meals regularly.</s>

<s>[INST] <<SYS>> The patient is a 14-year-old girl who started having left knee pain in the fall of 2007. She was not seen in Orthopedic Clinic until November 2007. The patient had an outside MRI performed that demonstrated left patellar chondromalacia only. The patient was referred to physical therapy for patellar tracking exercises. She was also given a brace. The patient reported increasing pain with physical therapy and mother strongly desired other treatment. It was explained to the mother in detail that this is a difficult problem to treat although majority of the patients get better with physical therapy. Her failure with nonoperative treatment is below the standard 6-month trial; however, given her symptoms and severe pain, lateral capsular release was offered. Risk and benefits of surgery were discussed. Risks of surgery including risk of anesthesia, infection, bleeding, changes in sensation and motion extremity, failure of procedure to relieve pain, need for postoperative rehab, and significant postoperative swelling. All questions were answered, and mother and daughter agreed to the above plans. <</SYS>> Hello [/INST] Good afternoon, dear, how old are you? [INST] I'm fourteen years old. [/INST] Good, and what brings you in for a visit today? [INST] My left knee hurts really bad. [/INST] Oh no, how long has this knee been hurting you? [INST] Well, since the fall of two thousand seven. [/INST] Have you seen another doctor for this? [INST] Mom, can you tell the doctor? [/INST] I see, and what did this doctor recommend? Thank you, yes, so this shows left patellar chondromalacia. Has she been to P T? I see, has she been wearing her brace? That's good, and how is your pain today, dear? [INST] P T only made the pain much worse, it hurts so much. [/INST] Well, we're in a pretty difficult spot here. The majority of my patients get significantly better by just going to P T. Usually, we manage this for six months without surgery, and she hasn't reached that milestone yet. But, because her pain is getting so severe, I can do a lateral capsular release on this knee. It's a small procedure, minimally invasive, and we can do it outpatient. Her kneecap is partially dislocating, so this surgery will get everything back into alignment. The risk of infection is actually less than one percent. We use antibiotics to control for infection. [INST] Will I be asleep for this? [/INST] Yes, you won't feel a thing. [INST] Will I need to go back to P T? [/INST] Yes, you'll need to go some after the surgery to make sure everything heals up okay. The other risks include bleeding, changes in sensation and motion extremity, failure of procedure to relieve pain, need for postoperative rehab, and significant postoperative swelling. [INST] Yeah, I think so too, I want to get back to playing soccer. [/INST]</s>

<s>[INST] <<SYS>> divorced. unknown history of tobacco/ETOH/illicit drug use. <</SYS>> Hello [/INST] Is she married? Any history of tobacco, alcohol or drug use?</s>

<s>[INST] <<SYS>> Possible free air under the diaphragm. <</SYS>> Hello [/INST] The patient has possible free air in their diaphragm. Seventy six. Unknown as of now.</s>

<s>[INST] <<SYS>> Positive findings of the foot that have been recorded. All other systems reviewed were negative. <</SYS>> Hello [/INST] Where do you feel the most pain? [INST] I'd have to say at the heels of my feet. I spend a lot of time on my feet at work. [/INST] I see. What kind of shoes do you normally wear to work? [INST] Regular tennis shoes. [/INST] Are they cushioned? [INST] Eh not really, but they're pretty durable. [/INST] I'd advise getting an orthotic for your shoes to help with the heel pain and resting your feet when you're home. In the meantime, I'd like for you to see a specialist to make sure nothing else is going on. [INST] Alright, I'm good with that plan. [/INST] Are you having any other problems? Joint pain, difficulty walking, nausea, vomiting, or other symptoms? [INST] No, just heel pain for now. [/INST]</s>

<s>[INST] <<SYS>> Positive for mother passing away in her late 60s from heart attack, father had liver cancer, and passed away from that. One of his children suffers from hypothyroidism, 2 grandchildren has cerebral palsy secondary to being prematurely born. <</SYS>> Hello [/INST] Okay, let's talk about your family history. [INST] Oh, I have very disturbing family history! [/INST] Why do you say so? [INST] Well, my mother passed away due to heart attack in her late sixties and my father had liver cancer and he passed away from that. [/INST] Oh- [INST] Oh, that is not all. My one son suffers from hypothyroidism and my daughter's two kids have cerebral palsy from being born prematurely. [/INST] Oh, that is so unfortunate. [INST] Yeah. [/INST]</s>

<s>[INST] <<SYS>> "Trouble breathing." <</SYS>> Hello [/INST] How are you feeling today? [INST] I have been having some trouble breathing. I had tightness in my chest after walking up stairs. [/INST] Let me listen to your lungs.</s>

<s>[INST] <<SYS>> First set of cardiac enzyme profile negative. H&H stable. BUN and creatinine within normal limits. <</SYS>> Hello [/INST] Okay so your blood report is back and the cardiac enzyme we were looking for are negative. [INST] Okay. [/INST] Your blood urea nitrogen, also known as B U N, is within normal limits and hydrogen is stable. Creatinine is also within the normal range. [INST] Great! [/INST]</s>

<s>[INST] <<SYS>> The patient had been previously a smoker. No other could be obtained because of tracheostomy presently. <</SYS>> Hello [/INST] Okay. It's mentioned in her report that she has a history of smoking. Well, it's alright. I think it's going to be difficult taking any past medical information from her.</s>

<s>[INST] <<SYS>> She has had no recent STDs and she is not currently sexually active. PPD status was negative in the past. PPD will be placed again today. Treatment adherence counseling was performed by both nursing staff and myself. Again, the patient is a 100% compliant with her meds. Last dental exam was in 11/07, where she had 2 teeth extracted. Last Pap smear was 1 year ago was negative. The patient has not had mammogram yet, as she is not of the age where she would start screening mammogram. She has no family history of breast cancer. <</SYS>> Hello [/INST] Good afternoon, young lady. [INST] Good afternoon, doctor. [/INST] Let's get the personal questions out of the way to begin, shall we? [INST] Sure. [/INST] Have you had any S T D s recently? [INST] No, not that I know of. [/INST] Are you sexually active? [INST] No, I'm not. [/INST] I'm looking here, and your last P P D was negative, but we'll do another one today. [INST] Okay, that's fine, doctor. [/INST] Have you been compliant with all of the medicine you've been prescribed? [INST] Yes, I've taken everything exactly as you told me to. [/INST] Good, do you remember when your last dentist appointment was? [INST] Yeah, it was in November of two thousand seven. [/INST] What did they do for you at your last visit? [INST] They pulled two teeth for me. [/INST] Good, and when was your last pap smear? [INST] It was about a year ago. [/INST] I assume it was negative? [INST] Yes, thankfully. [/INST] Have you had a mammogram yet? [INST] No, not yet. I'm not old enough. [/INST] Do you have a family history of breast cancer? [INST] No, I don't, at least not that I know of. [/INST]</s>

<s>[INST] <<SYS>> Right-sided weakness. <</SYS>> Hello [/INST] What brings you into the office today? [INST] I had a stroke about a month ago. The right side of my face is still not moving. [/INST] Is it only the right side of the face that is affected by paralysis? [INST] Yes. It has improved a little bit since I was in the hospital. [/INST] That is a good sign. It can take up to six months see how much movement you will regain.</s>

<s>[INST] <<SYS>> Include hypertension, dementia, urinary incontinence, chronic back pain, and degenerative joint disease of the spine. No history of diabetes, stroke or coronary artery disease. <</SYS>> Hello [/INST] Can you give me a quick run down of her medical history? I'm sorry to hear that. When was she diagnosed with dementia? Any history of heart disease, diabetes, or stroke?</s>

<s>[INST] <<SYS>> This is a 13-year-old male who had sustained a laceration from glass and had described numbness and tingling in his right ring finger. <</SYS>> Hello [/INST] Good afternoon, young man. [INST] Hello, doctor. [/INST] How old are you, young man? [INST] I'm thirteen, sir. [/INST] Thank you, so, what happened? [INST] I sliced my right ring finger with a piece of glass while I was playing around with my friends. [/INST] You need to be more careful, young man. What kind of symptoms do you feel in that finger? [INST] You're right. I have a lot of, um, numbness and tingling in it. [/INST]</s>

<s>[INST] <<SYS>> Hypersensitivity to Coumadin. <</SYS>> Hello [/INST] Your bloodwork came back from the Coumadin sensitivity test. The results showed a high level of sensitivity. I am going to adjust your dosage of Coumadin to a much lower dose. This will help reduce the bruising and the bleeding episodes. Do you have any questions? [INST] No. [/INST]</s>

<s>[INST] <<SYS>> None. <</SYS>> Hello [/INST] Do you have any known drug allergies? [INST] No. [/INST]</s>

<s>[INST] <<SYS>> Mom brings the patient in today for possible ear infection. He is complaining of left ear pain today. He was treated on 04/14/2004, with amoxicillin for left otitis and Mom said he did seem to get better but just started complaining of the left ear pain today. He has not had any fever but the congestion has continued to be very thick and purulent. It has never really resolved. He has a loose, productive-sounding cough but not consistently and not keeping him up at night. No wheezing or shortness of breath. <</SYS>> Hello [/INST] How's this little guy doing today? Oh, I'm sorry to hear that. Let's have a look see. Did that seem to help? Has he been running any fevers? He sounds a bit congested. Is his cough productive? Does it seem to be keeping him up at night? How does the mucous look? And no shortness of breath or wheezing that you've noticed?</s>

<s>[INST] <<SYS>> No noted exposures. <</SYS>> Hello [/INST] Hello. What is the reason for your visit today? [INST] I keep having this dry cough and it gets hard to breathe at times. [/INST] Were you exposed to anything recently? [INST] Here's a note from a contractor that worked on my house recently. I wasn't sure what it meant. [/INST] I see. It looks like you may have been exposed to asbestos. [INST] Oh, no! Am I going to be fine? [/INST] I'll take a look, but I want to ask you a quick question. Did you have any family living with you at the time? [INST] Nope. I live alone, so my family wasn't there to be exposed. [/INST]</s>

<s>[INST] <<SYS>> I needed a blood transfusion. <</SYS>> Hello [/INST] No, this is his first one.</s>

<s>[INST] <<SYS>> Coronary artery bypass surgery and a prior angioplasty and prostate biopsies. <</SYS>> Hello [/INST] It looks like you have an extensive medical history. [INST] I blame my heart. It's caused me the most trouble. I had coronary artery bypass surgery in twenty ten along with an angioplasty. [/INST] I'm sorry that your heart has been giving you so much trouble. I'm happy that you're here with us today and taking the right measures to keep yourself healthy. [INST] Oh, and I forgot to mention that I've had prostate biopsies in the past. [/INST] When did you have the biopsies done? [INST] Last year. [/INST] Did they come back negative? [INST] Yes, fortunately. I guess my prostate isn't as troublesome as my heart. [/INST] I understand.</s>

<s>[INST] <<SYS>> I have a lot of swelling in my legs. <</SYS>> Hello [/INST] Hello, how are you? [INST] I am not so good. [/INST] Oh, what is going on with you? [INST] Well, I have lot of swelling in my legs. [/INST] Hm, okay.</s>

<s>[INST] <<SYS>> Significant for recurrent UTIs as she was recently to the hospital about 3 weeks ago for urinary tract infection. She has chronic incontinence and bladder atony, for which eventually it was decided for the care of the patient to put a Foley catheter and leave it in place. She has had right-sided CVA. She has had atrial fibrillation status post pacemaker. She is a type 2 diabetic with significant neuropathy. She has also had significant pain on the right side from her stroke. She has a history of hypothyroidism. Past surgical history is significant for cholecystectomy, colon cancer surgery in 1998. She has had a pacemaker placement. <</SYS>> Hello [/INST] Tell me about your past problems. [INST] Sure. I just came into the hospital I think about three weeks back for recurrent urine infections. [/INST] Yes it says here that you have bladder problems from a long time, mostly related to tone and capacity. [INST] Yes that is why they put catheter in me. [/INST] Okay and you have recently had right side C V A? [INST] Yes, because of my heart problems they had to put pacemaker in. [/INST] Okay. Good. [INST] I have hereditary diabetes. [/INST] Okay and your neural problem is associated to that as well. [INST] That's right. [/INST] You have pain on the right side now? [INST] Yes, because of my stroke. [/INST] And you take thyroid medications too? [INST] Yes, for my hypothyroidism. [/INST] Okay. [INST] Yeah. [/INST] What surgeries have you had in the past? [INST] I have had many surgeries. They took out my gall bladder, then colon cancer surgery was in nineteen ninety eight. [/INST] And now pacemaker placement, right? [INST] Yes, that is correct. [/INST]</s>

<s>[INST] <<SYS>> The patient is an 84-year-old woman with a history of hypertension, severe tricuspid regurgitation with mild pulmonary hypertension, mild aortic stenosis, and previously moderate mitral regurgitation although not seen recently and I was asked to perform cardiology consultation for her because there was concern for atrial fibrillation after a fall. Basically the patient states that yesterday she fell and she is not certain about the circumstances, on her driveway, and on her left side hit a rock. When she came to the emergency room, she was found to have a rapid atrial tachyarrhythmia, and was put on Cardizem with reportedly heart rate in the 50s, so that was stopped. Review of EKGs from that time shows what appears to be multifocal atrial tachycardia with followup EKG showing wandering atrial pacemaker. An ECG this morning showing normal sinus rhythm with frequent APCs. Her potassium at that time was 3.1. She does recall having palpitations because of the pain after the fall, but she states she is not having them since and has not had them prior. She denies any chest pain nor shortness of breath prior to or since the fall. She states clearly she can walk and she would be able to climb 2 flights of stairs without problems. <</SYS>> Hello [/INST] Hi, how are you doing? [INST] I'm good. Thank you. [/INST] How old are you, young lady? [INST] Eighty four. [/INST] What brings you here? [INST] I had a fall. And I was told to consult you for my heart conditions. [/INST] Okay. Um? Can you tell me a little detail about anything you experienced before or diagnosed before? [INST] Yeah, I have high blood pressure. And they also diagnosed me with other heart diseases. I cannot pronounce all the names I don't remember. [/INST] That's fine. Let me go through your medical record first. Let's see what we have here. Looks like you have your plate full. Your record says you had hypertension I mean, high blood pressure. Also, you have a history of severe tricuspid regurgitation with mild pulmonary hypertension, mild aortic stenosis, and previously moderate mitral regurgitation. [INST] Wow! Those are a lot of fancy words that I can never remember. [/INST] Ha ha. So, it says here they they want me to check you for atrial fibrillation. Yet another fancy word to add to your list. [INST] What does it mean? [/INST] It means I must check if you have faster than normal heartbeat after your fall. In simple words, just to check if there are any irregularities in your heart beating, okay? [INST] Hm, okay. [/INST] So tell me what happened? How did you fall? [INST] I'm not sure about how it happened, but yeah, I fell yesterday on my driveway and kind of hit a rock. [/INST] Which side did you hit the rock? [INST] Um I think it was left side. [/INST] What happened in the emergency room? [INST] They gave me some medicine. And they put something on my finger. They said that my heart rate was very high. [/INST] Yeah, in the record it says that they found rapid atrial tachyarrhythmia. So, according to this, they have given you Cardizem and they stopped it when your heart rate came to fifties. Let me review your electrocardiogram from emergency. It says that there was rapid heart rate. Your heart was really beating very fast and then there was one more electrocardiogram which showed that your pacemaker is acting weird. [INST] They also did the same test this morning. [/INST] One they did this morning shows normal rate with frequent early heartbeats. Looks like they also tested your blood. Your potassium level is three point one. How was your heart feeling when you fell yesterday? [INST] I felt that I just ran in a race. I could feel all the pain after that fall. It was ugly. My heart was pounding so fast it was ready to come out, I never felt like that before in my life. [/INST] Did you feel the same way afterwards as well? [INST] No, it was just after fall. It did not stay like that for long, I was normal later. I never felt it again after that incident. [/INST] That is good. Do you have any pain or discomfort in your chest? [INST] I don't think so. [/INST] How about before the fall? Did you have any pain or discomfort in your chest before the fall? [INST] Nope. [/INST] how about shortness of breath? [INST] No, not even before the fall. I'm able to walk and I'm sure I can climb stairs. Maybe two floors without any problems. [/INST]</s>

<s>[INST] <<SYS>> Listed as unknown in the chart as far as other psychiatric illnesses. The patient himself states that his parents are deceased and that he raised himself in the Philippines. <</SYS>> Hello [/INST] Do you have anyone with psychiatric symptoms in the family? [INST] No, I don't have family! [/INST] What do you mean? [INST] My mom dad died and I was raised in the Philippines. [/INST] Adopted? [INST] No by myself. [/INST] Wow that must have been tough. [INST] Oh it's a story for another day. [/INST]</s>

<s>[INST] <<SYS>> She had a baby five months ago. She smokes a half pack a day. She denies alcohol and drug use. <</SYS>> Hello [/INST] Do you smoke? [INST] Yes, I do. [/INST] How much? I mean can you tell me approximate amount? [INST] Yes sure, I smoke half a pack a day. [/INST] How about alcohol and drugs? [INST] No, I do not drink or use. I have a five month old baby. [/INST]</s>

<s>[INST] <<SYS>> Negative for illicit drugs, alcohol, and tobacco. <</SYS>> Hello [/INST] How about any drugs, alcohol, or tobacco? [INST] No, no, and no. [/INST]</s>

<s>[INST] <<SYS>> The patient comes in today for a comprehensive evaluation. She is well-known to me. I have seen her in the past multiple times. <</SYS>> Hello [/INST] How's it going? [INST] Good, can't complain. [/INST] Glad to hear. So today we're going to do a comprehensive eval. It'll be a bit different than our usual visits together. Would you like your mom to step in the room, too? [INST] Yeah, that's not a problem. [/INST] Alright. I'll grab her from the waiting room. I'll be right back.</s>

<s>[INST] <<SYS>> GF with CAD, otherwise unremarkable. <</SYS>> Hello [/INST] Hello again! [INST] Hi! [/INST] The results from you M R I showed nothing concerning. The growth factors were normal with normal cell function and no signs of decreased blood supply to the brain. [INST] That's great news. [/INST] Yes it is.</s>

<s>[INST] <<SYS>> Benign breast lump in her mother; however, her paternal grandmother had breast cancer. The patient denies any palpitations, urinary incontinence, hair loss, or other concerns. She was recently treated for sinusitis. <</SYS>> Hello [/INST] Hello, I am Doctor Rez. I will ask you a few questions about your personal and family history, okay? [INST] Yes, that's okay. [/INST] Did any one in your family get diagnosed with any medical conditions? [INST] My mom has lumps in her breast but it is benign, however my granny on my father side had cancer. [/INST] What kind of cancer, do you know? [INST] Well, it was breast cancer don't know if there are types for it. [/INST] No, that's fine. Did you ever have palpitations? [INST] What do you mean by that? [/INST] Um, Palpitations means the sensation when you feel that your heart is racing or pounding really fast even without doing any strenuous exercise or anything. [INST] Oh, got it. No, I never had that. [/INST] What about any uncontrolled urine leakage? Any accidents? [INST] No. [/INST] What about any recent sudden hair loss or any other concerns? [INST] No, nothing like that. [/INST] Any other treatments in the past? [INST] Yeah, I recently got treatment for my sinus. [/INST]</s>

<s>[INST] <<SYS>> His father died from breast cancer. He also had diabetes. He has a strong family history of diabetes. His mother is 89. He has a sister with diabetes. He is unaware of any family members with neurological disorders. <</SYS>> Hello [/INST] Welcome in. [INST] Thank you. [/INST] Let us start with your family medical history. [INST] I have a lot of diabetes in the family. [/INST] Who has diabetes? [INST] My father had diabetes. He passed away. [/INST] I am so sorry. How did he pass away? [INST] He had cancer. He actually had breast cancer. [/INST] That is incredibly rare. Is your mother still with us? [INST] Yes, she is. She just had her eighty ninth birthday. Next year we are going to plan a big birthday bash for her. [/INST] Do you have any siblings? [INST] Yes. I have a sister. She has diabetes too. [/INST] Do you know of any family members with neurological disorders such as M S, epilepsy, or Huntington's? [INST] No. I don't know of anything like that. [/INST]</s>

<s>[INST] <<SYS>> The patient has multiple medical problems, for which she is under the care of Dr. X. She has a history of chronic obstructive lung disease and a history of gastroesophageal reflux disease. There is a history of anemia and there is a history of sciatica, which has been caused by arthritis. The patient has had skin cancers, which have been treated with local excision. <</SYS>> Hello [/INST] Hello, how are you? [INST] I am good, Doctor. [/INST] So, what brings you here today? [INST] Well, I have many medical issues and I see Doctor X for them, but I wanted a second opinion, so he referred me here. [/INST] Yeah, he is a good man! Don't worry we will take care of you. [INST] Thank you. [/INST] So, let me start by getting your medical history. [INST] Sure, I had skin cancer which was treated by removal of that part. [/INST] Okay. [INST] Other than that, I have anemia and an acid reflux problem. I also have history of C O P D. [/INST] Alright. [INST] I also suffer from sciatica which was caused mainly due to my arthritis. [/INST] I see.</s>

<s>[INST] <<SYS>> Excisional lymph node biopsy (9/03). <</SYS>> Hello [/INST] I remember you mentioned that you had one operation done in the past. [INST] I had a lymph node biopsy back in September of O three. [/INST] Did it come back negative? [INST] Fortunately, yes. [/INST]</s>

<s>[INST] <<SYS>> He has no known drug allergies. <</SYS>> Hello [/INST] Does he have any known drug allergies?</s>

<s>[INST] <<SYS>> Noncontributory. <</SYS>> Hello [/INST] Do you have major illnesses in the family like diabetes or high B P? [INST] No nothing. No major illnesses. [/INST] Okay. [INST] Yes. [/INST]</s>

<s>[INST] <<SYS>> This 34-year-old gentleman awoke this morning noting some itchiness to his back and then within very a short period of time realized that he had an itchy rash all over his torso and arms. No facial swelling. No tongue or lip swelling. No shortness of breath, wheezing, or other associated symptoms. He cannot think of anything that could have triggered this off. There have been no changes in his foods, medications, or other exposures as far as he knows. He states a couple of days ago he did work and was removing some insulation but does not remember feeling itchy that day. <</SYS>> Hello [/INST] Hello, sir. How are you feeling today? [INST] Very itchy. I just keep scratching myself. [/INST] Oh, wow. I can see the rashes all over your arms. Are there rashes anywhere else? [INST] Yeah, it's all over my back and stomach. [/INST] I see it on your torso. When did this all start? [INST] I woke up this morning and started itching my back. After a few minutes, I noticed the rash was on my arms, chest, back, and stomach areas. [/INST] I'm going to take a look at the rashes and the rest of your body. [INST] Sounds good. [/INST] It looks like your face and lips are not swollen. Could you say ah for me? [INST] Ah. [/INST] It looks like your tongue isn't swollen either. [INST] That's good to hear. [/INST] Have you been feeling a shortness of breath, wheezing, or other related symptoms? [INST] Not that I know of. [/INST] Sounds good. I wonder why this happened. Did you do anything the night before? [INST] Uh. A few days ago, I was working and had to remove some insulation. Other than that, I don't know what else could have given me these rashes. [/INST] I see. Do you remember being itchy after that? Did you try any new foods? [INST] Nope I was not itchy. Also, my diet has been the same. [/INST] Are you taking any new medications? [INST] I haven't. [/INST] You don't recall being exposed to any other substances? [INST] Not that I know of. [/INST]</s>

<s>[INST] <<SYS>> This is a return visit to the endocrine clinic for the patient with history as noted above. She is 45 years old. Her last visit was about 6 months ago. Since that time, the patient states her health has remained unchanged. Currently, primary complaint is one of fatigue that she feels throughout the day. She states, however, she is doing well with CPAP and wakes up feeling refreshed but tends to tire out later in the day. In terms of her thyroid issues, the patient states that she is not having signs or symptoms of thyroid excess or hypothyroidism. She is not reporting temperature intolerance, palpitations, muscle weakness, tremors, nausea, vomiting, constipation, hyperdefecation or diarrhea. Her weight has been stable. She is not reporting proximal muscle weakness. <</SYS>> Hello [/INST] Hello. Looks like we are here for a six months follow up. How are we doing? [INST] I have stayed relatively the same. My main complaint is that I feel tired throughout the day. The C P A P is doing fine and I wake up refreshed, but I don't like how I crash. [/INST] Alright. How are the thyroid issues? [INST] I seem to be fine. My thyroid gland does not seem enlarged and I can breathe like normal. No fever or anything. [/INST] Have you experienced any of the following: temperature intolerance, palpitations, muscle weakness, tremors, nausea, vomiting, constipation, or diarrhea? [INST] Nothing of the kind. [/INST] How has you weight been? [INST] It has been stable. [/INST] Any muscle weakness closest to the body's center? [INST] No, nothing like that. Not bad for forty five. [/INST]</s>

<s>[INST] <<SYS>> 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. <</SYS>> Hello [/INST] Can you tell me more about your parents, please? How are they doing? [INST] Thank you for asking, they're both doing very well. They're very healthy. [/INST] That's great to hear. How old are they? [INST] My mom is fifty, and my dad is forty. [/INST] Wonderful, do you have any siblings? [INST] Yeah, I have two sisters, one is a half sister, and the other we have the same mom and dad. [/INST] How old are they? [INST] My half sister and I have the same mom, and she's thirty four. My other sister is ten. [/INST] Do they have any history of medical conditions that you know about? [INST] My half sister, um, no. My other sister has had some yeast infections. [/INST]</s>

<s>[INST] <<SYS>> None. <</SYS>> Hello [/INST] Have you had any surgeries in the past? [INST] No, none. [/INST]</s>

<s>[INST] <<SYS>> C-section and D&C. <</SYS>> Hello [/INST] What type of surgery have you had in past? Anything big or small? [INST] I had a C section for my kiddo and one D and C. [/INST] Okay.</s>

<s>[INST] <<SYS>> Significant only for hemorrhoidectomy. He does have a history of depression and hypertension. <</SYS>> Hello [/INST] Any medical history? [INST] Um I suffer from depression and high blood pressure. [/INST] Are you taking anything for either? [INST] Only for high blood pressure. [/INST] Have you had surgeries in the past? [INST] I had surgery to get a few hemorrhoids removed back in two thousand and ten. [/INST]</s>

<s>[INST] <<SYS>> A 47-year-old Latin American man presented to the emergency room after being told to come in for a high potassium value drawn the previous day. He had gone to an outside clinic the day prior to presentation complaining of weakness and fatigue. Labs drawn there revealed a potassium of 7.0 and he was told to come here for further evaluation. At time of his assessment in the emergency room, he noted general malaise and fatigue for eight months. Over this same time period he had subjective fevers and chills, night sweats, and a twenty-pound weight loss. He described anorexia with occasional nausea and vomiting of non-bilious material along with a feeling of light-headedness that occurred shortly after standing from a sitting or lying position. He denied a productive cough but did note chronic left sided upper back pain located in the ribs that was worse with cough and better with massage. He denied orthopnea or paroxysmal nocturnal dyspnea but did become dyspneic after walking 2-3 blocks where before he had been able to jog 2-3 miles. He also noted that over the past year his left testicle had been getting progressively more swollen and painful. He had been seen for this at the onset of symptoms and given a course of antibiotics without improvement. Over the last several months there had been chronic drainage of yellowish material from this testicle. He denied trauma to this area. He denied diarrhea or constipation, changes in his urinary habits, rashes or skin changes, arthritis, arthralgias, abdominal pain, headache or visual changes. <</SYS>> Hello [/INST] I will ask some simple questions, okay? [INST] Hm [/INST] How old are you and how would you define yourself in terms of ethnicity? [INST] Well, I am forty seven and would proudly call myself as Latin American. [/INST] Great. What brings you to the emergency room? [INST] I had a blood test before and then it came out to be high potassium. I also went to a regular clinic the other day as I was feeling very weak and extremely tired. [/INST] Okay. [INST] My potassium came out to be seven and it was highlighted in red. That really scared me, so I wanted to know everything what's going on inside me. I told the emergency doctors too that all these weakness and tiredness is going on for more than half a year. [/INST] Did you noticed any other symptoms other than weakness? [INST] Yes, there was the fever and chills. I was sweating a lot in the nights, and I also had weight loss of around twenty pounds. During that time, I sometimes have nausea and was throwing up a lot. I was not eating. I always felt dizzy every time I tried to stand. [/INST] Did you have wet cough? [INST] No, not wet cough but I did notice back pain gets intense on the upper side whenever I coughed, like in my ribs. I normally massage that area and it gets better. [/INST] Any shortness of breath? [INST] Nope. [/INST] How about while sleeping or doing something else? [INST] Not while sleeping, but I did notice that if I'm walking for two to three blocks then I get out of breath easily. Previously it was not like this. I used to jog for two to three miles without even a single breath loss. [/INST] [INST] I noticed one more thing. I feel like my balls on one side are getting big. [/INST] Which side left or right? [INST] I think its left. [/INST] For how long? [INST] I guess over the past year. I did see someone when all of this started, and he put me on some antibiotics, but nothing changed. For last few months there is yellow fluid coming out of it too. [/INST] Did you ever get any type of injury in the area? [INST] No. [/INST] What about your bowel movements? [INST] Nope everything is as usual. [/INST] Any change in urinary habits? [INST] Nope. [/INST] Any changes in your skin? Any rash? Any kind of eyesight issue? [INST] Nope, no changes. [/INST] What about pain? Like headache or any joint pain? [INST] Nope, no pain anywhere. [/INST]</s>

<s>[INST] <<SYS>> Include dyslipidemia and hypertension. <</SYS>> Hello [/INST] Any known past medical history? [INST] I have high blood pressure. [/INST] Anything else? [INST] Yeah, I remember I also had higher number of fat in my blood. [/INST]</s>

<s>[INST] <<SYS>> Significant for occasional tiredness. This is intermittent and currently not severe. She is concerned about the possibly of glucose abnormalities such diabetes. We will check a glucose, lipid profile and a Hemoccult test also and a mammogram. Her review of systems is otherwise negative. <</SYS>> Hello [/INST] How're you doing? [INST] Good for the most part. I'm still pretty tired most days, but I'm trying to stay more active. I'm wondering if it has to do with my sugar levels? [/INST] Hm let's see. I'd like to check your glucose and lipid panels and get you back in here again. [INST] And oh I've noticed some blood in my stool. I'm not sure if it's related. [/INST] How long has that been going on? [INST] Maybe a week or so? [/INST] Are you having any other symptoms? Black or tarry stool? Nausea, vomiting, diarrhea? Lightheadedness? [INST] No, none of that. [/INST] I'd like to order a hemoccult then. It's going to check to see if you're still having blood in your stool. [INST] Can I do this at the blood work place? [/INST] Yes, they'll be able to help you and answer any additional questions you may have. [INST] Okay. I'll try to go in tomorrow. [/INST] Remember you need to fast for the lipid panel, so I'd recommend going in early tomorrow morning before eating breakfast. [INST] Okay, got it. [/INST] And before I send you on your way, have you been able to schedule your yearly mammogram? [INST] Oh shoot. I still need to do that. I'll call them tomorrow. [/INST]</s>