17204 lines (16948 with data), 125.9 kB

Patient O
presents O
with O
glaucoma O
, O
characterized O
by O
a O
definitive O
diagnosis O
of O
pigmentary O
glaucoma O
. O
Intraocular O
pressure O
measures O
at O
15 O
mmHg O
, O
while O
the O
visual O
field O
remains O
normal O
. O
Visual O
acuity O
is O
recorded O
as O
20 O
50 O
. O
The O
patient O
has O
not B-NEGATION
undergone O
prior O
cataract O
surgery O
, O
but O
has O
had O
LASIK O
surgery O
. O
Additionally O
, O
comorbid O
ocular O
diseases O
include O
macular O
degeneration O
. O

Patient O
has O
been O
diagnosed O
with O
primary O
open O
angle O
glaucoma O
. O
The O
patient O
's O
intraocular O
pressure O
is O
a O
concern O
and O
needs O
monitoring O
. O
There O
is O
moderate O
damage O
observed O
in O
the O
patient O
's O
visual O
field O
. O
The O
visual O
acuity O
is O
recorded O
at O
0 O
. O
3 O
. O
The O
patient O
has O
not B-NEGATION
undergone O
prior O
cataract O
surgery O
or O
LASIK O
surgery O
. O
The O
presence O
of O
corneal O
edema O
, O
along O
with O
glaucoma O
, O
suggests O
comorbid O
ocular O
diseases O
. O
The O
definitive O
diagnosis O
is O
primary O
open O
angle O
glaucoma O
, O
and O
the O
patient O
's O
ocular O
health O
requires O
close O
attention O
due O
to O
the O
combination O
of O
factors O
mentioned O
. O

The O
patient O
has O
been O
diagnosed O
with O
glaucoma O
, O
specifically O
primary O
open O
angle O
glaucoma O
POAG O
. O
Their O
intraocular O
pressure O
measures O
at O
48 O
mmHg O
, O
indicating O
elevated O
pressure O
within O
the O
eye O
. O
The O
patient O
exhibits O
advanced O
glaucomatous O
field O
damage O
in O
their O
visual O
field O
, O
and O
their O
visual O
acuity O
is O
recorded O
at O
20 O
150 O
. O
Notably O
, O
the O
patient O
has O
undergone O
prior O
cataract O
surgery O
. O
However O
, O
they O
have O
not B-NEGATION
had O
LASIK O
surgery O
. O
In O
addition O
to O
glaucoma O
, O
the O
patient O
also O
presents O
with O
comorbid O
ocular O
diseases O
, O
including O
diabetic O
retinopathy O
. O

Patient O
presents O
with O
uveitic O
glaucoma O
as O
the O
definitive O
diagnosis O
. O
Intraocular O
pressure O
measures O
at O
28 O
mmHg O
. O
Visual O
field O
assessment O
indicates O
early O
field O
damage O
. O
Visual O
acuity O
is O
measured O
at O
20 O
30 O
. O
No B-NEGATION
prior O
history O
of O
cataract O
surgery O
or O
LASIK O
surgery O
. O
Notably O
, O
patient O
also O
presents O
with O
comorbid O
ocular O
disease O
, O
specifically O
macular O
edema O
. O

The O
individual O
, O
aged O
39 O
, O
has O
been O
definitively O
diagnosed O
with O
anxiety O
. O
They O
are O
proficient O
in O
English O
and O
have O
reported O
experiencing O
significant O
anxiety O
symptoms O
. O
Their O
SSASI O
score O
is O
6 O
, O
HAM O
A O
score O
is O
20 O
, O
PHQ O
9 O
score O
is O
7 O
, O
and O
HAM O
D O
score O
is O
23 O
, O
indicating O
varying O
levels O
of O
anxiety O
and O
depressive O
symptoms O
. O
They O
have O
also O
expressed O
experiencing O
suicidal O
ideation O
. O
There O
is O
no B-NEGATION
history O
of O
dementia O
. O
Additional O
assessment O
using O
the O
GAD O
7 O
and O
Beck O
Depression O
Inventory O
is O
ongoing O
to O
further O
understand O
their O
condition O
. O

The O
patient O
presents O
with O
neovascular O
glaucoma O
, O
as O
evidenced O
by O
an O
intraocular O
pressure O
of O
22 O
mmHg O
. O
Visual O
field O
assessment O
indicates O
normal O
results O
, O
and O
the O
visual O
acuity O
is O
measured O
at O
0 O
. O
2 O
. O
The O
patient O
has O
undergone O
prior O
cataract O
surgery O
but O
has O
not B-NEGATION
had O
LASIK O
surgery O
. O
There O
is O
no B-NEGATION
information O
available O
about O
comorbid O
ocular O
diseases O
. O

The O
patient O
is O
25 O
years O
old O
and O
proficient O
in O
English O
and O
Swedish O
. O
Several O
anxiety O
assessment O
tools O
have O
been O
used O
to O
evaluate O
the O
patient O
's O
condition O
. O
The O
SSASI O
, O
HAM O
A O
, O
PHQ O
9 O
, O
HAM O
D O
, O
GAD O
7 O
, O
and O
Beck O
Depression O
Inventory O
scores O
indicate O
varying O
levels O
of O
anxiety O
and O
depression O
. O
The O
patient O
reports O
experiencing O
suicidal O
ideation O
. O
There O
is O
no B-NEGATION
indication O
of O
dementia O
. O

The O
patient O
, O
a O
12 O
year O
old O
individual O
proficient O
in O
English O
and O
Spanish O
, O
is O
experiencing O
symptoms O
of O
anxiety O
. O
While O
a O
definitive O
diagnosis O
has O
not O
been O
made O
, O
the O
patient O
's O
SSASI O
score O
is O
12 O
, O
HAM O
A O
score O
is O
25 O
, O
HAM O
D O
score O
is O
14 O
, O
and O
there O
are O
no B-NEGATION
indications O
of O
suicidal O
ideation O
or O
dementia O
. O
The O
patient O
's O
condition O
is O
being O
assessed O
using O
the O
PHQ O
9 O
, O
GAD O
7 O
, O
and O
Beck O
Depression O
Inventory O
scales O
. O

The O
individual O
, O
an O
adult O
proficient O
in O
English O
and O
Dutch O
, O
has O
received O
a O
definitive O
diagnosis O
of O
anxiety O
. O
Assessments O
reveal O
elevated O
scores O
on O
various O
scales O
, O
including O
HAM O
A O
18 O
, O
PHQ O
9 O
22 O
, O
HAM O
D O
24 O
, O
and O
GAD O
7 O
12 O
. O
Suicidal O
ideation O
is O
present O
, O
while O
dementia O
is O
not B-NEGATION
. O

The O
individual O
under O
consideration O
is O
a O
58 O
year O
old O
person O
proficient O
in O
English O
and O
Turkish O
languages O
. O
A O
definitive O
diagnosis O
of O
anxiety O
has O
been O
established O
. O
Assessments O
have O
indicated O
a O
SSASI O
score O
, O
a O
HAM O
A O
score O
of O
12 O
, O
a O
HAM O
D O
score O
of O
19 O
, O
a O
GAD O
7 O
score O
of O
9 O
, O
and O
an O
8 O
on O
the O
Beck O
Depression O
Inventory O
. O
No B-NEGATION
presence O
of O
suicidal O
ideation O
has O
been O
observed O
. O
Additionally O
, O
the O
individual O
has O
been O
diagnosed O
with O
dementia O
. O


Patient O
has O
been O
diagnosed O
with O
Chronic O
Obstructive O
Pulmonary O
Disease O
COPD O
in O
stage O
II O
according O
to O
the O
GOLD O
classification O
. O
His O
definitive O
diagnosis O
for O
COPD O
has O
been O
confirmed O
, O
and O
his O
FEV1 O
level O
is O
measured O
at O
50 O
. O
The O
patient O
experienced O
two O
exacerbations O
in O
the O
past O
month O
. O
Notably O
, O
he O
has O
never O
been O
a O
smoker O
. O
Although O
he O
does O
not B-NEGATION
currently O
receive O
any O
COPD O
treatments O
, O
he O
does O
have O
a O
history O
of O
asthma O
as O
a O
lung O
comorbidity O
. O
No B-NEGATION
other O
comorbidities O
are O
present O
. O

The O
patient O
, O
diagnosed O
with O
COPD O
, O
has O
a O
definitive O
diagnosis O
and O
is O
in O
Stage O
IV O
according O
to O
the O
GOLD O
classification O
. O
Their O
FEV1 O
is O
measured O
at O
65 O
, O
indicating O
impaired O
lung O
function O
. O
Over O
the O
past O
12 O
months O
, O
they O
have O
experienced O
8 O
exacerbations O
of O
their O
COPD O
. O
The O
patient O
is O
undergoing O
treatment O
, O
including O
using O
EVB O
and O
participating O
in O
pulmonary O
rehabilitation O
. O
They O
have O
a O
history O
of O
heavy O
smoking O
, O
with O
a O
daily O
consumption O
of O
2 O
packs O
of O
cigarettes O
. O
Alongside O
COPD O
, O
the O
patient O
has O
been O
diagnosed O
with O
lung O
cancer O
, O
making O
it O
a O
comorbid O
condition O
. O
No B-NEGATION
other O
comorbidities O
are O
reported O
in O
the O
medical O
history O
. O

Patient O
has O
a O
confirmed O
diagnosis O
of O
Chronic O
Obstructive O
Pulmonary O
Disease O
COPD O
characterized O
by O
an O
FEV1 O
of O
72 O
, O
placing O
him O
in O
GOLD O
stage O
II O
. O
Notably O
, O
he O
experienced O
his O
first O
exacerbation O
two O
weeks O
ago O
. O
Current O
COPD O
treatments O
include O
the O
administration O
of O
steroids O
. O
Notably O
, O
he O
has O
no B-NEGATION
history O
of O
smoking O
and O
does O
not B-NEGATION
report O
any O
lung O
related O
comorbidities O
. O
However O
, O
he O
does O
have O
a O
history O
of O
glaucoma O
as O
an O
additional O
comorbidity O
. O

The O
individual O
's O
definitive O
diagnosis O
indicates O
COPD O
. O
Their O
FEV1 O
value O
stands O
at O
55 O
, O
categorizing O
them O
within O
the O
early O
stage O
of O
COPD O
according O
to O
the O
GOLD O
classification O
. O
As O
of O
now O
, O
there O
have O
been O
no B-NEGATION
reported O
exacerbations O
. O
Treatment O
for O
COPD O
has O
not B-NEGATION
yet O
been O
initiated O
. O
Furthermore O
, O
there O
is O
no B-NEGATION
history O
of O
smoking O
. O
Additionally O
, O
the O
patient O
does O
not B-NEGATION
have O
any O
reported O
lung O
comorbidities O
or O
other O
comorbidities O
. O

The O
patient O
, O
diagnosed O
with O
breast O
cancer O
, O
has O
undergone O
a O
definitive O
diagnosis O
. O
HER2 O
status O
is O
positive O
, O
while O
information O
about O
hormone O
receptors O
is O
not O
specified O
. O
The O
patient O
has O
not B-NEGATION
received O
prior O
chemotherapy O
or O
radiotherapy O
. O
No B-NEGATION
prior O
mastectomy O
has O
been O
performed O
The O
patient O
's O
performance O
status O
is O
ECOG O
1 O
. O


The O
patient O
's O
breast O
cancer O
is O
at O
stage O
2 O
. O
The O
HER2 O
status O
is O
positive O
, O
while O
hormone O
receptors O
PR O
and O
ER O
are O
negative O
. O
The O
patient O
hasn O
' I-NEGATION
t I-NEGATION
undergone O
prior O
chemotherapy O
, O
but O
has O
received O
prior O
radiotherapy O
. O
Mastectomy O
has O
not B-NEGATION
been O
performed O
previously O
. O
The O
patient O
's O
performance O
status O
is O
Karnofsky O
70 O
. O


The O
patient O
has O
received O
a O
definitive O
diagnosis O
of O
breast O
cancer O
. O
Key O
details O
include O
a O
negative O
HER2 O
status O
and O
hormone O
receptor O
information O
. O
The O
patient O
has O
not B-NEGATION
undergone O
prior O
chemotherapy O
, O
radiotherapy O
, O
or O
mastectomy O
. O
Their O
performance O
status O
is O
ECOG O
1 O
. O


The O
patient O
has O
been O
diagnosed O
with O
COVID O
19 O
. O
The O
definitive O
diagnosis O
was O
confirmed O
through O
PCR O
testing O
. O
The O
patient O
exhibited O
symptoms O
including O
fever O
, O
headache O
, O
and O
body O
pains O
. O
Due O
to O
the O
severity O
of O
the O
condition O
, O
the O
patient O
required O
hospitalization O
and O
ventilation O
support O
. O
At O
the O
time O
of O
assessment O
, O
the O
patient O
's O
oxygen O
saturation O
level O
was O
96 O
. O
The O
patient O
had O
not B-NEGATION
received O
any O
vaccination O
against O
COVID O
19 O
prior O
to O
this O
illness O
. O
Additionally O
, O
the O
patient O
had O
a O
history O
of O
bronchiectasis O
, O
a O
comorbid O
respiratory O
disease O
. O

The O
patient O
has O
received O
a O
definitive O
diagnosis O
of O
COVID O
19 O
through O
a O
PCR O
test O
. O
Their O
reported O
symptoms O
include O
fever O
and O
muscle O
pain O
. O
They O
have O
not B-NEGATION
required O
hospitalization O
or O
ventilation O
for O
their O
condition O
. O
The O
patient O
's O
vaccination O
status O
indicates O
that O
they O
have O
received O
a O
2 O
shot O
COVID O
19 O
vaccine O
series O
along O
with O
a O
booster O
dose O
. O
Their O
oxygen O
saturation O
level O
is O
at O
97 O
. O
There O
are O
no B-NEGATION
comorbid O
respiratory O
diseases O
reported O
in O
their O
medical O
history O
. O

The O
patient O
's O
definitive O
diagnosis O
of O
COVID O
19 O
is O
based O
solely O
on O
a O
positive O
result O
from O
a O
rapid O
test O
. O
Their O
reported O
symptoms O
include O
headache O
and O
fatigue O
. O
They O
have O
not B-NEGATION
required O
hospitalization O
or O
ventilation O
support O
. O
The O
patient O
is O
unvaccinated O
against O
COVID O
19 O
. O
Their O
oxygen O
saturation O
level O
is O
at O
98 O
. O
They O
have O
a O
history O
of O
asthma O
as O
a O
comorbid O
respiratory O
disease O
. O

The O
individual O
under O
consideration O
has O
not B-NEGATION
received O
a O
definitive O
diagnosis O
for O
COVID O
19 O
. O
They O
have O
experienced O
symptoms O
such O
as O
headache O
but O
have O
not B-NEGATION
required O
hospitalization O
or O
ventilation O
. O
Their O
vaccination O
status O
indicates O
that O
they O
are O
unvaccinated O
. O
Information O
regarding O
their O
oxygen O
saturation O
is O
not O
provided O
. O
Additionally O
, O
there O
are O
no B-NEGATION
reported O
comorbid O
respiratory O
diseases O
in O
this O
case O
. O

The O
patient O
has O
been O
diagnosed O
definitively O
with O
rheumatoid O
arthritis O
and O
is O
undergoing O
active O
treatment O
with O
methotrexate O
, O
with O
no B-NEGATION
prior O
DMARD O
treatment O
. O
They O
are O
also O
taking O
ibuprofen O
for O
their O
condition O
. O
The O
patient O
has O
3 O
swollen O
joints O
and O
does O
not B-NEGATION
have O
tuberculosis O
. O
Comorbidities O
include O
hypertension O
. O

The O
patient O
's O
definitive O
diagnosis O
is O
rheumatoid O
arthritis O
. O
Currently O
, O
there O
is O
no B-NEGATION
active O
DMARD O
treatment O
, O
but O
there O
was O
prior O
treatment O
with O
hydroxychloroquine O
. O
Prednisone O
is O
being O
used O
along O
with O
other O
RA O
medications O
. O
The O
patient O
has O
3 O
swollen O
and O
2 O
tender O
joints O
. O
There O
is O
no B-NEGATION
history O
of O
tuberculosis O
. O
The O
DAS O
28 O
CRP O
score O
is O
4 O
. O
Comorbidities O
are O
absent B-NEGATION
. O

The O
patient O
has O
a O
definitive O
diagnosis O
of O
rheumatoid O
arthritis O
. O
They O
are O
currently O
undergoing O
active O
anti O
TNF O
therapy O
as O
their O
DMARD O
treatment O
. O
Prior O
to O
this O
, O
they O
were O
treated O
with O
methotrexate O
. O
Naproxen O
is O
being O
used O
as O
another O
medication O
for O
their O
rheumatoid O
arthritis O
. O
The O
patient O
has O
5 O
swollen O
joints O
and O
2 O
tender O
joints O
. O
They O
have O
a O
history O
of O
past O
tuberculosis O
. O
There O
are O
no B-NEGATION
comorbidities O
reported O
for O
the O
patient O
. O

The O
patient O
has O
a O
definitive O
diagnosis O
of O
rheumatoid O
arthritis O
and O
is O
currently O
undergoing O
active O
treatment O
with O
hydroxychloroquine O
, O
without B-NEGATION
prior O
DMARD O
treatment O
. O
Additionally O
, O
the O
patient O
is O
taking O
ibuprofen O
for O
their O
condition O
. O
They O
are O
experiencing O
symptoms O
in O
6 O
tender O
joints O
and O
have O
a O
DAS O
28 O
CRP O
score O
of O
5 O
. O
5 O
. O
The O
patient O
has O
comorbid O
diabetes O
but O
no B-NEGATION
history O
of O
tuberculosis O
. O

Patient O
has O
a O
definitive O
diagnosis O
of O
rheumatoid O
arthritis O
. O
They O
are O
undergoing O
active O
anti O
TNF O
therapy O
as O
their O
DMARD O
treatment O
, O
with O
no B-NEGATION
prior O
DMARD O
treatment O
or O
other O
RA O
medications O
. O
The O
patient O
does O
not B-NEGATION
have O
tuberculosis O
and O
reports O
no B-NEGATION
comorbidities O
. O

The O
patient O
's O
definitive O
diagnosis O
is O
sickle O
cell O
anemia O
SS O
genotype O
. O
A O
blood O
transfusion O
was O
administered O
one O
week O
ago O
. O
The O
hemoglobin O
level O
is O
currently O
5 O
. O
8 O
g O
dL O
. O
The O
patient O
's O
last O
vaso O
occlusive O
crisis O
occurred O
two O
months O
ago O
. O
There O
is O
no B-NEGATION
history O
of O
stroke O
. O

The O
individual O
has O
been O
diagnosed O
with O
sickle O
cell O
anemia O
SC O
, O
a O
hereditary O
blood O
disorder O
. O
Their O
hemoglobin O
level O
is O
8 O
. O
7 O
g O
dl O
. O
They O
have O
experienced O
five O
vaso O
occlusive O
crises O
in O
the O
last O
12 O
months O
. O
Additionally O
, O
the O
patient O
has O
a O
history O
of O
stroke O
that O
occurred O
12 O
years O
ago O
. O
Blood O
transfusion O
has O
never B-NEGATION
been O
administered O
to O
this O
patient O
. O

The O
patient O
has O
been O
diagnosed O
with O
sickle O
cell O
anemia O
SB O
. O
Three O
weeks O
ago O
, O
the O
patient O
received O
a O
blood O
transfusion O
. O
Their O
current O
hemoglobin O
level O
is O
10 O
. O
5 O
. O
The O
patient O
's O
last O
vaso O
occlusive O
crisis O
occurred O
six O
months O
ago O
, O
and O
they O
have O
never B-NEGATION
had O
a O
history O
of O
stroke O
. O


This O
patient O
, O
diagnosed O
with O
sickle O
cell O
anemia O
, O
has O
a O
hemoglobin O
level O
of O
7 O
. O
5 O
g O
dL O
. O
They O
experienced O
a O
vaso O
occlusive O
crisis O
two O
weeks O
ago O
but O
have O
no B-NEGATION
history O
of O
stroke O
. O
Blood O
transfusions O
have O
not B-NEGATION
been O
required O
in O
their O
medical O
history O
. O

The O
patient O
, O
diagnosed O
with O
type O
2 O
diabetes O
, O
has O
a O
confirmed O
diagnosis O
with O
a O
definitive O
assessment O
. O
Their O
HbA1c O
level O
stands O
at O
7 O
. O
2 O
, O
indicating O
their O
blood O
glucose O
control O
over O
recent O
months O
. O
Fasting O
glucose O
measures O
138 O
, O
while O
their O
BMI O
is O
45 O
, O
signifying O
their O
body O
mass O
index O
. O
The O
patient O
is O
not B-NEGATION
on O
insulin O
therapy O
nor B-NEGATION
taking O
metformin O
or O
other O
anti O
diabetic O
drugs O
. O
There O
are O
no B-NEGATION
specific O
diet O
restrictions O
in O
place O
. O
Limited O
exercise O
is O
possible O
due O
to O
being O
confined O
to O
a O
wheelchair O
. O
There O
is O
no B-NEGATION
history O
of O
ketoacidosis O
. O
The O
patient O
has O
comorbidities O
including O
lung O
cancer O
, O
hypertension O
, O
and O
dementia O
. O
Recent O
medical O
events O
include O
a O
myocardial O
infarction O
six O
months O
ago O
. O

The O
individual O
under O
consideration O
exhibits O
characteristics O
indicative O
of O
type O
2 O
diabetes O
. O
The O
diagnosis O
is O
definitive O
, O
with O
a O
recorded O
HbA1c O
level O
of O
4 O
. O
5 O
and O
a O
glucose O
level O
of O
95 O
. O
The O
patient O
's O
BMI O
is O
28 O
, O
and O
they O
do O
not B-NEGATION
require O
insulin O
treatment O
. O
Instead O
, O
they O
are O
prescribed O
5 O
ml O
of O
metformin O
and O
a O
thiazolidinedione O
as O
other O
anti O
diabetic O
medications O
. O
The O
patient O
adheres O
to O
a O
low O
calorie O
diet O
and O
engages O
in O
a O
weekly O
regimen O
of O
walking O
2 O
miles O
. O
A O
history O
of O
ketoacidosis O
is O
present O
, O
along O
with O
comorbidities O
encompassing O
hypertension O
and O
a O
thyroid O
disorder O
. O
Notably O
, O
the O
patient O
has O
not B-NEGATION
experienced O
any O
instances O
of O
hospitalization O
. O

The O
patient O
is O
diagnosed O
with O
type O
2 O
diabetes O
. O
The O
diagnosis O
is O
definitive O
, O
indicated O
by O
an O
HbA1c O
level O
of O
6 O
and O
fasting O
blood O
sugar O
of O
115 O
. O
The O
patient O
has O
a O
BMI O
of O
35 O
. O
Insulin O
is O
being O
used O
, O
along O
with O
8 O
. O
5 O
mL O
of O
metformin O
and O
a O
sulfonylurea O
for O
additional O
anti O
diabetic O
treatment O
. O
Dietary O
restrictions O
involve O
periodic O
fasting O
, O
and O
the O
patient O
engages O
in O
500 O
meters O
of O
daily O
walking O
for O
exercise O
. O
There O
is O
no B-NEGATION
history O
of O
ketoacidosis O
, O
and O
comorbidities O
are O
absent B-NEGATION
, O
except O
for O
a O
stroke O
event O
in O
the O
previous O
year O
. O

The O
patient O
, O
diagnosed O
with O
type O
2 O
diabetes O
, O
has O
received O
a O
definitive O
diagnosis O
. O
Their O
HbA1c O
level O
is O
5 O
. O
5 O
, O
with O
a O
glucose O
level O
of O
100 O
. O
The O
patient O
's O
BMI O
is O
32 O
. O
They O
are O
not B-NEGATION
using O
insulin O
, O
but O
they O
are O
taking O
5 O
mL O
of O
metformin O
. O
No B-NEGATION
other O
anti O
diabetic O
drugs O
are O
being O
used O
. O
The O
patient O
follows O
a O
keto O
diet O
and O
engages O
in O
regular O
exercise O
by O
jogging O
2 O
miles O
per O
day O
. O
The O
patient O
has O
a O
history O
of O
ketoacidosis O
and O
hypertension O
. O
They O
have O
never O
been O
hospitalized O
due O
to O
their O
condition O
. O

The O
patient O
, O
diagnosed O
with O
type O
2 O
diabetes O
HbA1c O
6 O
. O
3 O
, O
fasting O
blood O
sugar O
115 O
, O
has O
a O
BMI O
of O
40 O
. O
Insulin O
is O
not B-NEGATION
currently O
prescribed O
, O
but O
they O
are O
taking O
8 O
. O
5 O
mL O
of O
metformin O
. O
No B-NEGATION
other O
anti O
diabetic O
drugs O
are O
being O
used O
. O
The O
patient O
follows O
a O
low O
calorie O
diet O
and O
does O
not B-NEGATION
engage O
in O
regular O
exercise O
. O
There O
's O
no B-NEGATION
history O
of O
ketoacidosis O
, O
but O
they O
do O
have O
chronic O
kidney O
disease O
as O
a O
comorbidity O
. O
Hospitalization O
due O
to O
diabetes O
has O
not B-NEGATION
occurred O
. O

An O
elderly O
female O
with O
past O
medical O
history O
of O
hypertension O
, O
severe O
aortic O
stenosis O
, O
hyperlipidemia O
, O
and O
right O
hip O
arthroplasty O
. O
Presents O
after O
feeling O
a O
snap O
of O
her O
right O
leg O
and O
falling O
to O
the O
ground O
. O
No B-NEGATION
head O
trauma O
or O
loss O
of O
consciousness O
. O


A O
75F O
with O
a O
PMHx O
significant O
for O
severe O
PVD O
, O
CAD O
, O
DM O
, O
and O
CKD O
presented O
after O
being O
found O
down O
unresponsive O
at O
home O
. O
She O
was O
found O
to O
be O
hypoglycemic O
to O
29 O
with O
hypotension O
and O
bradycardia O
. O
Her O
hypotension O
and O
confusion O
improved O
with O
hydration O
. O
She O
had O
a O
positive O
UA O
which O
eventually O
grew O
klebsiella O
. O
She O
had O
temp O
96 O
. O
3 O
, O
respiratory O
rate O
22 O
, O
BP O
102 O
26 O
, O
a O
leukocytosis O
to O
18 O
and O
a O
creatinine O
of O
6 O
baseline O
2 O
. O
Pt O
has O
blood O
cultures O
positive O
for O
group O
A O
streptococcus O
. O
On O
the O
day O
of O
transfer O
her O
blood O
pressure O
dropped O
to O
the O
60s O
. O
She O
was O
anuric O
throughout O
the O
day O
. O
She O
received O
80mg O
IV O
solumedrol O
this O
morning O
in O
the O
setting O
of O
low O
BPs O
and O
rare O
eos O
in O
urine O
. O
On O
arrival O
to O
the O
MICU O
pt O
was O
awake O
but O
drowsy O
. O
On O
ROS O
, O
pt O
denies B-NEGATION
pain O
, O
lightheadedness O
, O
headache O
, O
neck O
pain O
, O
sore O
throat O
, O
recent O
illness O
or O
sick O
contacts O
, O
cough O
, O
shortness O
of O
breath O
, O
chest O
discomfort O
, O
heartburn O
, O
abd O
pain O
, O
n O
v O
, O
diarrhea O
, O
constipation O
, O
dysuria O
. O
Is O
a O
poor O
historian O
regarding O
how O
long O
she O
has O
had O
a O
rash O
on O
her O
legs O
. O

An O
87 O
yo O
woman O
with O
h O
o O
osteoporosis O
, O
multiple O
recent O
falls O
, O
CAD O
, O
who O
presents O
from O
nursing O
home O
with O
C2 O
fracture O
. O
The O
patient O
was O
in O
her O
usual O
state O
of O
health O
at O
her O
nursing O
home O
until O
yesterday O
morning O
when O
she O
sustained O
a O
fall O
when O
trying O
to O
get O
up O
to O
go O
to O
the O
bathroom O
. O
The O
fall O
was O
not B-NEGATION
witnessed O
, O
but O
the O
patient O
reportedly O
did O
not B-NEGATION
lose O
consciousness O
. O
The O
patient O
complained O
of O
neck O
and O
rib O
pain O
. O
She O
was O
taken O
to O
OSH O
, O
where O
she O
was O
found O
to O
have O
a O
comminuted O
fracture O
of O
C2 O
. O
In O
the O
ED O
, O
the O
patient O
's O
VS O
were O
T O
99 O
. O
1 O
, O
BP O
106 O
42 O
, O
P O
101 O
, O
R O
24 O
. O
She O
had O
an O
ECG O
which O
showed O
sinus O
tachycardia O
and O
ST O
depressions O
in O
V3 O
and O
V4 O
. O
CT O
head O
was O
negative B-NEGATION
for O
ICH O
. O


A O
94 O
year O
old O
female O
with O
hx O
recent O
PE O
DVT O
, O
atrial O
fibrillation O
, O
CAD O
presents O
with O
fever O
and O
abdominal O
pain O
. O
Earlier O
, O
she O
presented O
with O
back O
pain O
and O
shortness O
of O
breath O
. O
She O
was O
found O
to O
have O
bilateral O
PE O
's O
and O
new O
afib O
and O
started O
on O
coumadin O
. O
Her O
HCT O
dropped O
slightly O
, O
requiring O
blood O
transfusion O
, O
with O
guaic O
positive O
stools O
. O
She O
was O
discharged O
and O
returned O
with O
abdominal O
cramping O
and O
black O
stools O
. O
EGD O
showed O
a O
small O
gastric O
and O
duodenal O
ulcer O
healing O
, O
esophageal O
stricture O
, O
no B-NEGATION
active O
bleeding O
. O
She O
also O
had O
an O
abdominal O
CT O
demonstrating O
a O
distended O
gallbladder O
with O
gallstones O
and O
biliary O
obstruction O
with O
several O
CBD O
stones O
. O

This O
is O
a O
41 O
year O
old O
male O
patient O
with O
medical O
history O
of O
alcohol O
abuse O
, O
cholelithiasis O
, O
hypertension O
, O
obesity O
who O
presented O
to O
his O
local O
hospital O
with O
hematemasis O
. O
On O
Friday O
evening O
he O
had O
several O
episodes O
of O
vomiting O
of O
bright O
and O
dark O
red O
material O
. O
In O
the O
emergency O
department O
, O
initial O
vs O
were O
T O
98 O
. O
6 O
P66 O
BP145 O
89 O
R16 O
O2 O
sat O
98 O
RA O
. O
He O
was O
started O
on O
a O
protonix O
gtt O
and O
octreotide O
gtt O
given O
his O
elevated O
liver O
function O
tests O
. O
Lab O
tests O
show O
elevated O
lipase O
, O
pancytopenia O
and O
coagulopathy O
. O
He O
had O
a O
right O
upper O
abdominal O
quadrant O
ultrasound O
which O
demonstrated O
gallstones O
and O
sludge O
and O
ascites O
. O
As O
such O
given O
new O
ascites O
and O
abdominal O
pain O
he O
was O
given O
levofloxacin O
750mg O
IV O
and O
flagyl O
500mg O
IV O
reportedly O
for O
spontaneous O
bacterial O
peritonitis O
prophylaxis O
. O
On O
the O
floor O
, O
he O
reports O
that O
he O
had O
two O
episodes O
of O
vomiting O
of O
dark O
red O
emesis O
. O
Per O
his O
nurse O
it O
was O
about O
75ml O
and O
was O
gastrocult O
positive O
. O
He O
has O
right O
upper O
abdominal O
quadrant O
pain O
radiating O
to O
his O
back O
. O
He O
also O
reports O
slow O
increase O
in O
abdominal O
girth O
with O
more O
acute O
distention O
and O
lower O
extremity O
swelling O
over O
the O
two O
days O
prior O
to O
admission O
. O
The O
patient O
denies B-NEGATION
fever O
, O
chills O
, O
night O
sweats O
, O
headache O
, O
sinus O
tenderness O
, O
rhinorrhea O
or O
congestion O
. O
Denied B-NEGATION
cough O
, O
shortness O
of O
breath O
. O
He O
also O
denied B-NEGATION
chest O
pain O
or O
tightness O
. O



A O
55y O
o O
F O
with O
sarcoidosis O
, O
COPD O
, O
idiopathic O
cardiomyopathy O
with O
EF O
40 O
and O
diastolic O
dysfunction O
, O
varices O
s O
p O
TIPS O
and O
hypothyroidism O
presenting O
today O
with O
confusion O
. O
She O
was O
brought O
to O
the O
ED O
by O
her O
husband O
for O
evaluation O
after O
he O
noted O
worsening O
asterixis O
. O
While O
in O
the O
waiting O
room O
the O
pt O
became O
more O
combative O
and O
then O
unresponsive O
. O
In O
the O
ED O
VS O
Temp O
97 O
. O
9F O
, O
HR O
115 O
, O
BP O
122 O
80 O
, O
R O
18 O
, O
O2 O
sat O
98 O
2L O
NC O
. O
She O
was O
unresponsive O
but O
able O
to O
protect O
her O
airway O
and O
so O
not O
intubated O
. O
She O
vomited O
x1 O
and O
received O
Zofran O
as O
well O
as O
1 O
. O
5 O
L O
NS O
. O
Labs O
were O
significant O
for O
K O
5 O
. O
5 O
, O
BUN O
46 O
, O
Cr O
2 O
. O
2 O
up O
from O
baseline O
of O
0 O
. O
8 O
, O
and O
ammonia O
of O
280 O
. O
Stool O
was O
Guaiac O
negative O
. O
A O
urinalysis O
and O
CXR O
were O
done O
and O
are O
pending O
, O
and O
a O
FAST O
revealed O
hepatosplenomegaly O
but O
no B-NEGATION
intraperitoneal O
fluid O
. O



A O
43 O
year O
old O
woman O
with O
history O
of O
transverse O
myelitis O
leading O
to O
paraplegia O
, O
depression O
, O
frequent O
pressure O
ulcers O
, O
presenting O
with O
chills O
and O
reporting O
she O
felt O
" O
as O
if O
dying O
" O
. O
Upon O
presentation O
, O
she O
denied B-NEGATION
any O
shortness O
of O
breath O
, O
nausea O
, O
vomiting O
, O
but O
did O
report O
diarrhea O
with O
two O
loose O
bowel O
movements O
per O
day O
. O
Patient O
reported O
that O
she O
had O
a O
fallout O
with O
her O
VNA O
and O
has O
not O
had O
any O
professional O
wound O
care O
. O
Patient O
is O
agitated O
, O
with O
rigors O
, O
complaining O
of O
feeling O
cold O
and O
back O
pain O
. O
Patient O
rolled O
and O
found O
to O
have O
a O
stage O
IV O
decubitus O
ulcer O
on O
coccyx O
and O
buttocks O
, O
heels O
. O
Admission O
labs O
significant O
for O
thrombocytosis O
, O
elevated O
lactate O
, O
and O
prolonged O
PT O
. O


A O
67 O
y O
. O
o O
. O
M O
with O
end O
stage O
COPD O
on O
home O
oxygen O
, O
tracheobronchomalacia O
s O
p O
Y O
stent O
, O
h O
o O
RUL O
resection O
for O
squamous O
cell O
carcinoma O
with O
Cyberknife O
treatment O
. O
Patient O
had O
Y O
stent O
placed O
complicated O
by O
cough O
and O
copious O
secretions O
requiring O
multiple O
therapeutic O
aspirations O
. O
Last O
bronchoscopy O
was O
at O
OSH O
, O
where O
patient O
had O
copious O
secretions O
that O
were O
aspirated O
. O
Pt O
reports O
compliance O
with O
Mucomyst O
nebs O
and O
Mucinex O
. O
Patient O
reports O
decreaed O
appetitie O
, O
50 O
lb O
wt O
loss O
in O
6 O
months O
. O
Decreased O
activity O
tolerance O
. O
Smokes O
5 O
cig O
day O
. O
PET O
scan O
revealed O
FDG O
avid O
soft O
tissue O
mass O
adjacent O
to O
lung O
resection O
site O
with O
some O
FDG O
avid O
nodes O
concerning O
for O
recurrence O
. O
On O
arrival O
, O
vitals O
were O
T98 O
. O
6 O
HR86 O
BP106 O
78 O
O289 O
. O
Pt O
denied B-NEGATION
chest O
pain O
, O
palpitations O
, O
trauma O
, O
F O
C O
, O
N O
V O
D O
. O
Pt O
. O
presents O
with O
worsening O
SOB O
with O
R O
shoulder O
pain O
and O
weakness O
. O


This O
is O
a O
76 O
year O
old O
female O
with O
personal O
history O
of O
diastolic O
congestive O
heart O
failure O
, O
atrial O
fibrillation O
on O
Coumadin O
, O
presenting O
with O
low O
hematocrit O
and O
shortness O
of O
breath O
. O
Her O
hematocrit O
dropped O
from O
28 O
to O
16 O
. O
9 O
over O
the O
past O
6 O
weeks O
with O
progressive O
shortness O
of O
breath O
, O
worse O
with O
exertion O
over O
the O
past O
two O
weeks O
. O
She O
reports O
orthopnea O
. O
She O
denies B-NEGATION
fevers O
, O
chills O
, O
chest O
pain O
, O
palpitaitons O
, O
cough O
, O
abdominal O
pain O
, O
constipation O
or O
diahrrea O
, O
melena O
, O
blood O
in O
her O
stool O
, O
dysuria O
or O
rash O
. O
Her O
electrocardiogram O
present O
no B-NEGATION
significant O
change O
from O
previous O
. O
Her O
Guaiac O
was O
reported O
as O
being O
positive O
. O


78 O
year O
old O
female O
with O
PMHx O
HTN O
, O
dCHF O
, O
Diabetes O
, O
CKD O
, O
Atrial O
fibrillation O
on O
coumadin O
, O
ischemic O
stroke O
, O
admitted O
after O
presenting O
to O
cardiology O
clinic O
today O
with O
confusion O
and O
Somnolence O
. O
Of O
note O
, O
she O
was O
recently O
discharged O
after O
presyncope O
falls O
. O
At O
that O
time O
, O
lasix O
was O
stopped O
and O
atenolol O
was O
switched O
to O
metoprolol O
as O
there O
was O
concern O
that O
blunting O
of O
tachycardia O
could O
be O
contributing O
to O
falls O
. O
She O
was O
discharged O
to O
rehab O
previously O
living O
at O
home O
. O
Per O
report O
from O
the O
ER O
, O
patient O
has O
had O
confusion O
at O
home O
for O
3 O
weeks O
, O
though O
no B-NEGATION
family O
accompanies O
her O
to O
corroborate O
this O
story O
, O
and O
patient O
denies B-NEGATION
this O
. O
The O
patient O
is O
not B-NEGATION
sure O
why O
she O
is O
in O
the O
hospital O
. O
She O
saw O
her O
cardiologist O
today O
, O
who O
referred O
her O
to O
the O
ER O
after O
she O
appeared O
to O
be O
dehydrated O
, O
somnolent O
, O
and O
confused O
. O
The O
patient O
denies B-NEGATION
headache O
, O
blurry O
vision O
, O
numbness O
, O
tingling O
or O
weakness O
. O
No B-NEGATION
CP O
. O
SOB O
, O
worsening O
DOE O
. O
No B-NEGATION
nausea O
, O
vomiting O
. O



A O
63 O
yo O
man O
with O
h O
o O
biphenotypic O
ALL O
, O
now O
Day O
32 O
from O
allogeneic O
SCT O
, O
who O
presents O
with O
one O
week O
of O
worsening O
SOB O
and O
two O
days O
of O
a O
clear O
productive O
cough O
. O
The O
patient O
states O
his O
SOB O
occured O
when O
lying O
flat O
, O
but O
not O
with O
activity O
. O
Also O
admitted O
to O
chest O
pressure O
which O
would O
come O
and O
go O
in O
his O
left O
chest O
no O
related O
to O
the O
SOB O
. O
Sleeps O
with O
3 O
pillows O
no O
change O
from O
baseline O
, O
denies B-NEGATION
PND O
; O
admits O
to O
a O
slight O
increase O
in O
lower O
extremity O
edema O
. O
Admits O
to O
low O
grade O
fevers O
to O
the O
99 O
's O
and O
crampy O
abdominal O
pain O
. O
Denies B-NEGATION
chills O
, O
night O
sweats O
, O
vomiting O
, O
or O
diarrhea O
. O
Patient O
also O
has O
a O
history O
of O
CMV O
infection O
, O
aspergillus O
and O
Leggionare O
's O
disease O
and O
is O
on O
posaconazole O
. O
His O
CXR O
showed O
an O
opacification O
of O
the O
left O
basilar O
lobe O
and O
also O
right O
upper O
lobe O
concerning O
for O
pneumonia O
as O
well O
as O
a O
small O
loculated O
right O
pleural O
effusion O
. O

85M O
dementia O
, O
colon O
cancer O
and O
recent O
colectomy O
with O
primary O
reanastomosis O
p O
w O
melena O
. O
HCT O
30 O
to O
23 O
but O
hemodynamically O
stable O
. O
NGL O
negative O
. O
Exam O
notable O
for O
Tm O
99 O
BP O
128 O
50 O
HR O
70 O
RR O
16 O
with O
sat O
100 O
on O
RA O
. O
WD O
man O
, O
NAD O
. O
Chest O
clear O
, O
JVP O
8cm O
. O
RR O
s1s2 O
. O
Soft O
abdomen O
, O
well O
healed O
surgical O
scar O
. O
No B-NEGATION
edema O
or O
cord O
. O
Labs O
notable O
for O
WBC O
7K O
, O
HCT O
24 O
, O
K O
4 O
. O
0 O
, O
Cr O
0 O
. O
7 O
. O

51 O
year O
old O
man O
with O
multiple O
sclerosis O
, O
quadriparesis O
, O
hypertension O
, O
restrictive O
lung O
disease O
, O
chronic O
constipation O
and O
small O
bowel O
obstruction O
after O
ileostomy O
, O
multiple O
urinary O
tract O
infections O
also O
after O
placement O
of O
suprapubic O
tube O
, O
presents O
with O
small O
bowel O
obstruction O
and O
urinary O
tract O
infection O
. O
Admitted O
today O
as O
his O
home O
health O
aide O
noticed O
his O
urine O
output O
was O
low O
, O
75cc O
overnight O
when O
he O
usually O
has O
about O
1 O
liter O
overnight O
. O
Over O
the O
past O
two O
weeks O
he O
has O
had O
mild O
earaches O
, O
a O
sorethroat O
as O
well O
as O
some O
rhinorrhea O
. O
He O
denies B-NEGATION
any O
abdominal O
pain O
, O
has O
not B-NEGATION
sujectively O
noticed O
any O
change O
in O
abdominal O
distention O
. O
In O
the O
Emergency O
Department O
, O
he O
was O
noted O
to O
be O
severely O
dehydrated O
on O
exam O
, O
and O
creatinine O
level O
was O
1 O
. O
4 O
up O
from O
0 O
. O
6 O
. O

The O
patient O
is O
a O
79 O
yoF O
w O
a O
h O
o O
CAD O
s O
p O
RCA O
stenting O
, O
diastolic O
CHF O
, O
1 O
MR O
, O
HTN O
, O
Hyperlipidemia O
, O
previous O
smoking O
history O
, O
and O
atrial O
fibrillation O
who O
presents O
for O
direct O
admission O
from O
home O
for O
progressive O
shortness O
of O
breath O
. O
According O
to O
Pt O
, O
her O
primary O
complaint O
is O
not B-NEGATION
shortness O
of O
breath O
, O
but O
cough O
X O
1 O
week O
which O
has O
been O
rarely O
productive O
of O
white O
sputum O
. O
She O
denies B-NEGATION
associated O
fevers O
, O
chills O
, O
nausea O
, O
vomiting O
, O
pleuritic O
pain O
, O
weight O
gain O
, O
or O
dietary O
indiscretion O
. O
She O
also O
reports O
a O
sore O
throat O
over O
the O
past O
3 O
days O
. O
She O
recently O
underwent O
thoracentesis O
for O
a O
moderate O
size O
pleueral O
effusion O
. O
Cytology O
of O
the O
effusion O
was O
negative O
for O
malignant O
cells O
. O
Pt O
denies B-NEGATION
recent O
palpitations O
, O
and O
reports O
that O
she O
has O
been O
compliant O
with O
all O
medications O
. O
She O
admits O
to O
recent O
fatigue O
and O
2 O
pillow O
orthopnea O
which O
has O
been O
present O
for O
months O
. O
Current O
etiology O
considerations O
include O
CHF O
vs O
intrinsic O
pulmonary O
disease O
infiltrative O
vs O
embolic O
disease O
. O
In O
order O
to O
optimize O
cardic O
function O
with O
atrial O
kick O
, O
pt O
underwent O
cardioversion O
and O
became O
hypotensive O
with O
a O
junctional O
rhythm O
requiring O
intubation O
. O
She O
was O
placed O
on O
dobutamine O
. O
Off O
of O
dobutamine O
, O
cardiac O
monitoring O
demonstrated O
a O
long O
QTc O
of O
700 O
and O
an O
atrial O
escape O
rhythm O
. O

A O
64 O
yo O
female O
with O
with O
history O
of O
atrial O
fibrillation O
, O
Chronic O
Obstructive O
Pulmonary O
Disease O
, O
hypertension O
, O
hyperlipidemia O
, O
repair O
of O
an O
atrial O
septum O
defect O
which O
was O
complicated O
by O
sternal O
wound O
infection O
and O
post O
operative O
atrial O
fibrillation O
treated O
with O
amiodarone O
, O
was O
initially O
admitted O
through O
the O
Emergency O
Department O
with O
shortness O
of O
breath O
and O
back O
pain O
, O
and O
was O
noted O
to O
have O
atrial O
fibrillation O
with O
rapid O
ventricular O
response O
. O
A O
computed O
tomography O
angiography O
demonstrated O
diffuse O
left O
anterior O
descending O
artery O
and O
post O
obstructive O
pneumonia O
concerning O
for O
malignancy O
. O
For O
her O
atrial O
fibrillation O
, O
she O
was O
started O
on O
diltiazem O
. O
For O
the O
pneumonia O
, O
she O
was O
treated O
with O
antibiotics O
. O
She O
was O
then O
transferred O
to O
the O
floor O
later O
that O
same O
night O
on O
metoprolol O
50 O
mg O
tid O
. O
While O
on O
the O
floor O
, O
she O
had O
a O
bronchoscopy O
performed O
which O
showed O
external O
compression O
of O
her O
left O
mainstem O
bronchus O
, O
and O
she O
had O
a O
biopsy O
via O
fine O
needle O
aspiration O
, O
which O
showed O
large O
cell O
carcinoma O
. O
She O
denies B-NEGATION
chest O
pain O
, O
shortness O
of O
breath O
and O
tachypnea O
. O
She O
does O
note O
some O
diaphoresis O
and O
occasional O
palpitations O
. O




This O
is O
a O
54 O
year O
old O
male O
patient O
with O
an O
idiopathic O
pulmonary O
fibrosis O
, O
who O
called O
today O
with O
worsening O
dyspnea O
for O
3 O
days O
. O
He O
had O
been O
in O
unusual O
state O
of O
good O
health O
at O
baseline O
respiratory O
status O
using O
4L O
nasal O
canula O
at O
rest O
and O
6L O
with O
exertion O
when O
3 O
days O
prior O
to O
admission O
, O
he O
hugged O
his O
cousin O
who O
has O
rats O
for O
pets O
and O
also O
the O
heat O
came O
up O
from O
the O
basement O
of O
his O
house O
. O
He O
feels O
that O
with O
these O
two O
events O
, O
his O
breathing O
became O
acutely O
worse O
and O
he O
is O
concerned O
for O
allergen O
exposure O
. O
He O
denies B-NEGATION
any O
sick O
contacts O
, O
fevers O
, O
chills O
, O
rhinorrhea O
. O
He O
did O
receive O
flu O
and O
pneumovax O
vaccines O
. O
He O
has O
had O
a O
recent O
admission O
last O
month O
with O
progressive O
dyspnea O
on O
exertion O
. O
The O
computed O
tomography O
revealed O
increased O
ground O
glass O
opacity O
in O
lower O
lobes O
superimposed O
on O
pulmonary O
fibrosis O
with O
elevated O
eosinophils O
peripherally O
12 O
. O
A O
bronchoalveolar O
lavage O
was O
also O
positive O
for O
eosinophils O
. O
He O
was O
started O
on O
high O
dose O
steroids O
prednisone O
60mg O
with O
plan O
for O
close O
outpatient O
follow O
up O
for O
eosinophilic O
lung O
disease O
. O
He O
was O
discharged O
on O
2 O
3L O
nasal O
canula O
. O
He O
then O
represented O
to O
the O
emergency O
department O
for O
spontaneous O
pneumomediastinum O
of O
unclear O
etiology O
. O
On O
day O
of O
current O
admission O
, O
the O
patient O
called O
his O
pulmonologist O
complaining O
of O
worsening O
shortness O
of O
breath O
since O
Saturday O
. O
Yesterday O
he O
was O
at O
pulmonary O
rehab O
and O
desaturated O
to O
the O
70s O
on O
6L O
with O
minimal O
exertion O
, O
and O
he O
is O
currently O
on O
4L O
nasal O
canula O
at O
rest O
. O
No O
sick O
contacts O
recently O
. O
He O
was O
asked O
to O
go O
to O
ED O
. O
In O
the O
ED O
, O
initial O
vs O
were O
98 O
. O
3 O
, O
96 O
, O
144 O
97 O
, O
24 O
, O
97 O
6L O
NC O
. O


Ms O
Known O
patient O
lastname O
241 O
is O
a O
Age O
over O
90 O
2398 O
year O
old O
woman O
with O
past O
medical O
history O
significant O
for O
hypertension O
, O
severe O
aortic O
stenosis O
, O
hyperlipidemia O
, O
arthroplasty O
. O
. O
Per O
the O
patient O
, O
she O
was O
standing O
and O
felt O
a O
snap O
of O
her O
right O
leg O
and O
fell O
to O
the O
ground O
. O
No B-NEGATION
head O
trauma O
or O
LOC O
. O
She O
was O
evaluated O
by O
orthopedics O
and O
transferred O
to O
medicine O
for O
optimization O
of O
her O
cardiac O
status O
. O
Review O
of O
systems O
Ear O
, O
Nose O
, O
Throat O
Dry O
mouth O
Cardiovascular O
Edema O
, O
Orthopnea O
Respiratory O
Dyspnea O
Flowsheet O
Data O
as O
of O
3294 O
3 O
6 O
10 O
33 O
PM O
Vital O
Signs O
Hemodynamic O
monitoring O
Fluid O
Balance O
24 O
hours O
Since O
96 O
AM O
Tmax O
37 O
. O
5 O
C O
99 O
. O
5 O
Tcurrent O
37 O
. O
5 O
C O
99 O
. O
5 O
HR O
102 O
93 O
102 O
bpm O
BP O
117 O
54 O
70 O
117 O
54 O
70 O
117 O
54 O
70 O
mmHg O
RR O
24 O
15 O
24 O
insp O
min O
SpO2 O
100 O
Heart O
rhythm O
ST O
Sinus O
Tachycardia O
. O
Clarify O
She O
appears O
comfortable O
with O
adequate O
pain O
control O
with O
prn O
morphine O
. O
Given O
her O
tight O
valvular O
stenosis O
, O
she O
is O
high O
risk O
for O
general O
anesthesia O
. O
would O
start O
standing O
tylenol O
1g O
q8 O
continue O
morphine O
IV O
prn O
for O
breakthrough O
plan O
for O
OR O
tomorrow O
am O
per O
ortho O
pending O
optimization O
of O
her O
cardiac O
function O
, O
and O
improvement O
in O
renal O
function O
. O
CAD O
No O
clear O
documentation O
, O
however O
given O
age O
calcific O
atherosclerosis O
is O
highly O
likely O
continue O
statin O
Hold O
beta O
blocker O
for O
now O
hold O
aspirin O
in O
perioperative O
period O
. O
ATRIAL O
FIBRILLATION O
In O
setting O
of O
acute O
pain O
and O
peri O
op O
. O
Will O
need O
to O
monitor O
as O
pt O
with O
high O
CHADS O
score O
, O
however O
in O
periop O
period O
would O
not O
be O
able O
to O
have O
systemic O
anticoagulation O
Rate O
control O
with O
beta O
blocker O
once O
stable O
If O
unstable O
, O
would O
use O
esmolol O
first O
, O
cardiovert O
last O
option O
. O
. O
HTN O
Better O
controlled O
on O
floor O
. O
Good O
BP O
control O
essential O
for O
preventing O
flash O
pulmonary O
edema O
in O
setting O
of O
AS O
. O
continue O
metoprolol O
, O
as O
above O
continue O
to O
monitor O
BP O
and O
consider O
adding O
another O
Doctor O
Last O
Name O
such O
as O
amlodipine O
5mg O
daily O
if O
BP O
sustains O
above O
SBP O
150s O
. O
Hyperlipidemia O
continue O
simvastatin O
40mg O
PO O
daily O
. O
FEN O
GI O
Low O
sodium O
diet O
, O
replete O
lytes O
PRN O
. O
CODE O
Confirmed O
DNR O
DNI O

Pt O
is O
a O
75F O
with O
a O
PMHx O
significant O
for O
severe O
PVD O
, O
CAD O
, O
DM O
, O
and O
CKD O
who O
presented O
to O
Hospital1 O
Location O
un O
1375 O
on O
6 O
25 O
after O
being O
found O
down O
unresponsive O
at O
home O
. O
She O
was O
found O
to O
be O
hypoglycemic O
to O
29 O
with O
hypotension O
and O
bradycardia O
. O
Her O
hypotension O
and O
confusion O
improved O
with O
hydration O
. O
She O
had O
a O
positive O
UA O
which O
eventually O
grew O
klebsiella O
, O
treated O
initially O
with O
levofloxacin O
. O
She O
had O
a O
leukocytosis O
to O
18 O
and O
a O
creatinine O
of O
6 O
up O
from O
presumed O
prior O
baseline O
of O
2 O
. O
On O
morning O
of O
transfer O
, O
pt O
had O
blood O
cultures O
result O
3 O
3 O
bottles O
positive O
for O
GAS O
, O
her O
antibiotics O
were O
switched O
to O
vancomycin O
which O
was O
then O
changed O
to O
ceftriaxone O
. O
Her O
blood O
pressure O
dropped O
to O
the O
60s O
. O
She O
was O
given O
a O
bolus O
of O
bicarb O
and O
transfered O
to O
their O
ICU O
. O
After O
an O
additional O
bolus O
of O
500cc O
she O
was O
started O
on O
levophed O
. O
She O
was O
anuric O
throughout O
the O
day O
. O
She O
had O
a O
midline O
placed O
on O
right O
side O
. O
She O
received O
80mg O
IV O
solumedrol O
this O
morning O
in O
the O
setting O
of O
low O
BPs O
and O
rare O
eos O
in O
urine O
. O
On O
arrival O
to O
the O
MICU O
pt O
was O
awake O
but O
drowsy O
. O
She O
was O
receiving O
levophed O
throughout O
her O
transfer O
. O
Arrival O
VS O
96 O
. O
3 O
68 O
102 O
26 O
22 O
97 O
2L O
NC O
on O
0 O
. O
04mcg O
kg O
min O
levophed O
. O
On O
ROS O
, O
pt O
denies B-NEGATION
pain O
, O
lightheadedness O
, O
headache O
, O
neck O
pain O
, O
sore O
throat O
, O
recent O
illness O
or O
sick O
contacts O
, O
cough O
, O
shortness O
of O
breath O
, O
chest O
discomfort O
, O
heartburn O
, O
abd O
pain O
, O
n O
v O
, O
diarrhea O
, O
constipation O
, O
dysuria O
. O
Is O
a O
poor O
historian O
regarding O
how O
long O
she O
has O
had O
a O
rash O
on O
her O
legs O
. O
States O
she O
has O
not B-NEGATION
felt O
ill O
and O
she O
was O
brought O
to O
the O
hospital O
because O
her O
daughter O
came O
home O
and O
found O
her O
sleeping O
. O
Does O
complain O
of O
feeling O
very O
thirsty O
. O
" O

The O
patient O
is O
an O
87 O
yo O
woman O
with O
h O
o O
osteoporosis O
, O
multiple O
recent O
falls O
, O
CAD O
, O
who O
presents O
from O
nursing O
home O
with O
C2 O
fracture O
and O
evidence O
of O
pulmonary O
emoblus O
. O
The O
patient O
was O
in O
her O
usual O
state O
of O
health O
at O
her O
nursing O
home O
until O
yesterday O
morning O
when O
she O
sustained O
a O
fall O
when O
trying O
to O
get O
up O
to O
go O
to O
the O
bathroom O
. O
The O
fall O
was O
not B-NEGATION
witnessed O
, O
but O
the O
patient O
reportedly O
did O
not B-NEGATION
lose O
consciousness O
. O
At O
3 O
30 O
that O
afternoon O
, O
the O
patient O
complained O
of O
neck O
and O
rib O
pain O
. O
She O
was O
taken O
to O
OSH O
, O
where O
she O
was O
found O
to O
have O
a O
comminuted O
fracture O
of O
C2 O
. O
She O
was O
transferred O
to O
Hospital1 O
1 O
for O
further O
evaluation O
. O
Of O
note O
, O
the O
patient O
was O
recently O
treated O
for O
CDiff O
infection O
at O
her O
nursing O
facility O
, O
per O
discussion O
with O
her O
daughter O
. O
. O
In O
the O
ED O
, O
the O
patient O
's O
VS O
were O
T O
99 O
. O
1 O
, O
BP O
106 O
42 O
, O
P O
101 O
, O
R O
24 O
. O
She O
had O
an O
ECG O
which O
showed O
sinus O
tachycardia O
and O
ST O
depressions O
in O
V3 O
and O
V4 O
. O
CT O
head O
was O
negative B-NEGATION
for O
ICH O
. O
She O
was O
seen O
by O
Trauma O
surgery O
, O
who O
recommended O
stabalization O
with O
a O
cervical O
collar O
for O
the O
next O
six O
to O
eight O
weeks O
, O
but O
they O
deemed O
that O
she O
is O
not B-NEGATION
an O
operable O
candidate O
. O

An O
82 O
M O
with O
COPD O
, O
s O
p O
bioprosthetic O
AVR O
for O
AS O
, O
afib O
s O
p O
CV O
, O
right O
nephrectomy O
for O
RCC O
, O
colon O
ca O
s O
p O
colectomy O
who O
presents O
with O
9 O
day O
hostory O
of O
productive O
cough O
and O
fevers O
. O
light O
of O
stairs O
baseline O
. O
dyspnea O
and O
productive O
cough O
of O
several O
weeks O
. O
Otherwise O
patient O
is O
without B-NEGATION
any O
complaints O
In O
the O
ED O
, O
initial O
vs O
were O
80 O
, O
sbp O
100 O
, O
mid O
90s O
on O
6L O
NC O
. O
Last O
vital O
signs O
prior O
to O
ER O
transfer O
were O
98 O
. O
1 O
, O
83 O
, O
116 O
40 O
, O
20 O
, O
95 O
on O
3L O
NC O
. O
Patient O
looked O
comnfortable O
. O
90 O
room O
air O
, O
INR O
8 O
, O
ABG O
, O
ARF O
, O
2 O
liters O
ivf O
. O
guiac O
brown O
, O
got O
levo O
, O
ceftriaxone O
. O
Physical O
Examination O
General O
Appearance O
No B-NEGATION
acute O
distress O
Eyes O
Conjunctiva O
PERRL O
Head O
, O
Ears O
, O
Nose O
, O
Throat O
Normocephalic O
Cardiovascular O
PMI O
Normal O
, O
S1 O
Normal O
, O
S2 O
Normal O
, O
Murmur O
Systolic O
Peripheral O
Vascular O
Right O
radial O
pulse O
Present O
, O
Left O
radial O
pulse O
Present O
, O
Right O
DP O
pulse O
Present O
, O
Left O
DP O
pulse O
Present O
Respiratory O
Chest O
Expansion O
Symmetric O
, O
Breath O
Sounds O
Crackles O
RLL O
, O
Wheezes O
diffuse O
Abdominal O
Soft O
, O
Non O
tender O
, O
Bowel O
sounds O
present O
Extremities O
Right O
lower O
extremity O
edema O
Absent B-NEGATION
, O
Left O
lower O
extremity O
edema O
Absent B-NEGATION
Skin O
Warm O
Neurologic O
Attentive O
, O
Follows O
simple O
commands O
, O
Responds O
to O
Verbal O
stimuli O
, O
Oriented O
to O
x3 O
, O
Movement O
Purposeful O
, O
Tone O
Normal O



Mr O
. O
Known O
patient O
lastname O
7952 O
is O
a O
41 O
yo O
M O
with O
PMH O
ETOH O
abuse O
, O
cholelithiasis O
, O
HTN O
, O
obesity O
who O
presented O
to O
Hospital3 O
with O
hematemasis O
. O
He O
reports O
that O
for O
the O
past O
6 O
years O
he O
has O
been O
drinking O
2 O
9 O
of O
a O
1 O
. O
7L O
bottle O
of O
vodka O
daily O
. O
On O
Friday O
evening O
he O
had O
several O
episodes O
of O
vomiting O
of O
bright O
and O
dark O
red O
material O
for O
which O
he O
presented O
to O
Hospital1 O
. O
He O
had O
an O
NG O
tube O
which O
reportedly O
failed O
to O
clear O
with O
lavage O
and O
patient O
self O
d O
c O
' O
d O
the O
NGT O
because O
he O
was O
vomiting O
around O
the O
tube O
. O
He O
was O
given O
4mg O
IV O
morphine O
for O
abdominal O
pain O
, O
ativan O
2mg O
IV O
for O
withdrawal O
, O
protonix O
40mg O
IV O
, O
zofran O
8mg O
IV O
, O
octreotide O
50mcg O
IV O
, O
and O
1 O
unit O
of O
platelets O
. O
In O
the O
ED O
, O
initial O
vs O
were O
T O
98 O
. O
6 O
P66 O
BP145 O
89 O
R16 O
O2 O
sat O
98 O
RA O
. O
He O
was O
started O
on O
a O
protonix O
gtt O
and O
octreotide O
gtt O
given O
his O
elevated O
LFT O
's O
. O
He O
was O
also O
given O
a O
bananna O
bag O
. O
He O
had O
a O
RUQ O
ultrasound O
which O
demonstrated O
gallstones O
and O
sludge O
and O
per O
ED O
resident O
report O
ascites O
. O
As O
such O
given O
new O
ascites O
and O
abdominal O
pain O
he O
was O
given O
levofloxacin O
750mg O
IV O
and O
flagyl O
500mg O
IV O
reportedly O
for O
SBP O
prophylaxis O
. O
He O
was O
evaluted O
by O
GI O
in O
the O
ED O
. O
. O
On O
the O
floor O
, O
he O
reports O
that O
he O
had O
two O
episodes O
of O
vomiting O
of O
dark O
red O
emesis O
. O
Per O
his O
nurse O
it O
was O
about O
75ml O
and O
was O
gastrocult O
positive O
. O
He O
otherwise O
endorese O
RUQ O
pain O
radiating O
to O
his O
back O
. O
He O
also O
reports O
slow O
increase O
in O
abdominal O
girth O
with O
more O
acute O
distention O
and O
lower O
extremity O
swelling O
over O
the O
two O
days O
prior O
to O
admission O
. O
Physical O
Examination O
Vitals O
BP O
153 O
92 O
P O
64 O
R O
20 O
O2 O
97 O
RA O
General O
Alert O
, O
oriented O
, O
no B-NEGATION
acute O
distress O
, O
no B-NEGATION
asterixis O
HEENT O
Sclera O
icteric O
, O
dry O
mucous O
membranes O
Neck O
supple O
, O
obese O
, O
JVP O
not O
elevated O
Lungs O
bibasilar O
crackles O
, O
no B-NEGATION
wheezes O
CV O
Regular O
rate O
and O
rhythm O
, O
3 O
16 O
soft O
nonradiating O
systolic O
murmur O
Abdomen O
obese O
distended O
, O
RUQ O
and O
epigastric O
tenderness O
to O
palpation O
, O
normoactive O
bowel O
sounds O
, O
no B-NEGATION
rebound O
or O
guarding O
. O
Ext O
warm O
, O
well O
perfused O
, O
1 O
pitting O
edema O
bilaterally O
, O
2 O
pulses O
Labs O
WBC O
2 O
. O
5 O
Hct O
36 O
. O
2 O
Plt O
28 O
Cr O
0 O
. O
5 O
Glucose O
111 O
Other O
labs O
PT O
PTT O
INR O
19 O
. O
1 O
31 O
. O
6 O
1 O
. O
7 O
, O
ALT O
AST O
37 O
165 O
, O
Alk O
Phos O
T O
Bili O
130 O
6 O
. O
9 O
, O
Amylase O
Lipase O
145 O
288 O
, O
Albumin O
2 O
. O
5 O
g O
dL O
, O
LDH O
278 O
IU O
L O
, O
Ca O
7 O
. O
9 O
mg O
dL O
, O
Mg O
1 O
. O
7 O
mg O
dL O
, O
PO4 O
3 O
. O
0 O
mg O
dL O





A O
52 O
year O
old O
woman O
with O
COPD O
and O
breast O
cancer O
who O
presented O
to O
an O
OSH O
with O
SOB O
and O
back O
pain O
for O
several O
weeks O
. O
Had O
been O
seen O
by O
PCP O
for O
the O
back O
pain O
and O
treated O
with O
pain O
meds O
. O
Subsequently O
developed O
rash O
that O
was O
thought O
to O
be O
zoster O
. O
In O
the O
last O
few O
days O
, O
increased O
O2 O
requirement O
2 O
liters O
at O
baseline O
4 O
liters O
, O
cough O
, O
fevers O
and O
sore O
throat O
. O
Noted O
sat O
of O
79 O
with O
ambulation O
at O
home O
. O
At O
OSH O
, O
diagnosed O
with O
" O
multi O
focal O
pneumonia O
. O
" O
In O
the O
process O
of O
obtaining O
a O
CT O
scan O
, O
had O
contrast O
infiltrate O
her O
arm O
with O
skin O
blistering O
and O
swelling O
. O
Treated O
with O
ceftriaxone O
and O
transferred O
to O
Hospital1 O
1 O
. O
Patient O
admitted O
from O
Transfer O
from O
other O
hospital O
History O
obtained O
from O
Patient O
, O
Medical O
records O
Physical O
Examination O
General O
Appearance O
Well O
nourished O
, O
No B-NEGATION
t I-NEGATION
Anxious O
, O
sleepy O
Eyes O
Conjunctiva O
PERRL O
, O
No O
t O
Sclera O
edema O
Head O
, O
Ears O
, O
Nose O
, O
Throat O
Normocephalic O
Cardiovascular O
S1 O
Normal O
, O
S2 O
Normal O
, O
No O
t O
S3 O
, O
No O
t O
S4 O
, O
Murmur O
No O
t O
Systolic O
Peripheral O
Vascular O
Right O
radial O
pulse O
Present O
, O
Left O
radial O
pulse O
Present O
, O
Right O
DP O
pulse O
Not O
assessed O
, O
Left O
DP O
pulse O
Not O
assessed O
Respiratory O
Chest O
Expansion O
No O
t O
Symmetric O
, O
Breath O
Sounds O
Wheezes O
expiratory O
, O
Diminished O
, O
scoliotic O
, O
can O
feel O
ribs O
on O
the O
back O
on O
the O
right O
move O
with O
breathing O
Abdominal O
Soft O
, O
Non O
tender O
, O
Bowel O
sounds O
present O
Extremities O
Right O
Trace O
, O
Left O
Trace O
, O
No O
t O
Cyanosis O
, O
Clubbing O
Musculoskeletal O
No O
t O
Unable O
to O
stand O
Skin O
Not O
assessed O
, O
No O
t O
Jaundice O
, O
resolving O
zoster O
rash O
on O
right O
lateral O
chest O
, O
right O
arm O
is O
wrapped O
Neurologic O
Attentive O
, O
Follows O
simple O
commands O
, O
Responds O
to O
Verbal O
stimuli O
, O
Oriented O
to O
person O
place O
time O
but O
sleepy O
, O
Movement O
Not O
assessed O
, O
Tone O
Not O
assessed O


Mr O
. O
Known O
patient O
lastname O
3887 O
is O
a O
67 O
y O
. O
o O
. O
M O
with O
end O
stage O
COPD O
on O
home O
O2 O
3 O
L O
NC O
, O
tracheobronchomalacia O
s O
p O
Y O
stent O
, O
s O
p O
RUL O
resection O
for O
squamous O
cell O
carcinoma O
with O
Cyberknife O
treatment O
in O
2764 O
. O
Patient O
had O
Y O
stent O
placed O
in O
2769 O
1 O
1 O
complicated O
by O
cough O
and O
copious O
secretions O
requiring O
multiple O
therapeutic O
aspirations O
. O
Last O
bronchoscopy O
was O
5 O
2769 O
at O
OSH O
, O
where O
patient O
had O
copious O
secretions O
that O
were O
aspirated O
. O
Pt O
reports O
compliance O
with O
Mucomyst O
nebs O
and O
Mucinex O
. O
He O
wears O
O2 O
" O
almost O
" O
24 O
hours O
day O
, O
but O
always O
at O
night O
. O
He O
does O
not O
wear O
his O
CPAP O
. O
Endorses O
inability O
to O
expectorate O
secretions O
and O
having O
" O
full O
feeling O
" O
for O
1 O
7 O
weeks O
. O
Decreaed O
appetitie O
, O
50 O
lb O
wt O
loss O
in O
6 O
months O
. O
Decreased O
activity O
tolerance O
. O
Smokes O
5 O
cig O
day O
. O
PET O
scan O
in O
6 O
12 O
revealed O
FDG O
avid O
soft O
tissue O
mass O
adjacent O
to O
RUL O
resection O
site O
with O
some O
FDG O
avid O
nodes O
concerning O
for O
recurrence O
. O
On O
arrival O
to O
Hospital1 O
17 O
, O
vitals O
were O
T98 O
. O
6 O
HR86 O
BP106 O
78 O
O289 O
. O
Pt O
denied B-NEGATION
chest O
pain O
, O
palpitations O
, O
trauma O
, O
F O
C O
, O
N O
V O
D O
. O
R O
shoulder O
full O
PROM O
, O
limited O
abduction O
on O
active O
ROM O
. O


This O
is O
a O
76 O
year O
old O
female O
with O
pmh O
of O
diastolic O
CHF O
, O
atrial O
fibrillation O
on O
coumadin O
, O
presenting O
with O
Hct O
16 O
. O
9 O
and O
shortness O
of O
breath O
. O
She O
had O
routine O
labs O
drawn O
yesterday O
at O
her O
PCP O
's O
office O
. O
Once O
her O
hematocrit O
came O
she O
was O
called O
and O
instructed O
to O
come O
to O
the O
ED O
. O
She O
is O
also O
reporting O
progressive O
shortness O
of O
breath O
worse O
with O
exertion O
over O
the O
past O
two O
weeks O
. O
She O
denies B-NEGATION
fevers O
, O
chills O
, O
chest O
pain O
, O
palpitaitons O
, O
cough O
, O
abdominal O
pain O
, O
constipation O
or O
diahrrea O
, O
melena O
, O
blood O
in O
her O
stool O
, O
dysuria O
, O
rash O
. O
She O
reports O
orthopnea O
. O
In O
the O
ED O
vitals O
were O
98 O
. O
4 O
131 O
49 O
, O
60 O
24 O
100 O
2L O
. O
ekg O
with O
NSR O
, O
twi O
in O
V1 O
, O
no O
significant O
change O
from O
previous O
. O
Repeat O
CBC O
showed O
Hct O
16 O
. O
1 O
with O
haptoglobin O
20 O
, O
and O
elevated O
LDH O
to O
315 O
. O
In O
addition O
, O
her O
guaiac O
was O
reported O
as O
being O
positive O
. O
Past O
medical O
history O
Hypertension O
Atrial O
flutter O
fibrillation O
, O
s O
p O
cardioversion O
2797 O
1 O
27 O
Diastolic O
heart O
failure O
Hysterectomy O
Bilateral O
hip O
replacements O
Social O
History O
Married O
for O
53 O
years O
with O
four O
children O
. O
She O
is O
retired O
from O
the O
airport O
. O
She O
does O
not O
smoke O
or O
drink O
. O
Occupation O
retired O
from O
airport O
Drugs O
denies O
Tobacco O
denies O
any O
history O
Alcohol O
denies O

40 O
year O
old O
woman O
with O
a O
h O
o O
alcoholism O
c O
b O
DTs O
seizures O
2 O
years O
ago O
, O
polysubstance O
abuse O
including O
IV O
heroin O
, O
cocaine O
, O
crack O
last O
use O
2 O
years O
ago O
, O
heroin O
inhalation O
last O
use O
2 O
days O
ago O
, O
hep O
C O
, O
presents O
for O
voluntary O
admission O
for O
detox O
. O
The O
patient O
would O
like O
to O
undergo O
detoxification O
so O
she O
can O
take O
care O
of O
her O
children O
. O
She O
also O
complains O
of O
abdominal O
pain O
, O
12 O
24 O
, O
lower O
quadrants O
, O
radiating O
to O
the O
back O
since O
yesterday O
. O
She O
cannot O
describe O
any O
relationship O
with O
food O
as O
she O
has O
not O
eaten O
anything O
. O
She O
says O
the O
pain O
has O
worsened O
since O
yesterday O
. O
She O
also O
complains O
of O
nausea O
, O
vomitting O
bilious O
but O
nonbloody O
, O
and O
diarrhea O
no O
black O
or O
red O
stools O
. O
Her O
last O
drink O
was O
9am O
on O
3154 O
2 O
15 O
. O
Recently O
stopped O
her O
methadone O
1 O
week O
ago O
in O
an O
effort O
to O
quit O
drug O
abuse O
. O
. O
In O
the O
ED O
she O
was O
98 O
. O
6 O
101 O
149 O
96 O
20 O
96 O
. O
She O
was O
Doctor O
Last O
Name O
2062 O
16 O
25 O
on O
CIWA O
. O
ROS O
Reports O
DOE O
, O
orthopnea O
. O
Also O
describes O
weight O
gain O
since O
given O
birth O
to O
her O
child O
17 O
months O
ago O
, O
she O
attributes O
this O
to O
her O
recent O
pregnancy O
. O
She O
complains O
of O
tremors O
and O
also O
complains O
of O
a O
moderate O
headache O
that O
's O
been O
stable O
. O
. O
Denies B-NEGATION
CP O
, O
fevers O
, O
chills O
, O
or O
cough O
, O
palpitations O
, O
edema O
, O
joint O
pains O
, O
rashes O
, O
AVH O
, O
SI O
, O
or O
HI O
. O
Past O
Medical O
History O
Alcoholism O
drinks O
baseline O
1 O
pint O
of O
liquor O
day O
, O
past O
week O
drinking O
1 O
liter O
of O
vodka O
day O
Polysubstance O
abuse O
including O
cocaine O
, O
IV O
heroin O
, O
and O
crack O
2 O
years O
ago O
, O
snorting O
heroin O
2 O
days O
ago O
. O
Hep O
C O
, O
never O
treated O
, O
unknown O
severity O
, O
genotype O
, O
etc O
Infectious O
endocarditis O
in O
her O
20s O
, O
6 O
wks O
of O
abx O
no O
surgeries O
No B-NEGATION
h O
o O
STDs O
, O
HIV O
neg O
3 O
weeks O
ago O
Hep O
B O
immunized O
Family O
History O
Alcoholism O
in O
mother O
, O
father O
, O
and O
sister O
. O
Father O
also O
used O
cocaine O
and O
sister O
also O
used O
ecstasy O
. O
Occupation O
Formerly O
worked O
at O
Investment O
Firm O
Quality O
Control O
Dept O
Physical O
Examination O
Vitals O
T O
99 O
. O
6 O
BP O
152 O
96 O
P O
99 O
R O
27 O
O2 O
99 O
RA O
General O
Alert O
, O
oriented O
x3 O
, O
anxious O
, O
labile O
with O
at O
times O
inappropriate O
laughter O
mixed O
with O
anxiety O
, O
obese O
woman O
. O
HEENT O
Sclera O
anicteric O
, O
MMM O
, O
oropharynx O
clear O
Neck O
supple O
, O
JVP O
difficult O
to O
assess O
given O
habitus O
Lungs O
Clear O
to O
auscultation O
bilaterally O
, O
no O
wheezes O
, O
rales O
, O
ronchi O
CV O
Tachycardic O
, O
regular O
rhythm O
, O
normal O
S1 O
S2 O
, O
no O
murmurs O
, O
rubs O
, O
gallops O
Abdomen O
soft O
, O
diffuse O
tenderness O
to O
palpation O
, O
obese O
, O
non O
distended O
, O
bowel O
sounds O
present O
, O
no O
rebound O
tenderness O
or O
guarding O
, O
no O
organomegaly O
. O
During O
the O
exam O
she O
complains O
of O
severe O
tenderness O
but O
a O
few O
minutes O
later O
is O
laughing O
and O
sitting O
comfortably O
in O
bed O
. O
Ext O
warm O
, O
well O
perfused O
, O
2 O
pulses O
, O
no O
clubbing O
, O
cyanosis O
or O
edema O
Labs O
PT O
PTT O
INR O
13 O
. O
7 O
29 O
. O
4 O
1 O
. O
2 O
, O
ALT O
AST O
106 O
249 O
, O
Alk O
Phos O
T O
Bili O
145 O
3 O
. O
0 O
, O
Amylase O
Lipase O
135 O
221 O
, O
Differential O
Neuts O
57 O
. O
3 O
, O
Lymph O
34 O
. O
1 O
, O
Mono O
7 O
. O
0 O
, O
Eos O
0 O
. O
8 O
, O
Lactic O
Acid O
1 O
. O
8 O
mmol O
L O
, O
Albumin O
4 O
. O
1 O
g O
dL O
, O
LDH O
329 O
IU O
L O
, O
Ca O
8 O
. O
2 O
mg O
dL O
, O
Mg O
1 O
. O
7 O
mg O
dL O
, O
PO4 O
2 O
. O
5 O
mg O
dL O

78 O
year O
old O
female O
with O
PMHx O
HTN O
, O
dCHF O
, O
Diabetes O
, O
CKD O
, O
Atrial O
fibrillation O
on O
coumadin O
, O
ischemic O
stroke O
, O
admitted O
after O
presenting O
to O
cardiology O
clinic O
today O
with O
confusion O
and O
Somnolence O
. O
Of O
note O
, O
she O
was O
recently O
discharged O
at O
the O
beginning O
of O
2876 O
4 O
14 O
after O
presyncope O
falls O
. O
At O
that O
time O
, O
lasix O
was O
stopped O
and O
atenolol O
was O
switched O
to O
metoprolol O
as O
there O
was O
concern O
that O
blunting O
of O
tachycardia O
could O
be O
contributing O
to O
falls O
. O
She O
was O
discharged O
to O
rehab O
previously O
living O
at O
home O
. O
Per O
report O
from O
the O
ER O
, O
patient O
has O
had O
confusion O
at O
home O
x O
3 O
weeks O
, O
though O
no O
family O
accompanies O
her O
to O
corroborate O
this O
story O
, O
and O
patient O
denies O
this O
. O
The O
patient O
is O
not O
sure O
why O
she O
is O
in O
the O
hospital O
. O
She O
saw O
her O
cardiologist O
today O
, O
who O
referred O
her O
to O
the O
ER O
after O
she O
appeared O
to O
be O
dehydrated O
, O
somnolent O
, O
and O
confused O
. O
The O
patient O
denies B-NEGATION
headache O
, O
blurry O
Vision O
, O
numbness O
, O
tingling O
or O
weakness O
. O
No O
CP O
. O
SOB O
, O
worsening O
DOE O
. O
No B-NEGATION
nausea O
, O
vomiting O
. O
Physical O
Exam O
GENERAL O
Intubated O
, O
NAD O
HEENT O
Normocephalic O
, O
atraumatic O
. O
No B-NEGATION
scleral O
icterus O
. O
MMM O
, O
OP O
clear O
. O
CARDIAC O
irregularly O
irregular O
. O
Normal O
S1 O
, O
S2 O
. O
No B-NEGATION
murmurs O
, O
rubs O
or O
Last O
Name O
un O
597 O
. O
LUNGS O
CTAB O
ABDOMEN O
Soft O
, O
NT O
, O
ND O
. O
BS O
EXTREMITIES O
1 O
edema O
NEUROLOGIC O
Mental O
status O
Intubated O
, O
off O
sedation O
, O
minimal O
arousal O
to O
voice O
stimulation O
. O
Not O
following O
commands O
. O
Cranial O
nerves O
Pupils O
sluggishly O
reactive O
, O
both O
post O
surgical O
, O
R O
4 O
3 O
, O
L O
3 O
. O
5 O
3 O
. O
Gaze O
midline O
and O
conjugate O
, O
face O
appears O
symmetric O
. O
Motor O
Withdraws O
LUE O
and O
LLE O
weakly O
, O
no O
response O
RUE O
, O
triple O
flexion O
RLE O
. O
Sensory O
withdraws O
to O
noxious O
stimulation O
weakly O
as O
above O
, O
L O
R O
Coordination O
unable O
to O
assess O
Gait O
unable O
to O
assess O

This O
is O
a O
87 O
year O
old O
female O
NH O
resident O
with O
a O
history O
of O
chronic O
atrial O
fibrillation O
, O
hypertension O
and O
hypothyroidism O
who O
presents O
to O
the O
Hospital O
Unit O
Name O
10 O
. O
She O
had O
been O
in O
her O
usual O
state O
of O
health O
until O
5 O
days O
ago O
when O
she O
suddenly O
began O
to O
have O
abdominal O
pain O
. O
Her O
abdominal O
pain O
was O
initially O
intermittent O
lasting O
for O
a O
few O
hours O
at O
at O
time O
. O
No O
clear O
correlation O
with O
food O
. O
Yesterday O
, O
she O
noticed O
that O
her O
pain O
was O
much O
more O
severe O
, O
3301 O
9 O
5 O
in O
severity O
and O
more O
localized O
to O
the O
right O
. O
This O
was O
accompanied O
by O
nausea O
and O
vomitting O
. O
She O
vomitted O
twice O
, O
with O
clear O
liquid O
emesis O
and O
was O
sent O
to O
Hospital3 O
. O
At O
Hospital1 O
, O
she O
was O
noted O
to O
have O
elevated O
amylase O
lipase O
to O
538 O
and O
516 O
with O
elevated O
bili O
to O
4 O
. O
1 O
and O
AST O
ALT O
to O
198 O
115 O
and O
was O
given O
ciprofloxacin O
, O
flagyl O
and O
500cc O
NS O
and O
was O
transferred O
to O
the O
Hospital1 O
1 O
emergency O
department O
. O
. O
At O
Hospital1 O
1 O
EDVS O
97 O
. O
9 O
HR O
83 O
157 O
92 O
RR O
18 O
97 O
RA O
. O
Elderly O
F O
, O
oriented O
X O
2 O
, O
NAD O
, O
flat O
jvp O
, O
CTA O
decreased O
b O
b O
, O
s1 O
s2 O
Last O
Name O
un O
, O
decreased O
BS O
, O
t O
at O
ruq O
, O
no B-NEGATION
edema O

Mr O
. O
Known O
patient O
lastname O
4075 O
is O
a O
63 O
yo O
man O
with O
h O
o O
biphenotypic O
ALL O
, O
now O
Day O
32 O
from O
allogeneic O
SCT O
, O
who O
presents O
to O
clinc O
with O
one O
week O
of O
worsening O
SOB O
and O
two O
days O
of O
a O
clear O
productive O
cough O
. O
The O
patient O
states O
his O
SOB O
occured O
when O
lying O
flat O
, O
but O
not O
with O
activity O
. O
Also O
admitted O
to O
chest O
pressure O
which O
would O
come O
and O
go O
in O
his O
left O
chest O
no O
related O
to O
the O
SOB O
. O
Sleeps O
with O
3 O
pillows O
no O
change O
from O
baseline O
, O
denies O
PND O
; O
admits O
to O
a O
slight O
increase O
in O
lower O
extremity O
edema O
. O
Admits O
to O
low O
grade O
fevers O
to O
the O
99 O
's O
and O
crampy O
abdominal O
pain O
. O
Denies B-NEGATION
chills O
, O
night O
sweats O
, O
vomiting O
, O
or O
diarrhea O
. O
Assessment O
and O
Plan O
Assesment O
This O
is O
a O
63 O
year O
old O
male O
with O
a O
history O
of O
h O
o O
biphenotypic O
ALL O
, O
now O
Day O
32 O
from O
allogeneic O
SCT O
, O
who O
presents O
with O
hypoxia O
, O
one O
week O
of O
worsening O
SOB O
, O
and O
two O
days O
of O
productive O
cough O
. O
Plan O
Hypoxia O
The O
patient O
developed O
acute O
onset O
of O
hypoxia O
accompanied O
by O
fever O
and O
a O
one O
day O
cough O
with O
sputum O
production O
. O
Given O
that O
the O
patient O
is O
about O
1 O
month O
s O
p O
allogenic O
SCT O
the O
differential O
is O
broad O
and O
would O
include O
bacterial O
pneumonia O
, O
viral O
pneumonia O
CMV O
, O
flu O
, O
and O
opportunistic O
infections O
including O
fungal O
infections O
. O
Patient O
also O
has O
a O
history O
of O
CMV O
infection O
, O
aspergillus O
and O
Leggionare O
's O
disease O
and O
is O
on O
posaconazole O
. O
His O
CXR O
showed O
an O
opacification O
of O
the O
left O
basilar O
lobe O
and O
also O
right O
upper O
lobe O
concerning O
for O
pneumonia O
as O
well O
as O
a O
small O
loculated O
right O
pleural O
effusion O
. O
Also O
in O
the O
differential O
is O
noninfectious O
causes O
such O
as O
PE O
, O
CHF O
, O
or O
MI O
. O
US O
were O
negative O
for O
clot O
and O
his O
first O
set O
of O
CE O
were O
negative O
. O


85y O
o O
m O
w O
hx O
AD O
, O
diverticulosis O
, O
recently O
dx O
colon O
ca O
s O
. O
p O
hemicolectomy O
p O
w O
dark O
stools O
and O
dropping O
Hct O
30 O
26 O
23 O
. O
NG O
lavage O
was O
negative O
in O
ED O
, O
however O
, O
pt O
with O
duodenal O
ulcer O
on O
EGD O
7 O
2 O
. O
Possibly O
recent O
PUD O
vs O
anastomotic O
site O
vs O
1 O
26 O
colon O
ca O
vs O
diverticulosis O
. O
Review O
of O
systems O
Constitutional O
No B-NEGATION
t O
Fever O
Cardiovascular O
No B-NEGATION
t O
Chest O
pain O
, O
No B-NEGATION
t O
Palpitations O
Respiratory O
No B-NEGATION
t O
Cough O
, O
No B-NEGATION
t O
Dyspnea O
Gastrointestinal O
No B-NEGATION
t O
Abdominal O
pain O
, O
No B-NEGATION
t O
Nausea O
, O
No B-NEGATION
t O
Emesis O
, O
No B-NEGATION
t O
Diarrhea O
, O
No B-NEGATION
t O
Constipation O
Since O
12 O
AM O
Tmax O
37 O
. O
3 O
C O
99 O
. O
2 O
Tcurrent O
37 O
. O
3 O
C O
99 O
. O
2 O
HR O
69 O
64 O
78 O
bpm O
BP O
150 O
73 O
91 O
128 O
39 O
65 O
150 O
99 O
103 O
mmHg O
RR O
16 O
16 O
24 O
insp O
min O
SpO2 O
100 O
Heart O
rhythm O
SR O
Sinus O
Rhythm O
O2 O
Delivery O
Device O
None O
SpO2 O
100 O
ABG O
Physical O
Examination O
General O
Appearance O
No O
acute O
distress O
, O
Thin O
Eyes O
Conjunctiva O
PERRL O
, O
No O
t O
Conjunctiva O
pale O
Head O
, O
Ears O
, O
Nose O
, O
Throat O
Normocephalic O
Lymphatic O
Cervical O
WNL O
, O
Supraclavicular O
WNL O
Cardiovascular O
S1 O
Normal O
, O
S2 O
Normal O
, O
RRR O
Peripheral O
Vascular O
Right O
radial O
pulse O
Present O
, O
Left O
radial O
pulse O
Present O
, O
Right O
DP O
pulse O
Present O
, O
Left O
DP O
pulse O
Present O
Respiratory O
Chest O
Expansion O
Symmetric O
, O
Breath O
Sounds O
Clear O
Abdominal O
Soft O
, O
Non O
tender O
, O
Bowel O
sounds O
present O
, O
No O
t O
Tender O
, O
healing O
colectomy O
scar O
, O
no O
erythema O
, O
tenderness O
, O
bleeding O
, O
oozing O
. O
Extremities O
Right O
Absent O
, O
Left O
Absent O
Skin O
Not O
assessed O
Neurologic O
Attentive O
, O
Follows O
simple O
commands O
, O
Responds O
to O
Verbal O
stimuli O
, O
Oriented O
to O
only O
new O
year O
and O
thought O
he O
was O
at O
Hospital1 O
947 O
, O
Alzheimer O
's O
pt O
with O
baseline O
dementia O
. O
Pt O
oriented O
to O
self O
, O
but O
not O
time O
or O
place O
. O
Movement O
Purposeful O
, O
Tone O
Normal O
Labs O
Radiology O
WBC O
9 O
. O
7 O
Hct O
24 O
. O
0 O
Plt O
593 O
Other O
labs O
PT O
PTT O
INR O
14 O
. O
4 O
27 O
. O
2 O
1 O
. O
3 O
" O

This O
is O
a O
51 O
year O
old O
M O
w O
a O
h O
o O
MS O
, O
quadraparesis O
, O
HTN O
, O
restrictive O
lung O
disease O
, O
chronic O
constipation O
and O
SBOs O
s O
p O
ileostomy O
, O
multiple O
UTIs O
also O
s O
p O
suprapubic O
tube O
presents O
with O
SBO O
and O
UTI O
. O
Of O
note O
he O
was O
just O
recently O
discharged O
from O
the O
Hospital1 O
52 O
on O
10 O
2 O
for O
an O
admission O
for O
a O
UTI O
negative O
cultures O
treated O
with O
cipro O
, O
shingles O
treated O
w O
acyclovir O
and O
SBO O
evaluated O
by O
surgery O
but O
managed O
conservatively O
. O
He O
returns O
today O
as O
his O
home O
health O
aide O
had O
noticed O
his O
Urine O
output O
was O
low O
, O
75cc O
overnight O
when O
he O
usually O
has O
about O
1 O
liter O
of O
UOP O
overnight O
. O
His O
ostomy O
output O
has O
been O
high O
. O
He O
has O
not O
noticed O
any O
symptoms O
. O
Over O
the O
past O
two O
weeks O
he O
has O
had O
mild O
earaches O
, O
a O
sorethroat O
as O
well O
as O
some O
rhinorrhea O
. O
He O
has O
not O
noticed O
any O
watery O
itchy O
eyes O
. O
He O
has O
not O
sure O
if O
he O
has O
had O
a O
change O
in O
his O
ostomy O
output O
or O
suprapubic O
output O
. O
He O
has O
not O
noticed O
any O
visual O
changes O
, O
he O
has O
not O
noticed O
any O
new O
neurologic O
si O
sx O
. O
He O
denies B-NEGATION
any O
abdominal O
pain O
, O
has O
not O
sujectively O
noticed O
any O
change O
in O
abdominal O
distention O
. O
He O
denies B-NEGATION
any O
pain O
in O
regards O
to O
his O
zoster O
now O
or O
when O
diagnosed O
. O
Denies B-NEGATION
CP O
, O
has O
an O
occasional O
cough O
that O
is O
not O
worsening O
. O
. O
In O
the O
ED O
, O
he O
was O
noted O
to O
be O
severely O
dehydrated O
on O
exam O
. O
His O
BP O
nadir O
was O
79 O
43 O
and O
HR O
peak O
was O
97 O
. O
T O
99 O
he O
usually O
" O
runs O
low O
" O
, O
new O
ARF O
1 O
. O
4 O
up O
from O
0 O
. O
6 O
. O

A O
64 O
yo O
F O
w O
PMHx O
sx O
for O
AF O
, O
COPD O
, O
HTN O
, O
hyperlipidemia O
who O
initially O
had O
an O
open O
ASD O
repair O
c O
b O
sternal O
wound O
infection O
and O
post O
operative O
AF O
in O
11 O
15 O
treated O
with O
amiodarone O
. O
On O
2 O
20 O
, O
she O
was O
initially O
admitted O
through O
the O
ED O
with O
SOB O
and O
back O
pain O
, O
and O
was O
noted O
to O
have O
atrial O
fibrillation O
with O
RVR O
. O
A O
CTA O
demonstrating O
diffuse O
LAD O
and O
post O
obstructive O
PNA O
concerning O
for O
malignancy O
. O
For O
her O
atrial O
fibrillation O
, O
she O
was O
started O
on O
diltiazem O
gtt O
, O
for O
which O
she O
was O
transferred O
to O
the O
Hospital O
Unit O
Name O
42 O
for O
monitoring O
. O
The O
atrial O
fibrillation O
was O
thought O
to O
be O
in O
the O
setting O
of O
a O
post O
obstructive O
pneumonia O
, O
for O
which O
she O
was O
treated O
with O
antibiotics O
. O
She O
was O
then O
transferred O
to O
the O
floor O
later O
that O
same O
night O
on O
metoprolol O
50 O
mg O
tid O
. O
While O
on O
the O
floor O
, O
she O
had O
a O
bronchoscopy O
performed O
which O
showed O
external O
compression O
of O
her O
left O
mainstem O
bronchus O
, O
and O
she O
had O
a O
biopsy O
FNA O
performed O
, O
which O
showed O
large O
cell O
carcinoma O
. O
She O
was O
then O
readmitted O
to O
the O
Hospital O
Unit O
Name O
42 O
yesterday O
with O
atrial O
fibrillation O
with O
HR O
130s O
, O
and O
was O
started O
on O
a O
diltiazem O
gtt O
. O
. O
In O
the O
Hospital O
Unit O
Name O
42 O
, O
she O
was O
started O
on O
po O
diltiazem O
, O
which O
was O
rapidly O
uptitrated O
to O
60 O
mg O
qid O
. O
She O
was O
called O
out O
this O
morning O
. O
Tonight O
, O
at O
8 O
30 O
pm O
, O
she O
was O
noted O
to O
have O
HR O
160s O
, O
w O
EKG O
c O
w O
AF O
with O
RVR O
, O
for O
which O
she O
received O
metoprolol O
5 O
mg O
IV O
x2 O
, O
followed O
by O
diltiazem O
10 O
mg O
IV O
x2 O
without O
conversion O
. O
She O
denies B-NEGATION
chest O
pain O
, O
SOB O
, O
tachypnea O
. O
She O
does O
note O
some O
diaphoresis O
and O
occasional O
palpitations O
. O



84 O
year O
old O
man O
with O
CAD O
s O
p O
CABG O
, O
DM O
, O
HTN O
, O
presented O
with O
2 O
days O
of O
black O
stools O
and O
coffee O
ground O
emesis O
. O
Pt O
reports O
of O
woke O
up O
2am O
on O
10 O
19 O
and O
had O
black O
soft O
loose O
BM O
, O
followed O
by O
nausea O
and O
and O
vomiting O
blackish O
liquid O
. O
He O
felt O
better O
but O
continued O
to O
have O
three O
more O
black O
stools O
over O
the O
next O
two O
days O
. O
He O
vomited O
a O
total O
of O
1 O
20 O
times O
before O
presenting O
to O
the O
hospital O
. O
He O
has O
been O
feeling O
lethargic O
and O
lightheaded O
and O
called O
the O
ambulence O
at O
the O
advice O
of O
his O
son O
. O
His O
stools O
were O
lightening O
in O
color O
prior O
arriving O
. O
He O
has O
not O
been O
using O
any O
new O
medications O
and O
has O
not O
had O
a O
prior O
GIB O
. O
. O
In O
the O
ED O
, O
initial O
VS O
98 O
. O
7 O
88 O
65 O
47 O
98 O
RA O
. O
He O
was O
BIBEMS O
with O
SBPs O
110 O
120s O
and O
has O
had O
similarly O
stable O
blood O
pressures O
since O
arrival O
. O
He O
had O
an O
NG O
lavage O
with O
coffee O
ground O
emesis O
that O
cleared O
with O
600 O
cc O
of O
flushing O
. O
During O
the O
lavage O
he O
had O
chest O
pressure O
and O
an O
EKG O
showed O
STD O
in O
V2 O
4 O
. O
He O
did O
not B-NEGATION
have O
radiation O
, O
pain O
, O
or O
diaphoresis O
. O
Home O
medications O
ALLOPURINOL O
300 O
mg O
Tablet O
by O
mouth O
daily O
GLIPIZIDE O
5 O
mg O
Extended O
Rel O
by O
mouth O
daily O
LOSARTAN O
COZAAR O
100 O
mg O
by O
mouth O
daily O
METFORMIN O
500 O
mg O
by O
mouth O
daily O
METOPROLOL O
TARTRATE O
50 O
mg O
by O
mouth O
daily O
PIOGLITAZONE O
ACTOS O
15 O
mg O
by O
mouth O
daily O
SIMVASTATIN O
80 O
mg O
Tablet O
by O
mouth O
daily O
ASPIRIN O
81 O
mg O
Tablet O
by O
mouth O
daily O
Past O
medical O
history O
Coronary O
artery O
disease O
s O
p O
triple O
vessel O
coronary O
artery O
bypass O
in O
7 O
2899 O
Hypertension O
Peripheral O
arterial O
disease O
Hypercholesterolemia O
Diabetes O
Osteoarthritis O
Gout O
Anemia O
Baseline O
32 O
35 O
with O
unrevealing O
w O
u O
by O
heme O
Right O
hernia O
repair O
in O
2877 O
Appendectomy O
in O
2841 O
Prostate O
disease O
N O
C O
Occupation O
Retired O
trial O
lawyer O
Drugs O
Denies O
Tobacco O
Denies O
Alcohol O
Occasional O

54 O
y O
o O
M O
w O
IPF O
, O
called O
today O
with O
worsening O
dyspnea O
x O
3 O
days O
. O
He O
had O
been O
in O
unusal O
state O
of O
health O
at O
baseline O
resp O
status O
using O
4L O
NC O
at O
rest O
and O
6L O
NC O
with O
exertion O
when O
3 O
days O
PTA O
, O
he O
hugged O
his O
cousin O
who O
has O
rats O
for O
pets O
and O
also O
the O
heat O
came O
up O
from O
the O
basement O
of O
his O
house O
. O
He O
feels O
that O
with O
these O
two O
events O
, O
he O
breathing O
became O
acutely O
worse O
and O
is O
concerned O
for O
allergen O
exposure O
. O
He O
denies B-NEGATION
any O
sick O
contacts O
, O
fevers O
, O
chills O
, O
worsening O
2169 O
productive O
2169 O
, O
rhinorrhea O
. O
He O
did O
receive O
flu O
and O
pneumovax O
. O
. O
He O
has O
had O
a O
recent O
admissions O
in O
11 O
26 O
with O
progressive O
DOE O
. O
CT O
revealed O
increased O
ground O
glass O
opacity O
in O
LL O
superimposed O
on O
pulmonary O
fibrosis O
with O
elevated O
eosinophils O
peripherally O
12 O
. O
A O
BAL O
was O
also O
positive O
for O
eosinophils O
. O
He O
was O
started O
on O
high O
dose O
steroids O
prednisone O
60mg O
2739 O
2 O
16 O
with O
plan O
for O
close O
outpatient O
follow O
up O
for O
eosinophilic O
lung O
disease O
. O
He O
was O
discharged O
on O
2 O
20 O
on O
2 O
3L O
NC O
. O
He O
then O
represented O
to O
Hospital1 O
1 O
on O
12 O
12 O
for O
spontaneous O
pneumomediastinum O
of O
unclear O
etiology O
. O
. O
On O
day O
of O
admission O
, O
Pt O
called O
pulmonologist O
Dr O
. O
First O
Name O
STitle O
c O
o O
worsening O
shortness O
of O
breath O
since O
Saturday O
3 O
23 O
. O
Yesterday O
he O
was O
at O
pulmonary O
rehab O
and O
desaturated O
to O
the O
70s O
on O
6L O
with O
minimal O
exertion O
, O
and O
he O
is O
currently O
on O
4L O
NC O
at O
rest O
. O
No O
sick O
contacts O
recently O
and O
Name2 O
NI O
2169 O
has O
not O
changed O
. O
He O
was O
asked O
to O
go O
to O
ED O
given O
concern O
for O
either O
acute O
exacerbation O
of O
underlying O
IPF O
vs O
superimposed O
infection O
vs O
pneumothorax O
. O
. O
In O
the O
ED O
, O
initial O
vs O
were O
98 O
. O
3 O
, O
96 O
, O
144 O
97 O
, O
24 O
, O
97 O
6L O
NC O
. O




















78 O
year O
old O
female O
with O
PMHx O
HTN O
, O
dCHF O
, O
Diabetes O
, O
CKD O
, O
Atrial O
fibrillation O
on O
coumadin O
, O
ischemic O
stroke O
, O
admitted O
after O
presenting O
with O
confusion O
and O
somnolence O
. O
She O
was O
recently O
discharged O
after O
presyncope O
falls O
. O
Patient O
has O
had O
confusion O
at O
home O
for O
3 O
weeks O
. O
The O
patient O
denies B-NEGATION
headache O
, O
blurry O
vision O
, O
numbness O
, O
tingling O
or O
weakness O
, O
nausea O
or O
vomiting O
. O







A O
79 O
year O
old O
female O
wit O
history O
of O
CAD O
, O
diastolic O
CHF O
, O
HTN O
, O
Hyperlipidemia O
, O
previous O
smoking O
history O
, O
and O
atrial O
fibrillation O
who O
presents O
for O
direct O
admission O
from O
home O
for O
progressive O
shortness O
of O
breath O
. O
Patient O
denies B-NEGATION
recent O
palpitations O
, O
and O
reports O
that O
she O
has O
been O
compliant O
with O
all O
medications O
. O
She O
admits O
to O
recent O
fatigue O
and O
2 O
pillow O
orthopnea O
which O
has O
been O
present O
for O
months O
. O
Patient O
underwent O
cardioversion O
and O
became O
hypotensive O
with O
a O
junctional O
rhythm O
requiring O
intubation O
. O
She O
was O
placed O
on O
dobutamine O
. O
Off O
of O
dobutamine O
, O
cardiac O
monitoring O
demonstrated O
a O
long O
QTc O
and O
an O
atrial O
escape O
rhythm O
. O






A O
40 O
year O
old O
woman O
comes O
to O
the O
clinic O
complaining O
of O
gritty O
sensation O
in O
her O
eyes O
. O
She O
also O
has O
difficulty O
swallowing O
dry O
foods O
with O
no B-NEGATION
pain O
or O
heartburn O
. O
The O
patient O
is O
a O
schoolteacher O
and O
must O
drink O
water O
frequently O
during O
lectures O
due O
to O
her O
mouth O
dryness O
. O
She O
also O
reports O
occasional O
joint O
pain O
. O
Medical O
history O
is O
not O
significant O
other O
than O
the O
confirmed O
Sjogren O
disease O
with O
no B-NEGATION
other O
rheumatologic O
disease O
. O
She O
is O
sexually O
active O
with O
her O
husband O
and O
has O
2 O
children O
both O
delivered O
by O
natural O
vaginal O
delivery O
. O
She O
has O
no B-NEGATION
history O
of O
any O
kind O
of O
surgery O
. O
Physical O
examination O
shows O
conjunctival O
erythema O
and O
cracking O
of O
the O
lips O
. O
The O
remainder O
of O
the O
examination O
and O
history O
is O
normal O
. O
Her O
lab O
result O
shows O
elevated O
ESR O
50 O
mm O
h O


A O
31 O
year O
old O
woman O
comes O
to O
the O
office O
due O
to O
3 O
days O
of O
rash O
on O
her O
left O
arm O
. O
The O
lesion O
is O
mildly O
pruritic O
but O
not B-NEGATION
painful O
. O
She O
is O
otherwise O
healthy O
and O
occasionally O
takes O
ibuprofen O
during O
the O
first O
few O
days O
of O
her O
menstrual O
period O
. O
Temperature O
is O
37 O
C O
, O
blood O
pressure O
is O
110 O
75 O
mm O
Hg O
, O
and O
pulse O
is O
95 O
min O
. O
The O
lesion O
is O
like O
a O
target O
sign O
known O
as O
erythema O
migrans O
. O
She O
recently O
went O
for O
an O
adventure O
trip O
in O
New O
Hampshire O
. O
The O
patient O
is O
diagnosed O
with O
Lyme O
disease O
. O

A O
57 O
year O
old O
man O
comes O
to O
the O
emergency O
department O
due O
to O
constipation O
. O
His O
last O
bowel O
movement O
was O
2 O
days O
ago O
. O
He O
complains O
of O
spending O
about O
30 O
minutes O
once O
attempting O
to O
defecate O
. O
He O
also O
has O
lower O
back O
pain O
. O
There O
is O
no B-NEGATION
history O
of O
trauma O
. O
The O
pain O
is O
not O
relieved O
with O
over O
the O
counter O
pain O
medications O
. O
His O
vital O
signs O
are O
within O
normal O
limits O
. O
Examination O
shows O
low O
back O
pain O
that O
is O
worse O
with O
back O
flexion O
and O
raising O
of O
the O
legs O
; O
it O
radiates O
into O
his O
left O
leg O
. O
Pinprick O
in O
the O
perianal O
area O
does O
not O
cause O
rapid O
contraction O
of O
the O
anal O
sphincter O
. O
The O
rest O
of O
the O
neurologic O
examination O
is O
normal O
. O
He O
is O
suspected O
of O
Cauda O
Equina O
syndrome O
and O
referred O
to O
a O
spinal O
MRI O
. O

A O
30 O
year O
old O
man O
who O
is O
a O
computer O
scientist O
came O
to O
the O
clinic O
with O
the O
lab O
result O
stating O
azoospermia O
. O
The O
patient O
is O
sexually O
active O
with O
his O
wife O
and O
does O
not O
use O
any O
contraception O
methods O
. O
They O
have O
been O
trying O
to O
conceive O
for O
the O
past O
year O
with O
no O
success O
. O
The O
patient O
has O
a O
past O
medical O
history O
of O
recurrent O
pneumonia O
, O
shortness O
of O
breath O
, O
and O
persistent O
cough O
that O
produces O
large O
amounts O
of O
thick O
sputum O
. O
The O
patient O
had O
multiple O
lung O
infections O
during O
childhood O
. O
He O
does O
not O
smoke O
, O
use O
illicit O
drugs O
or O
alcohol O
. O
The O
patient O
has O
no B-NEGATION
history O
of O
other O
medical O
conditions O
including O
allergies O
or O
any O
kind O
of O
surgery O
. O
On O
physical O
examination O
, O
the O
digits O
show O
clubbing O
. O
An O
ultrasound O
shows O
bilateral O
absence O
of O
the O
vas O
deferens O
, O
and O
FEV1 O
was O
75 O
on O
the O
respiratory O
function O
test O
. O

A O
20 O
year O
old O
man O
comes O
to O
the O
clinic O
for O
his O
routine O
checkup O
. O
The O
patient O
wears O
glasses O
for O
myopia O
and O
takes O
no B-NEGATION
medications O
. O
Vital O
signs O
are O
normal O
. O
On O
physical O
examination O
, O
the O
patient O
is O
tall O
with O
long O
upper O
extremities O
and O
fingers O
. O
The O
face O
appears O
narrow O
with O
down O
slanted O
palpebral O
fissures O
, O
flattened O
malar O
bones O
, O
and O
a O
small O
jaw O
. O
The O
lungs O
are O
clear O
on O
auscultation O
. O
The O
abdomen O
is O
soft O
with O
no B-NEGATION
organomegaly O
. O
The O
patient O
is O
diagnosed O
with O
Marfan O
syndrome O
, O
and O
he O
is O
cooperative O
with O
his O
medical O
appointments O
. O
He O
is O
working O
as O
driver O
. O

















A O
39 O
year O
old O
woman O
comes O
to O
the O
clinic O
complaining O
of O
arthralgias O
and O
nodules O
on O
her O
legs O
. O
She O
has O
no B-NEGATION
fever O
or O
other O
skin O
rashes O
. O
The O
prior O
medical O
condition O
is O
unremarkable O
, O
and O
she O
takes O
no O
medications O
. O
On O
physical O
examination O
, O
there O
is O
moderate O
hepatomegaly O
. O
The O
lesions O
on O
her O
legs O
are O
tender O
and O
present O
predominantly O
on O
the O
anterior O
surface O
of O
the O
lower O
extremities O
. O
She O
doesn O
' O
t O
smoke O
and O
drinks O
alcohol O
occasionally O
. O
The O
patient O
has O
2 O
male O
sexual O
partners O
. O
Vital O
signs O
are O
normal O
. O
Chest O
x O
ray O
demonstrates O
enlarged O
hilar O
lymph O
nodes O
, O
and O
laboratory O
testing O
reveals O
an O
elevated O
ACE O
level O
. O
Biopsy O
of O
the O
skin O
lesion O
shows O
noncaseating O
granulomas O
that O
stain O
negative O
for O
fungi O
acid O
fast O
bacilli O
. O

A O
2 O
year O
old O
boy O
is O
brought O
to O
the O
office O
by O
his O
parents O
due O
to O
a O
rash O
that O
started O
1 O
week O
ago O
. O
A O
similar O
red O
, O
itchy O
rash O
on O
the O
cheeks O
, O
trunk O
, O
and O
arms O
has O
occurred O
intermittently O
since O
infancy O
. O
The O
patient O
has O
had O
a O
few O
upper O
respiratory O
infections O
but O
no O
major O
illnesses O
. O
Vaccinations O
are O
up O
to O
date O
, O
and O
he O
takes O
no O
medications O
. O
He O
is O
on O
a O
balanced O
diet O
, O
and O
he O
is O
healthy O
in O
appearance O
. O
Vital O
signs O
and O
milestone O
examination O
are O
within O
normal O
limits O
. O
Similar O
findings O
are O
observed O
on O
the O
cheeks O
and O
proximal O
upper O
extremities O
. O
The O
diaper O
area O
is O
clear O
, O
and O
no B-NEGATION
mucosal O
lesions O
are O
present O
. O




A O
23 O
year O
old O
man O
comes O
to O
the O
emergency O
department O
following O
an O
episode O
of O
syncope O
. O
He O
was O
working O
out O
when O
he O
felt O
dizzy O
and O
passed O
out O
without O
head O
injury O
. O
He O
has O
had O
3 O
other O
episodes O
of O
light O
headedness O
over O
the O
last O
year O
, O
all O
happening O
during O
physical O
activity O
. O
He O
never O
had O
this O
experience O
while O
resting O
. O
He O
has O
no O
other O
medical O
conditions O
. O
The O
patient O
does O
not O
use O
tobacco O
, O
alcohol O
, O
or O
illicit O
drugs O
. O
His O
father O
died O
suddenly O
at O
age O
35 O
. O
Vital O
signs O
are O
within O
normal O
limits O
. O
On O
physical O
examination O
, O
the O
patient O
has O
a O
harsh O
systolic O
murmur O
. O
The O
lungs O
are O
clear O
with O
no B-NEGATION
peripheral O
edema O
. O
Echocardiography O
shows O
asymmetric O
interventricular O
septal O
hypertrophy O
. O



A O
63 O
year O
old O
man O
comes O
to O
the O
clinic O
for O
recent O
unintentional O
weight O
loss O
. O
The O
patient O
also O
has O
epigastric O
discomfort O
after O
meals O
. O
He O
has O
no O
known O
medical O
problems O
and O
takes O
no O
medications O
. O
His O
blood O
pressure O
is O
130 O
75 O
and O
pulse O
rate O
is O
88 O
min O
. O
He O
is O
not B-NEGATION
febrile O
. O
Upper O
endoscopy O
shows O
a O
lesion O
in O
the O
stomach O
that O
shows O
typical O
features O
of O
diffuse O
type O
adenocarcinoma O
presenting O
with O
signet O
ring O
cells O
that O
do O
not O
form O
glands O
. O

A O
39 O
year O
old O
man O
comes O
to O
the O
emergency O
department O
with O
an O
acute O
onset O
of O
severe O
left O
toe O
pain O
. O
The O
toe O
is O
red O
and O
exhibits O
swelling O
. O
The O
patient O
is O
not B-NEGATION
febrile O
, O
and O
does O
not O
remember O
any O
recent O
trauma O
. O
Medical O
history O
is O
not O
significant O
except O
for O
the O
similar O
attacks O
and O
the O
diagnosis O
of O
gouty O
arthritis O
. O
His O
medication O
history O
includes O
Allopurinol O
to O
prevent O
gouty O
attacks O
. O
His O
father O
has O
the O
same O
medical O
condition O
. O
However O
, O
his O
older O
brother O
who O
is O
41 O
years O
old O
is O
healthy O
with O
no B-NEGATION
history O
of O
gouty O
arthritis O
. O
Physical O
examination O
shows O
a O
swollen O
, O
tender O
first O
metatarsophalangeal O
joint O
. O
Aspiration O
of O
the O
joint O
showed O
high O
leukocyte O
count O
, O
negative O
Gram O
stain O
, O
and O
numerous O
needle O
shaped O
crystals O
, O
which O
is O
compatible O
with O
gouty O
arthritis O
. O










A O
43 O
year O
old O
woman O
, O
gravida O
3 O
para O
3 O
, O
comes O
to O
the O
clinic O
complaining O
of O
recently O
painful O
menstrual O
cycles O
. O
The O
patient O
's O
last O
menstrual O
period O
was O
2 O
weeks O
ago O
. O
Urine O
β O
hCG O
is O
negative O
. O
Menarche O
was O
at O
age O
12 O
, O
and O
menstrual O
periods O
occur O
every O
28 O
days O
and O
lasts O
for O
5 O
days O
. O
She O
is O
sexually O
active O
with O
her O
husband O
and O
does O
not B-NEGATION
have O
pain O
with O
intercourse O
. O
BMI O
is O
23 O
kg O
m2 O
and O
Vital O
signs O
are O
normal O
. O
On O
physical O
examination O
, O
the O
uterus O
is O
uniformly O
enlarged O
and O
tender O
. O
She O
is O
candidate O
for O
hysterectomy O
with O
the O
diagnosis O
of O
adenomyosis O
. O









48 O
M O
with O
a O
h O
o O
HTN O
hyperlipidemia O
, O
bicuspid O
aortic O
valve O
, O
and O
tobacco O
abuse O
who O
presented O
to O
his O
cardiologist O
on O
2148 O
10 O
1 O
with O
progressive O
SOB O
and O
LE O
edema O
. O
TTE O
revealed O
severe O
aortic O
stenosis O
with O
worsening O
LV O
function O
. O
EF O
was O
25 O
. O
RV O
pressure O
was O
41 O
and O
had O
biatrial O
enlargement O
. O
Noted O
to O
have O
2 O
aortic O
insufficiency O
with O
mild O
MR O
. O
He O
was O
sent O
home O
from O
cardiology O
clinic O
with O
Lasix O
and O
BB O
which O
he O
did O
not O
tolerate O
, O
continued O
to O
have O
worsening O
SOB O
and O
LE O
edema O
and O
finally O
presented O
here O
for O
evaluation O
. O
During O
this O
admission O
repeat O
echo O
confirmed O
critical O
aortic O
stenosis O
showing O
left O
ventricular O
hypertrophy O
with O
cavity O
dilation O
and O
severe O
global O
hypokinesis O
, O
severe O
aortic O
valve O
stenosis O
with O
underlying O
bicuspid O
aortic O
valve O
, O
dilated O
ascending O
aorta O
, O
mild O
pulmonary O
artery O
systolic O
hypertension O
. O
The O
patient O
underwent O
a O
preop O
workup O
for O
valvular O
replacement O
with O
preop O
chest O
CT O
scan O
and O
carotid O
US O
showing O
moderate O
heterogeneous O
plaque O
with O
bilateral O
1 O
39 O
ICA O
stenosis O
. O
He O
also O
underwent O
a O
cardiac O
cath O
with O
right O
heart O
cath O
to O
evaluate O
his O
pulm O
art O
pressures O
which O
showed O
no B-NEGATION
angiographically O
apparent O
flow O
limiting O
coronary O
artery O
disease O
. O



74M O
hx O
of O
CAD O
s O
p O
CABG O
, O
EF O
60 O
prior O
CVA O
no O
residual O
deficits O
, O
HTN O
, O
HL O
, O
DMII O
, O
Moderate O
to O
Severe O
PVD O
was O
referred O
to O
cardiology O
for O
evaluation O
of O
PVD O
, O
and O
on O
examination O
patient O
was O
found O
to O
have O
carotid O
bruits O
. O
Upon O
further O
review O
of O
symptoms O
the O
pt O
reports O
Occasional O
dizziness O
, O
no O
prior O
syncope O
occasional O
HA O
, O
Denies B-NEGATION
CP O
SOB O
. O
No B-NEGATION
sensory O
or O
motor O
defects O
. O
He O
recalls O
that O
he O
might O
have O
had O
a O
stroke O
10 O
15 O
years O
ago O
without O
any O
residual O
deficit O
. O
Prior O
to O
CABG O
he O
only O
had O
diaphoresis O
. O
Further O
review O
of O
systems O
is O
notable O
for O
absence B-NEGATION
of O
chest O
pain O
, O
dyspnea O
on O
exertion O
, O
paroxysmal O
nocturnal O
dyspnea O
, O
orthopnea O
, O
palpitations O
, O
syncope O
or O
presyncope O
. O
He O
underwent O
Carotid O
U O
S O
that O
showed O
significant O
bilateral O
carotid O
stenosis O
, O
L O
R O
. O
Angiography O
revealed O
an O
80 O
stenosis O
of O
the O
R O
ICA O
and O
a O
90 O
L O
ICA O
stenosis O
. O
Cerebral O
angiography O
further O
revealed O
patent O
right O
ACA O
and O
MCA O
and O
patent O
left O
ACA O
and O
left O
MCA O
. O
Past O
Medical O
History O
CAD O
s O
p O
CABG O
in O
2154 O
Hospital1 O
112 O
Prior O
CVA O
Bilateral O
carotid O
artery O
disease O
Anemia O
PVD O
Hypertension O
Diabetes O
c O
b O
retinopathy O
and O
peripheral O
neuropathy O
Cataracts O
s O
p O
surgery O
Thyroid O
nodule O
Colon O
polyps O
s O
p O
resection O
Intermittent O
Lower O
back O
pain O
Proteinuria O
s O
p O
right O
elbow O
fracture O
as O
a O
child O
Arthritis O

Patient O
is O
a O
55yo O
woman O
with O
h O
o O
ESRD O
on O
HD O
and O
peritoneal O
dialysis O
who O
presented O
with O
watery O
, O
non O
bloody O
diarrhea O
and O
weakness O
. O
She O
has O
a O
history O
of O
2 O
prior O
C O
diff O
infections O
, O
the O
most O
recent O
just O
1 O
month O
ago O
. O
Recent O
antibx O
use O
in O
the O
last O
month O
on O
prior O
admission O
. O
Was O
also O
txd O
for O
Cdiff O
at O
that O
time O
for O
14 O
d O
. O
course O
with O
po O
vanco O
. O
Pt O
was O
initially O
admitted O
to O
the O
ICU O
and O
was O
septic O
on O
pressors O
levophed O
until O
the O
morning O
of O
8 O
26 O
with O
leukocytosis O
but O
no B-NEGATION
fever O
. O
C O
diff O
assay O
positive O
on O
admission O
, O
and O
pt O
had O
leukocytosis O
consistent O
with O
C O
diff O
. O
Patient O
was O
placed O
on O
Vanco O
po O
, O
Flagyl O
IV O
and O
Flagyl O
po O
initially O
, O
and O
when O
patient O
improved O
she O
was O
transitioned O
to O
Vanco O
oral O
and O
Flagyl O
oral O
on O
8 O
29 O
. O
Patient O
was O
treated O
with O
Vanco O
for O
an O
extended O
course O
of O
6 O
weeks O
given O
her O
recurrent O
C O
diff O
. O
Pt O
was O
also O
encouraged O
to O
take O
probiotics O
and O
to O
bleach O
her O
home O
when O
she O
was O
discharged O
. O







70 O
y O
o O
with O
COPD O
on O
2 O
. O
5 O
3 O
. O
5L O
O2 O
at O
baseline O
, O
OSA O
and O
obesity O
hypoventilation O
syndrome O
, O
dCHF O
, O
discharged O
2132 O
8 O
24 O
now O
presents O
with O
agitation O
and O
altered O
mental O
status O
with O
hypoxia O
and O
O2 O
sats O
70s O
on O
BipAp O
with O
5L O
. O
Pt O
agitated O
then O
somnolent O
at O
initial O
presentation O
. O
Daughter O
reported O
increased O
agitation O
and O
altered O
mental O
status O
x O
2 O
3 O
days O
with O
O2 O
sats O
60s O
70s O
at O
home O
. O
Daughter O
has O
also O
noted O
increased O
LE O
edema O
and O
weight O
gain O
which O
prompted O
a O
phone O
call O
to O
her O
PCP O
and O
increased O
lasix O
dose O
from O
80daily O
to O
100mg O
daily O
with O
some O
mild O
improvement O
in O
edema O
. O
She O
has O
had O
decreased O
appetite O
, O
PO O
intake O
, O
energy O
level O
at O
home O
with O
difficulty O
with O
ADLs O
. O
No B-NEGATION
recent O
history O
of O
fever O
, O
cough O
, O
chills O
, O
sputum O
production O
, O
CP O
, O
abd O
pain O
, O
or O
other O
complaints O
other O
than O
chronic O
right O
thigh O
pain O
last O
1 O
2 O
months O
. O
Daughter O
also O
reports O
med O
compliance O
and O
compliance O
with O
BiPap O
at O
night O
. O
Past O
Medical O
History O
CAD O
; O
s O
p O
4 O
vessel O
CABG O
in O
2119 O
CHF O
; O
EF O
55 O
, O
mild O
AS O
obesity O
hypoventilation O
syndrome O
obstructive O
sleep O
apnea O
DM2 O
ventricular O
tachycardia O
; O
s O
p O
ICD O
in O
2127 O
hypothyroidism O
schizophrenia O
COPD O
Pneumona O
treated O
in O
4 O
7 O
at O
Hospital1 O

62 O
yo O
male O
with O
hx O
of O
CVA O
, O
neurogenic O
bladder O
with O
indwelling O
suprapubic O
catheter O
with O
multiple O
prior O
admissions O
for O
UTIs O
, O
altered O
mental O
status O
, O
and O
urosepsis O
presents O
to O
the O
hospital O
in O
urosepsis O
now O
resolved O
after O
treatment O
with O
vanc O
meropenem O
. O
Per O
CT O
there O
is O
a O
non O
obstructing O
stone O
in O
the O
L O
ureter O
, O
no B-NEGATION
evidence O
of O
urethral O
strictures O
. O
Significant O
leaking O
around O
suprapubic O
cath O
site O
. O
Started O
on O
ditropan O
changed O
over O
to O
detrol O
. O
Urologist O
not O
concerned O
with O
leaking O
and O
will O
f O
u O
with O
pt O
next O
week O
. O
s O
p O
CVA O
Neurogenic O
bladder O
s O
p O
suprapubic O
cath O
Recurrent O
UTIs O
with O
Klebsiella O
Pseudomonas O
Non O
hodgkins O
Marginal O
Zone O
Lymphoma O
of O
the O
left O
orbit O
Dx O
in O
03 O
s O
p O
R O
CHOP O
x O
6 O
cycles O
Bells O
Palsy O
BPH O
Hypertension O
Partial O
Bowel O
obstruction O
s O
p O
colostomy O
Hepatitis O
C O
Cryoglobulinemia O
SLE O
with O
transverse O
myelitis O
, O
anti O
dsDNA O
Ab O
Insulin O
Dependant O
Diabetic O
Fungal O
Esophagitis O
Stage O
IV O
? O
Urinary O
Tract O
Infections O
pseudomonas O
enterococcus O





65 O
yo O
man O
with O
history O
of O
CAD O
and O
prior O
MI O
, O
HLD O
, O
HTN O
, O
ventricular O
tachycardia O
, O
and O
syncope O
was O
admitted O
earlier O
today O
evaluation O
of O
syncope O
and O
ventricular O
arrhythmias O
. O
He O
was O
recently O
discharged O
after O
a O
negative O
work O
up O
for O
syncope O
which O
included O
the O
implantation O
of O
a O
cardiac O
monitoring O
device O
. O
It O
was O
interrogated O
at O
the O
OSH O
and O
per O
report O
the O
monitor O
read O
from O
yesterday O
40 O
seconds O
of O
VT O
and O
then O
bradycardia O
with O
a O
rate O
of O
39 O
shortly O
thereafter O
corresponding O
with O
his O
symptoms O
. O
Overnight O
, O
the O
patient O
went O
into O
monomorphic O
VT O
on O
telemetry O
. O
The O
patient O
was O
found O
to O
be O
unresponsive O
. O
CPR O
was O
initiated O
, O
unclear O
if O
the O
patient O
had O
a O
pulse O
. O
Within O
one O
minute O
the O
patient O
returned O
to O
sinus O
rhythm O
. O
The O
patient O
does O
not O
report O
any O
symptoms O
prior O
to O
this O
episode O
. O
Currently O
, O
the O
patient O
feels O
presyncope O
and O
nausea O
, O
but O
denies B-NEGATION
chest O
pain O
. O
Patient O
is O
to O
be O
transferred O
to O
the O
CCU O
for O
catheterization O
and O
EPS O
. O


The O
patient O
is O
a O
57 O
year O
old O
man O
with O
abdominal O
pain O
and O
vomiting O
. O
The O
pain O
started O
gradually O
about O
20 O
hours O
ago O
in O
the O
epigastric O
and O
periumbilical O
regions O
, O
radiating O
to O
his O
back O
. O
He O
drinks O
around O
60 O
units O
of O
alcohol O
per O
week O
and O
smokes O
22 O
cigarettes O
per O
day O
. O
He O
is O
healthy O
with O
no B-NEGATION
history O
of O
allergies O
or O
using O
any O
medications O
. O
His O
family O
history O
is O
positive O
for O
type O
2 O
diabetes O
his O
father O
and O
sister O
. O
He O
lives O
alone O
and O
has O
no O
children O
. O
The O
abdomen O
is O
tender O
and O
soft O
. O
His O
bowel O
sounds O
are O
normal O
. O
His O
heart O
rate O
is O
115 O
min O
and O
blood O
pressure O
110 O
75 O
mmHg O
. O
The O
lab O
results O
are O
remarkable O
for O
leukocytosis O
19 O
. O
5 O
, O
urea O
of O
8 O
. O
5 O
, O
high O
CRP O
145 O
, O
high O
amylase O
1200 O
and O
Glc O
level O
of O
15 O
. O
Cross O
sectional O
imaging O
was O
negative B-NEGATION
for O
obstructive O
pancreatitis O
. O






A O
53 O
year O
old O
man O
presents O
with O
chronic O
HCV O
infection O
for O
the O
past O
2 O
years O
. O
His O
past O
medical O
history O
is O
only O
significant O
for O
inguinal O
hernia O
surgery O
when O
he O
was O
20 O
years O
old O
. O
He O
is O
on O
IFN O
100 O
mg O
week O
plus O
RBV O
400 O
mg O
day O
combination O
therapy O
for O
the O
past O
9 O
months O
. O
Direct O
antiviral O
drugs O
were O
added O
to O
his O
treatment O
6 O
months O
ago O
. O
His O
medical O
record O
shows O
previous O
positive O
HCV O
RNA O
tests O
as O
well O
as O
positive O
enzyme O
immunoassay O
for O
anti O
HCV O
antibodies O
. O
The O
recent O
biopsy O
was O
negative B-NEGATION
for O
hepatocellular O
carcinoma O
and O
was O
only O
remarkable O
for O
chronic O
inflammation O
compatible O
with O
a O
chronic O
viral O
hepatitis O
. O
There O
is O
no B-NEGATION
evidence O
of O
alcoholic O
liver O
disease O
, O
bleeding O
from O
esophageal O
varices O
, O
hemochromatosis O
, O
autoimmune O
hepatitis O
or O
metabolic O
liver O
disease O
. O
He O
is O
an O
alert O
male O
with O
no B-NEGATION
acute O
distress O
. O
His O
BP O
130 O
75 O
, O
HR O
90 O
min O
and O
BMI O
27 O
. O
His O
abdomen O
is O
soft O
with O
no B-NEGATION
ascites O
or O
tenderness O
. O
The O
lower O
extremities O
are O
normal O
with O
no B-NEGATION
edema O
. O


The O
patient O
is O
a O
24 O
year O
old O
man O
who O
has O
had O
type O
1 O
diabetes O
for O
11 O
years O
. O
He O
presents O
to O
the O
emergency O
room O
with O
hyperglycemia O
and O
concern O
for O
possible O
diabetic O
ketoacidosis O
after O
not O
taking O
his O
insulin O
for O
3 O
days O
. O
The O
patient O
reports O
that O
he O
is O
currently O
homeless O
and O
has O
lost O
his O
supply O
of O
insulin O
, O
syringes O
, O
glucometer O
, O
and O
glucose O
testing O
supplies O
. O
The O
patient O
states O
that O
at O
the O
time O
of O
his O
initial O
diagnosis O
with O
type O
1 O
diabetes O
he O
was O
hospitalized O
with O
a O
glucose O
value O
1000 O
mg O
dL O
. O
At O
the O
time O
, O
he O
was O
experiencing O
polyuria O
, O
polydipsia O
, O
and O
polyphagia O
. O
He O
reports O
that O
he O
has O
been O
on O
insulin O
since O
the O
time O
of O
his O
diagnosis O
, O
and O
he O
has O
never O
been O
prescribed O
oral O
agents O
for O
diabetes O
management O
. O
Most O
recently O
, O
he O
has O
been O
using O
insulin O
glargine O
55 O
units O
once O
daily O
, O
and O
insulin O
aspart O
sliding O
scale O
3 O
times O
daily O
. O
The O
patient O
has O
had O
previous O
episodes O
of O
diabetic O
ketoacidosis O
, O
for O
which O
he O
was O
hospitalized O
. O
With O
this O
episode O
of O
hyperglycemia O
, O
he O
is O
not B-NEGATION
experiencing O
any O
nausea O
, O
vomiting O
, O
or O
abdominal O
discomfort O
, O
and O
he O
appears O
well O
. O
His O
lab O
studies O
showed O
A1c O
11 O
. O
3 O
Creatinine O
0 O
. O
9 O
mg O
dL O
with O
eGFR O
60 O
mL O
min O
Aspartate O
aminotransferase O
AST O
17 O
U O
L O
Alanine O
aminotransferase O
ALT O
14 O
U O
L O
Beta O
hydroxybutyrate O
0 O
. O
1 O
mmol O
L O
Bicarbonate O
25 O
mEq O
L O
Anion O
Gap O
14 O
mEq O
L O

The O
patient O
is O
a O
33 O
year O
old O
woman O
complained O
of O
fatigue O
, O
weight O
gain O
and O
abnormal O
spotting O
between O
menses O
. O
No B-NEGATION
hirsutism O
or O
nipple O
discharge O
was O
detected O
. O
Her O
BMI O
was O
34 O
. O
Her O
lab O
results O
were O
remarkable O
for O
high O
TSH O
level O
13 O
mU O
L O
and O
low O
free O
T4 O
level O
0 O
. O
2 O
ng O
dl O
. O
Her O
anti O
TPO O
levels O
were O
extremely O
high O
120 O
IU O
ml O
. O
She O
was O
diagnosed O
with O
Hashimoto O
's O
thyroiditis O
. O
Her O
aunt O
, O
brother O
and O
mother O
have O
the O
same O
disease O
. O
After O
starting O
250 O
mcg O
Levothyroxine O
per O
day O
, O
her O
symptoms O
improved O
significantly O
and O
her O
periods O
are O
normal O
. O
She O
is O
still O
overweight O
with O
BMI O
of O
31 O
. O
Her O
most O
recent O
thyroid O
profile O
revealed O
all O
results O
except O
for O
anti O
TPO O
within O
the O
normal O
range O
TSH O
2 O
. O
35 O
mU O
L O
Free O
T4 O
2 O
. O
7 O
ng O
dl O
Anti O
TPO O
75 O
IU O
ml O


The O
patient O
is O
a O
47 O
year O
old O
Asian O
woman O
complaining O
of O
persistent O
feelings O
of O
sadness O
. O
She O
lost O
interest O
in O
activities O
she O
used O
to O
enjoy O
. O
She O
states O
that O
her O
mood O
is O
mostly O
depressed O
for O
the O
past O
3 O
weeks O
. O
She O
also O
lost O
her O
appetite O
, O
which O
led O
to O
about O
5kg O
weight O
loss O
. O
She O
complains O
of O
loss O
of O
energy O
and O
feelings O
of O
worthlessness O
nearly O
every O
day O
. O
She O
is O
not O
using O
any O
drugs O
and O
she O
does O
not O
smoke O
. O
She O
doesn O
' O
t O
drink O
alcohol O
. O
She O
used O
to O
exercise O
every O
day O
for O
at O
least O
30 O
min O
. O
But O
she O
doesn O
' O
t O
have O
enough O
energy O
to O
do O
so O
for O
the O
past O
3 O
weeks O
. O
She O
also O
has O
some O
digestive O
issues O
recently O
. O
She O
is O
married O
and O
has O
4 O
children O
. O
She O
is O
menopausal O
. O
Her O
husband O
was O
recently O
diagnosed O
with O
colon O
cancer O
and O
he O
is O
starting O
his O
chemotherapy O
. O
There O
is O
nothing O
remarkable O
in O
her O
past O
medical O
history O
and O
her O
drug O
history O
is O
only O
positive O
for O
Vit O
D3 O
1000 O
units O
daily O
. O
Her O
family O
history O
is O
negative B-NEGATION
for O
any O
psychologic O
problems O
. O
Her O
HAM O
D O
score O
is O
20 O
. O

The O
patient O
is O
a O
32 O
year O
old O
obese O
woman O
who O
came O
to O
the O
clinic O
with O
weight O
concerns O
. O
She O
is O
165 O
cm O
tall O
and O
her O
weight O
is O
113 O
kg O
. O
She O
is O
complaining O
of O
sleep O
apnea O
, O
PCO O
and O
dissatisfaction O
with O
her O
body O
shape O
. O
She O
is O
a O
high O
school O
teacher O
married O
for O
5 O
years O
. O
She O
doesn O
' O
t O
use O
any O
contraceptive O
methods O
for O
the O
past O
4 O
months O
and O
she O
had O
no B-NEGATION
prior O
pregnancies O
. O
She O
doesn O
' O
t O
smoke O
or O
use O
any O
drugs O
. O
She O
likes O
to O
try O
diets O
and O
exercise O
to O
lose O
weight O
. O
She O
completed O
the O
four O
square O
step O
test O
in O
14 O
seconds O
. O
Her O
BP O
130 O
80 O
, O
HR O
195 O
min O
and O
her O
BMI O
is O
41 O
. O
54 O
. O
Her O
labs O
FBS O
98 O
mg O
dl O
TG O
150 O
mg O
dl O
Cholesterol O
180 O
mg O
dl O
LDL O
90 O
mg O
dl O
HDL O
35 O
mg O
dl O
Her O
cardiac O
assessment O
is O
normal O
. O
Her O
joints O
and O
ROM O
are O
within O
normal O
. O


A O
3 O
day O
old O
Asian O
female O
infant O
presents O
with O
jaundice O
that O
started O
a O
day O
ago O
. O
She O
was O
born O
at O
38w3d O
of O
gestation O
, O
after O
an O
uncomplicated O
pregnancy O
. O
The O
family O
history O
is O
unremarkable O
. O
The O
baby O
is O
breastfed O
. O
Vital O
signs O
are O
reported O
as O
axillary O
temperature O
36 O
. O
3 O
C O
, O
heart O
rate O
154 O
beats O
min O
, O
respiratory O
rate O
37 O
breaths O
min O
, O
and O
blood O
pressure O
65 O
33 O
mm O
Hg O
. O
Her O
weight O
is O
3 O
. O
2 O
kg O
, O
length O
is O
53 O
cm O
, O
and O
head O
circumference O
36 O
cm O
. O
Her O
sclera O
are O
yellow O
and O
her O
body O
is O
icteric O
. O
No B-NEGATION
murmurs O
or O
any O
other O
abnormalities O
are O
detected O
in O
the O
heart O
and O
lung O
auscultation O
. O
Her O
liver O
and O
spleen O
are O
normal O
on O
palpation O
. O
Laboratory O
results O
are O
as O
follows O
Serum O
total O
bilirubin O
21 O
. O
02 O
mg O
dL O
Direct O
bilirubin O
of O
2 O
. O
04 O
mg O
dL O
AST O
37 O
U O
L O
ALT O
20 O
U O
L O
GGT O
745 O
U O
L O
Alkaline O
phosphatase O
531 O
U O
L O
Creatinine O
0 O
. O
3 O
mg O
dL O
Urea O
29 O
mg O
dL O
Na O
147 O
mEq O
L O
K O
4 O
. O
5 O
mEq O
L O
CRP O
3 O
mg O
L O
Complete O
blood O
cell O
count O
within O
the O
normal O
range O
. O
She O
is O
diagnosed O
with O
uncomplicated O
neonatal O
jaundice O
that O
may O
require O
phototherapy O
. O




A O
62 O
year O
old O
African O
American O
man O
presented O
with O
left O
upper O
and O
lower O
extremity O
weakness O
, O
associated O
with O
dark O
visual O
spot O
in O
right O
eye O
, O
right O
facial O
numbness O
, O
facial O
drop O
and O
slurred O
speech O
. O
He O
denied B-NEGATION
dyspnea O
, O
headache O
, O
palpitations O
, O
chest O
pain O
, O
fever O
, O
dizziness O
, O
bowel O
or O
urinary O
incontinence O
, O
loss O
of O
consciousness O
. O
His O
medical O
history O
was O
significant O
for O
hypertension O
, O
hyperlipidemia O
and O
hypothyroidism O
. O
He O
smokes O
cigarette O
1 O
pack O
per O
day O
for O
40 O
years O
and O
alcohol O
consumption O
of O
5 O
to O
6 O
beers O
per O
week O
. O
He O
is O
not O
aware O
about O
his O
family O
history O
. O
He O
is O
using O
Levothyroxine O
, O
Atorvastatin O
and O
HTCZ O
. O
His O
vital O
signs O
were O
stable O
in O
the O
primary O
evaluation O
. O
Left O
sided O
facial O
droop O
, O
dysarthria O
, O
and O
left O
sided O
hemiplegia O
were O
seen O
in O
the O
physical O
exam O
. O
His O
National O
Institutes O
of O
Health O
Stroke O
Scale O
NIHSS O
score O
was O
calculated O
as O
7 O
. O
Initial O
CT O
angiogram O
of O
head O
and O
neck O
reported O
no O
acute O
intracranial O
findings O
. O
Intravenous O
recombinant O
tissue O
plasminogen O
activator O
t O
PA O
was O
administered O
as O
well O
as O
high O
dose O
statin O
therapy O
. O
The O
patient O
was O
admitted O
to O
the O
intensive O
care O
unit O
to O
be O
monitored O
for O
24 O
hours O
. O
MRI O
of O
the O
head O
revealed O
an O
acute O
1 O
. O
7 O
cm O
infarct O
of O
the O
right O
periventricular O
white O
matter O
and O
posterior O
right O
basal O
ganglia O
. O


A O
34 O
year O
old O
man O
comes O
to O
the O
clinic O
complaining O
of O
dizziness O
and O
severe O
diarrhea O
since O
yesterday O
. O
He O
has O
returned O
from O
an O
international O
trip O
few O
days O
ago O
and O
was O
living O
in O
a O
camp O
in O
Sudan O
for O
a O
month O
. O
He O
developed O
abdominal O
pain O
followed O
by O
bloating O
and O
nausea O
as O
well O
as O
loose O
bowel O
movements O
. O
Soon O
he O
was O
having O
profuse O
watery O
diarrhea O
without O
odor O
. O
The O
stool O
is O
watery O
and O
white O
but O
the O
patient O
has O
no B-NEGATION
fever O
. O
Blood O
pressure O
is O
95 O
62 O
lying O
down O
and O
drops O
to O
75 O
40 O
standing O
. O
The O
skin O
turgor O
has O
reduced O
. O
HR O
is O
110 O
and O
he O
looks O
ill O
with O
dry O
mucosa O
. O
V O
. O
cholerae O
was O
seen O
in O
dark O
field O
microscopy O
of O
a O
fresh O
stool O
specimen O
. O
The O
lab O
study O
is O
as O
bellow O
Sodium O
137 O
meq O
L O
Potassium O
2 O
meq O
L O
Chloride O
94meq O
L O
CO2 O
15 O
meq O
L O
Fecal O
leukocytes O
None O
seen O
Fecal O
occult O
blood O
Negative O



The O
patient O
is O
a O
17 O
year O
old O
boy O
complaining O
of O
severe O
migratory O
pain O
in O
the O
right O
lower O
quadrant O
of O
his O
abdomen O
that O
started O
four O
days O
ago O
. O
The O
pain O
is O
accompanied O
by O
nausea O
and O
vomiting O
. O
He O
was O
febrile O
with O
tenderness O
, O
rebound O
tenderness O
and O
guarding O
on O
palpation O
. O
His O
WBC O
was O
elevated O
with O
dominant O
neutrophils O
. O
CT O
scan O
showed O
evidence O
of O
acute O
perforated O
appendicitis O
with O
free O
fluid O
in O
the O
pelvis O
. O
Diagnostic O
laparoscopy O
revealed O
phlegmon O
with O
no B-NEGATION
other O
abdominal O
abnormalities O
. O
He O
is O
now O
a O
candidate O
for O
emergent O
laparoscopic O
appendectomy O
under O
general O
anesthesia O
. O


A O
42 O
year O
old O
healthy O
woman O
came O
to O
the O
clinic O
to O
have O
her O
flu O
shot O
in O
early O
October O
. O
She O
works O
in O
a O
rehab O
center O
and O
has O
no O
underlying O
disease O
. O
It O
's O
her O
first O
time O
getting O
the O
vaccine O
this O
year O
. O
She O
is O
married O
for O
5 O
years O
and O
uses O
barrier O
methods O
of O
contraception O
. O
Her O
menstrual O
cycle O
is O
irregular O
. O
She O
does O
not O
smoke O
. O
She O
is O
not O
on O
any O
medications O
. O
She O
exercises O
regularly O
for O
30 O
minutes O
a O
day O
at O
least O
5 O
days O
a O
week O
. O
She O
has O
no B-NEGATION
history O
of O
allergies O
to O
any O
food O
or O
drugs O
. O
Her O
past O
surgical O
history O
is O
significant O
for O
tonsillectomy O
and O
she O
is O
otherwise O
healthy O
. O




19 O
yo O
Hispanic O
female O
G1P1 O
at O
32 O
6 O
weeks O
of O
gestational O
age O
presented O
to O
the O
OB O
clinic O
for O
routine O
follow O
up O
complaining O
of O
mild O
headache O
and O
leg O
swelling O
. O
Primary O
evaluation O
revealed O
BP O
of O
146 O
99 O
and O
urine O
dipstick O
with O
3 O
proteins O
. O
Her O
BP O
and O
U O
A O
were O
normal O
in O
previous O
visit O
. O
Repeat O
BP O
a O
few O
hours O
later O
is O
150 O
100 O
mmHg O
. O
Laboratory O
studies O
showed O
a O
normal O
hematocrit O
, O
platelet O
count O
, O
and O
liver O
transaminase O
levels O
. O
She O
is O
complaining O
of O
fatigue O
but O
no B-NEGATION
fever O
or O
chills O
. O
She O
is O
also O
suffering O
of O
headaches O
with O
no O
vision O
changes O
. O
No B-NEGATION
shortness O
of O
breath O
, O
cough O
, O
chest O
pain O
, O
orthopnea O
and O
palpitations O
or O
skin O
rash O
were O
observed O
. O
Her O
physical O
exam O
was O
negative B-NEGATION
for O
abdominal O
pain O
, O
change O
in O
bowel O
habits O
, O
nausea O
, O
vomiting O
, O
dysuria O
, O
frequency O
, O
hematuria O
or O
frothy O
urine O
. O
Leg O
swelling O
was O
observed O
with O
no B-NEGATION
arthralgia O
or O
back O
pain O
. O
She O
has O
no O
specific O
past O
medical O
issues O
and O
only O
uses O
prenatal O
vitamins O
. O
Her O
family O
history O
is O
positive O
for O
DM O
type O
2 O
and O
HTN O
. O
She O
is O
a O
social O
alcohol O
consumer O
with O
the O
negative O
history O
of O
smoking O
or O
drug O
use O
. O
She O
is O
only O
have O
one O
partner O
in O
past O
2 O
years O
and O
didn O
' O
t O
have O
any O
contraceptive O
methods O
since O
2 O
years O
ago O
. O
Her O
BMI O
was O
24 O
at O
the O
first O
visit O
when O
she O
was O
at O
6 O
weeks O
of O
gestational O
age O
. O
She O
is O
getting O
weight O
normally O
during O
her O
pregnancies O
. O


The O
patient O
is O
a O
34 O
year O
old O
African O
American O
man O
with O
the O
known O
history O
of O
Sickle O
cell O
disease O
comes O
to O
the O
clinic O
with O
severe O
bone O
pain O
. O
The O
patient O
had O
severe O
pain O
in O
his O
lower O
back O
that O
radiated O
to O
both O
thighs O
scored O
9 O
out O
of O
10 O
. O
The O
patient O
has O
had O
positive O
history O
of O
sickle O
cell O
crises O
since O
childhood O
. O
He O
also O
had O
the O
same O
symptoms O
in O
past O
two O
weeks O
treated O
with O
oxycodone O
which O
was O
not O
beneficial O
to O
his O
pain O
. O
His O
PCP O
sent O
him O
to O
the O
emergency O
department O
to O
receive O
intra O
venous O
pain O
modulators O
. O
The O
patient O
is O
afebrile O
within O
the O
normal O
blood O
pressure O
. O
No B-NEGATION
splenomegaly O
was O
detected O
in O
the O
physical O
exam O
. O
He O
has O
no O
positive O
history O
of O
drug O
allergy O
. O
He O
won O
' O
t O
smoke O
or O
uses O
any O
illicit O
drugs O
. O
The O
lab O
study O
is O
as O
bellow O
Hgb O
8 O
g O
dl O
WBC O
10000 O
mm3 O
Plt O
300000 O
ml O
MCV O
106 O
fL O
Hemoglobine O
electrophoresis O
91 O
HbS O
6 O
HbF O
3 O
HbA2 O
AST O
22 O
U O
L O
ALT O
43 O
U O
L O
Alk O
P O
53 O
U O
L O
Ferritin O
1200 O
ng O
ml O

Fernandez O
is O
a O
41 O
year O
man O
who O
is O
a O
professional O
soccer O
player O
. O
He O
came O
to O
the O
clinic O
with O
itchy O
foot O
. O
Physical O
exam O
revealed O
localized O
scaling O
and O
maceration O
between O
the O
third O
and O
fourth O
of O
his O
right O
toe O
. O
It O
became O
inflamed O
and O
sore O
, O
with O
mild O
fissuring O
. O
The O
dorsum O
and O
sole O
of O
the O
foot O
was O
unaffected O
. O
There O
is O
no O
pus O
or O
tearing O
in O
the O
affected O
area O
. O
He O
didn O
' O
t O
use O
ant O
topical O
ointment O
on O
the O
lesion O
and O
has O
no B-NEGATION
positive O
history O
for O
any O
underlying O
disease O
such O
as O
DM O
. O
He O
smokes O
15 O
cigarettes O
per O
day O
and O
drinks O
a O
beer O
per O
day O
. O
His O
family O
history O
is O
positive O
for O
hyperlipidemia O
in O
her O
mother O
and O
MI O
in O
her O
father O
. O
He O
is O
in O
relation O
with O
several O
partners O
and O
use O
condom O
during O
the O
intercourse O
. O
His O
physical O
exam O
and O
lab O
studies O
were O
normal O
otherwise O
. O
Tinea O
pedis O
infection O
confirmed O
as O
his O
diagnosis O
by O
the O
observation O
of O
segmented O
fungal O
hyphae O
during O
a O
microscopic O
KOH O
wet O
mount O
examination O
. O

A O
5 O
months O
old O
male O
brought O
to O
the O
pediatrics O
surgery O
clinic O
with O
the O
complaint O
of O
empty O
scrotum O
at O
the O
right O
side O
. O
The O
baby O
boy O
is O
a O
first O
child O
who O
was O
born O
at O
the O
age O
of O
38 O
weeks O
with O
NVD O
from O
a O
healthy O
mother O
. O
The O
mother O
had O
a O
normal O
pregnancy O
with O
no O
complication O
. O
The O
baby O
boy O
weighted O
3200 O
gr O
with O
the O
height O
of O
50 O
cm O
. O
He O
is O
breast O
feeding O
and O
now O
weighted O
as O
6 O
. O
5 O
kg O
with O
the O
height O
of O
62 O
cm O
. O
He O
has O
no B-NEGATION
developmental O
delay O
in O
the O
physical O
assessment O
. O
There O
is O
a O
palpable O
testis O
is O
the O
left O
scrotum O
with O
non O
palpable O
testis O
in O
the O
right O
scrotum O
. O
The O
penis O
is O
normal O
in O
shape O
and O
size O
and O
he O
is O
not O
circumcised O
. O
The O
diagnostic O
laparoscopy O
showed O
an O
abdominal O
undescended O
testis O
. O

The O
patients O
is O
a O
25 O
year O
old O
G1 O
P1 O
pregnant O
woman O
who O
is O
24W3D O
gestational O
old O
who O
developed O
a O
sudden O
unset O
of O
fever O
and O
chills O
, O
accompany O
with O
nausea O
and O
vomiting O
. O
She O
also O
complains O
of O
dysuria O
, O
urgency O
and O
frequency O
. O
She O
also O
reports O
some O
severe O
pain O
in O
the O
flank O
. O
Her O
vital O
signs O
are O
T O
39 O
. O
7ºC O
, O
P O
117 O
, O
R O
20 O
, O
and O
BP O
113 O
74 O
mm O
Hg O
. O
Physical O
examination O
reveals O
tenderness O
on O
palpation O
of O
both O
costovertebral O
angles O
. O
She O
has O
no B-NEGATION
history O
of O
recurrent O
UTI O
prior O
to O
her O
pregnancy O
or O
any O
other O
underlying O
disease O
. O
The O
urine O
culture O
showed O
Gram O
negative O
rod O
shaped O
bacterial O
cells O
, O
leukocytes O
, O
and O
leukocyte O
casts O
. O
The O
blood O
culture O
is O
negative O
. O
A O
CBC O
shows O
Hb O
12 O
. O
9 O
g O
dL O
, O
Hct O
39 O
, O
MCV O
76 O
fL O
, O
WBC O
count O
14 O
, O
120 O
µL O
. O



The O
patient O
is O
a O
41 O
year O
old O
obese O
woman O
coming O
to O
the O
emergency O
room O
with O
abdominal O
pain O
and O
vomiting O
. O
The O
pain O
that O
started O
gradually O
yesterday O
is O
located O
in O
the O
epigastric O
and O
periumbilical O
regions O
, O
radiating O
to O
her O
back O
. O
She O
drinks O
alcohol O
frequently O
and O
does O
not O
smoke O
. O
She O
has O
no B-NEGATION
history O
of O
allergies O
and O
uses O
only O
multivitamins O
daily O
. O
Her O
family O
history O
is O
positive O
for O
hypertension O
her O
mother O
. O
She O
lives O
with O
her O
husband O
and O
has O
3 O
children O
. O
The O
abdomen O
is O
tender O
and O
soft O
. O
Her O
bowel O
sounds O
are O
normal O
. O
Her O
heart O
rate O
is O
115 O
min O
and O
blood O
pressure O
110 O
75 O
mmHg O
. O
The O
lab O
studies O
are O
remarkable O
for O
leukocytosis O
19 O
. O
5 O
, O
urea O
of O
8 O
. O
5 O
, O
high O
CRP O
145 O
, O
high O
amylase O
1200 O
and O
Glucose O
level O
of O
15 O
. O
Her O
abdominal O
CT O
scan O
revealed O
acute O
edematous O
interstitial O
pancreatitis O
with O
enlarged O
common O
bile O
duct O
and O
intrahepatic O
duct O
confirming O
gall O
stone O
pancreatitis O
. O
Her O
pregnancy O
test O
is O
negative B-NEGATION
and O
she O
is O
not O
breastfeeding O
. O






The O
patient O
is O
a O
55 O
year O
old O
man O
diagnosed O
with O
HCV O
2 O
years O
ago O
and O
the O
recent O
coinfection O
with O
HBV O
. O
His O
past O
medical O
history O
is O
non O
significant O
. O
He O
is O
on O
IFN O
, O
RBV O
and O
direct O
antiviral O
drugs O
for O
the O
past O
6 O
months O
. O
The O
patient O
takes O
no O
other O
medications O
. O
His O
medical O
records O
show O
previous O
positive O
HCV O
RNA O
tests O
and O
a O
positive O
enzyme O
immunoassay O
for O
anti O
HCV O
antibodies O
. O
The O
recent O
biopsy O
was O
negative B-NEGATION
for O
hepatocellular O
carcinoma O
and O
was O
only O
remarkable O
for O
chronic O
inflammation O
compatible O
with O
a O
chronic O
viral O
hepatitis O
. O
There O
is O
no B-NEGATION
evidence O
of O
alcoholic O
liver O
disease O
, O
bleeding O
from O
esophageal O
varices O
, O
hemochromatosis O
, O
autoimmune O
hepatitis O
, O
or O
metabolic O
liver O
disease O
. O
He O
is O
an O
alert O
male O
with O
no B-NEGATION
acute O
distress O
. O
His O
BP O
130 O
75 O
, O
HR O
90 O
min O
and O
BMI O
27 O
. O
His O
abdomen O
is O
soft O
with O
no O
ascites O
or O
tenderness O
. O
The O
lower O
extremities O
are O
normal O
with O
no B-NEGATION
edema O
. O

The O
patient O
is O
a O
25 O
year O
old O
man O
with O
type O
1 O
diabetes O
confirmed O
with O
molecular O
analysis O
7 O
years O
ago O
. O
He O
presents O
to O
the O
clinic O
with O
shortness O
of O
breath O
and O
fatigue O
during O
activities O
. O
He O
claims O
mild O
dyspnea O
after O
climbing O
3 O
floors O
, O
no B-NEGATION
dyspnea O
at O
rest O
and O
no B-NEGATION
angina O
New O
York O
Heart O
Association O
class O
2 O
. O
He O
is O
diagnosed O
with O
cardiomyopathy O
that O
will O
be O
treated O
with O
ACE O
inhibitors O
and O
Beta O
blockers O
. O
His O
takes O
70 O
30 O
Insulin O
and O
vitamin O
D O
supplements O
. O
His O
past O
medical O
history O
is O
not O
significant O
for O
any O
other O
medical O
issues O
. O
His O
family O
history O
is O
positive O
for O
DM O
type O
1 O
in O
his O
uncle O
and O
his O
grandfather O
. O
His O
lab O
study O
is O
as O
bellow O
FBS O
100 O
mg O
dl O
HbA1c O
6 O
. O
5 O
Cholesterol O
190 O
mg O
dl O
TG O
140 O
mg O
dl O
LDL O
125 O
mg O
dl O
HDL O
40 O
mg O
dl O




A O
67 O
year O
old O
healthy O
woman O
came O
to O
the O
clinic O
to O
have O
her O
flu O
shot O
in O
early O
October O
. O
She O
works O
at O
a O
rehab O
center O
and O
has O
no O
underlying O
disease O
. O
It O
is O
her O
first O
vaccination O
this O
year O
. O
she O
is O
menopausal O
and O
has O
4 O
children O
. O
She O
does O
not O
some O
. O
She O
takes O
daily O
multivitamins O
and O
anti O
hypertensive O
drugs O
. O
She O
exercises O
regularly O
for O
30 O
minutes O
a O
day O
at O
least O
5 O
days O
a O
week O
. O
She O
has O
no B-NEGATION
allergies O
to O
any O
food O
or O
drugs O
. O

A O
46 O
year O
old O
Asian O
woman O
with O
MDD O
complains O
of O
persistent O
feelings O
of O
sadness O
and O
loss O
of O
interest O
in O
daily O
activities O
. O
She O
states O
that O
her O
mood O
is O
still O
depressed O
most O
of O
the O
days O
. O
She O
complains O
of O
loss O
of O
energy O
and O
feelings O
of O
worthlessness O
nearly O
every O
day O
. O
She O
is O
on O
anti O
depressants O
for O
the O
past O
6 O
months O
, O
but O
the O
symptoms O
are O
still O
present O
. O
She O
does O
not O
drink O
alcohol O
or O
smoke O
. O
She O
used O
to O
exercise O
every O
day O
for O
at O
least O
30 O
min O
. O
, O
but O
she O
doesn O
' O
t O
have O
enough O
energy O
to O
do O
so O
for O
the O
past O
3 O
weeks O
. O
She O
also O
has O
some O
digestive O
issues O
recently O
. O
She O
is O
married O
and O
has O
4 O
children O
. O
She O
is O
menopausal O
. O
Her O
husband O
was O
diagnosed O
with O
colon O
cancer O
a O
year O
ago O
and O
is O
undergoing O
chemotherapy O
. O
Her O
past O
medical O
history O
is O
unremarkable O
. O
Her O
family O
history O
is O
negative B-NEGATION
for O
any O
psychologic O
problems O
. O
Her O
HAM O
D O
score O
is O
20 O
. O

The O
patient O
is O
a O
34 O
year O
old O
obese O
woman O
who O
comes O
to O
the O
clinic O
with O
weight O
concerns O
. O
She O
is O
165 O
cm O
tall O
, O
and O
her O
weight O
is O
113 O
kg O
BMI O
41 O
. O
5 O
. O
In O
the O
past O
, O
she O
unsuccessfully O
used O
antiobesity O
agents O
and O
appetite O
suppressants O
. O
She O
is O
complaining O
of O
sleep O
apnea O
, O
PCO O
and O
dissatisfaction O
with O
her O
body O
shape O
. O
She O
is O
a O
high O
school O
teacher O
. O
She O
is O
married O
for O
5 O
years O
. O
She O
doesn O
' O
t O
use O
any O
contraceptive O
methods O
for O
the O
past O
4 O
months O
and O
she O
had O
no B-NEGATION
prior O
pregnancies O
. O
She O
rarely O
exercises O
and O
movement O
seems O
to O
be O
hard O
for O
her O
. O
She O
is O
not O
able O
to O
complete O
the O
four O
square O
step O
test O
in O
less O
than O
15 O
seconds O
. O
She O
does O
not O
smoke O
or O
use O
any O
drugs O
. O
Her O
BP O
130 O
80 O
, O
HR O
195 O
min O
and O
her O
BMI O
is O
41 O
. O
54 O
. O
Her O
lab O
results O
FBS O
98 O
mg O
dl O
TG O
150 O
mg O
dl O
Cholesterol O
180 O
mg O
dl O
LDL O
90 O
mg O
dl O
HDL O
35 O
mg O
dl O
She O
is O
considering O
a O
laparoscopic O
gastric O
bypass O
. O

The O
patient O
is O
a O
16 O
year O
old O
girl O
recently O
diagnosed O
with O
myasthenia O
gravis O
, O
class O
IIa O
. O
She O
complains O
of O
diplopia O
and O
weakness O
affecting O
in O
her O
upper O
extremities O
. O
She O
had O
a O
positive O
anti O
AChR O
antibody O
test O
, O
and O
her O
single O
fiber O
electromyography O
SFEMG O
was O
positive O
. O
She O
is O
on O
acetylcholinesterase O
inhibitor O
treatment O
combined O
with O
immunosuppressants O
. O
But O
she O
still O
has O
some O
symptoms O
. O
She O
does O
not O
smoke O
or O
use O
illicit O
drugs O
. O
She O
is O
not O
sexually O
active O
, O
and O
her O
menses O
are O
regular O
. O
Her O
physical O
exam O
and O
lab O
studies O
are O
not O
remarkable O
for O
any O
other O
abnormalities O
. O
BP O
110 O
75 O
Hgb O
11 O
g O
dl O
WBC O
8000 O
mm3 O
Plt O
300000 O
ml O
Creatinine O
0 O
. O
5 O
mg O
dl O
BUN O
10 O
mg O
dl O
Beta O
hcg O
negative B-NEGATION
for O
pregnancy O



The O
patient O
is O
a O
55 O
year O
old O
man O
who O
was O
recently O
diagnosed O
with O
Parkinson O
's O
disease O
. O
He O
is O
complaining O
of O
slowness O
of O
movement O
and O
tremors O
. O
His O
disease O
is O
ranked O
as O
mild O
, O
Hoehn O
Yahr O
Stage O
I O
. O
His O
past O
medical O
history O
is O
significant O
for O
hypertension O
and O
hypercholesterolemia O
. O
He O
lives O
with O
his O
wife O
. O
They O
have O
three O
children O
. O
He O
used O
to O
be O
active O
with O
gardening O
before O
his O
diagnosis O
. O
He O
complains O
of O
shaking O
and O
slow O
movement O
. O
He O
had O
difficulty O
entering O
through O
a O
door O
, O
as O
he O
was O
frozen O
and O
needed O
guidance O
to O
step O
in O
. O
His O
handwriting O
is O
getting O
smaller O
. O
He O
is O
offered O
Levodopa O
and O
Trihexyphenidyl O
. O
He O
is O
an O
alert O
and O
cooperative O
man O
who O
does O
not B-NEGATION
have O
any O
signs O
of O
dementia O
. O
He O
does O
not O
smoke O
or O
use O
any O
illicit O
drugs O
. O