Medtrans 2nd Batch

obi keyterms

2006-03-15T01:59:00.000+08:00

abdominopelvic CT scan
abstain
adenofibroma
adnexa
Advil
amniotic fluid
ampicillin
Ancef
anorexic
anterior leaf of the broad ligament
apex
Apgar score
appendiceal abscess
autostapler
axilla
bimanual examination
bladder blade
blunt dissection
bowel gas
breast implant reconstruction
broad ligament
G-section
Candida
carcinoma in situ
cardinal ligament
cuadad
cephalad, cephalic
cervical os
cervical stump
cervicitis
Chlamydia enzyme test
CIN-3 (cervical intraepithelial neoplasia, grade 3)
Colace
Compazine
condyloma acuminatum
cryosurgery
cystadenoma
cystitis
cystocele
cystourethrocele
D&C (dilatation and curettage)
Darvocet-N 100
deciduoid reaction
DeLee trap
Demulen
descensus
diplococci
dysplasia
enterocele
epithelial cells
estrogen replacement therapy
exploratory laparotomy
exteriorized
extracellular
extubated
exudate
fallopian tube
fetal heart tones
fibrocystic disease, breasts
fibromyomata
finger cot
finger dissection
Flagyl
flank pain
Fleet enema
follicular cyst
forceps blade
forzen section diagnosis
fundal height
fundectomy
fundus of the uterus
Garnerella
gestation
giant cell formation
gonorrhea
gravida
herpes simplex
hypertrophic
hysterectomy clamp
induration
infundibulopelvic ligament
introitus
Jorgenson scissors
Kocher clamp
labium minus
large-cell carcinoma
leiomyomata
leukorrhea
linea alba
LMP (last menstrual period)
low cervical transverse
C-section
mammogram
mastitis
Mayo scissors
meconium
menarche
menometrorrhagia
Mighty-Vac vacuum extractor
multipara
myoma
nonstress test (pregnancy)
O'Connor-O'Sullivan retractor
ovarian cystadenoma
Pap smear
papilloma
para 3, 2-0-1-2
pedicle
pelvic inflammatory disease (PID)
pelvic relaxation
Pfannenstiel incision
placenta
postcoital
Premarin
pretibial edema
primipara
progesterone
Provera
reapproximated
rectocele
rectovaginal septum
rectus muscles
retorverted uterus
Rh negative
unsensitized
round ligament
rugous
salpingo-oophorectomy
secretory endometrium
Stadol
STD screen subcutaneous mastectomy
submucous
sulfa
suture
0 Dexon
chromiccontinuous
figure-of-8
imbricating
interlocking
locking
running
suture-ligated
TA-55 articulator
TA-55 Roticulator
TAH ( total abdominal hysterectomy)
tenaculum
Thayer-Martin test
toluidine O
toxemia
transceted
Trichomonas
tubal pregnancy
Tzanck smear
urethrovesical angle
uterine decensus
uterine gutter
uterine leiomyomata
vaginal cuff
vaginal vault
VBAC (vaginal birth after cesarean)
vector
vesicouterine reflection
vesicovaginal fistula
Vicodin
wet mount
zinc oxide ointment
Zovirax

Gastro keyterms

2006-03-15T01:47:00.000+08:00

abdominal series
abscess
acid regurgitation
acute abdomen series
adenopathy
adherent
adhesions
air-contrast barium enema
air-fluid level
ANA ( antinuclear antibody)
anal sphincter
antacid
antibiotic
antireflux
AP diameter of chest
appendectomy
appendicitis
appendix
gangrenous
rectocecal
approximated
ASHD (anteriosclerotic heart disease)
atrophic gastritis
auscultation
bands
barium enema
belching
bethanechol
bile
bile reflux
biliary colic
bloating
bowel sounds
breath sounds
C. (Clostridium) difficile
cecum
cholecystitis
cholelithiasis
clamped
codeine
colon
ascending
descending
proximal
sigmoid
transverse
colonoscopy
constipation
COPD ( chronic obstructive pulmonary disease)
copious
Crohn disease
curvilinear incision
cystic artery
cystic duct
debris
dehydration
Demerol
diabetes mellitus
diarrhea
diet
BRAT
clear liquid
high-bulk
low-fat
difficulty swallowing
diffusely
discrete
dissection
blunt
finger
diverticulitis
diverticulosis
diveritculum, diveritcula
dorsal lithotomy position
duodenal bulb
duodenal ulcer
duodenitis
duodenum
dysfunction
dyspeptic
dysphagia
early satiety
electrocautery
electrocoagulated
electrophoresis
emergent
endoscopy
endotracheal
enteric-coated aspirin
epigastrium
Epstein-Barr (EB)
esophageal hyperkeratosis
esophagitis
excised
exercise-induced asthma
exploratory laparotomy
external muscular fascia
external oblique muscle
fascial defect
fecalith
fevers, chills, and sweats.
FEV1
filmy adhesions
full-thickness skin graft
fundus
gallbladder ultrasound
gallstones
gangrene
gangrenous appendicitis
gastric antrum
gastric contents
gastric mucosa
gastroduodenal
gastroenteritis
gastroscope
gastroscopy
general endotracheal anesthesia
GERD
Gram stain
grasper
guaiac-positive stool
gutter
Hasson retractor
Hasson trocar
hematemesis
Hemoccult card
hemorrhage
hemorrhoids
external
internal
hemostasis
hernia
hiatal
indirect
inguinal
sliding-type hiatal
herniorrhapy
hilar clip
hyaline casts
hyperactive
hypoactive
ileus
incision
indigestion
induced
inflammatory bowel disease
inflamed
infraumbilical incision
intraoperative
irritable bowel syndrome
jugular venous distention
Kocher clamp
KUB x-ray
laparoscopic cholecystectomy
lap pad (laparotomy)
left lower quadrant
left upper quadrant
left shift (on differential WBC count)
ligate, ligated
ligature
liver panel
long-standing
McBurney's point
mesoappendix
midepigastric
muscle layers
muscle-splitting technique
multisystem
nausea
necrosis, necrotic
NG ( nongastric) tube
normal saline
NSAID (nonsteroidal antiinflammatory drug)
obliquely
obstipated
Olympus GIF-K gastroscope
omentum
operative cholangiogram
operative field
organic disease
palpitations
paralytic
parrot scissors
paternal
pending
peptic ulcer disease
perforation
peripheral edema
peritoneal cavity
peritoneal fluid
peritonealized
periumbilical area
phlegm
pleural effusion
pleurisy
pneumoperitoneum
port
epigastric
lateral
umbilical
profuse
prothrombin time (PT, protime)
protrusion
purulent debris
pylorus
radiating
rebound constipation
rebound tenderness
rectum
referred tenderness
reflux
regurgitation
retrocecal
rheumatoid factor
rhythm
right lower quadrant
right upper quadrant
rugal folds
serum protein
sigmoidoscopy
sinus bradycardia
small bowel obstruction
small bowel series
sphincter
spillage
sponge and needle counts
Steri-strips
stoolculture
subcostal plane
substernal
superficial tenderness
supine
surgical clips
suture
0
2-0
3-0
catgut
dermal
interrupted
PDS
plain
Vicryl
Z-type
suture removal
symptomatic
tinkling bowel sounds
transit time
tympanitic
upper GI x-ray
upper GI with small bowel series
x3
viral gastroenteritis
vomiting

Clinic A 60026

2006-02-28T13:59:00.000+08:00

Patient Name: Maroney, Lorraine
MRNo: 487867

Mrs. Maroney returns for followup of osteoarthritis of the knees. She has decided that she wants to have the right total knee replaced. This is booked with Dr. Ares in late July. She would like to have the left injected. She thinks the injections do help, but unfortunately, they do not last very long. She remains on naproxen in the form of Aleve 20 mg t.i.d.

PHYSICAL EXAM: Weight 182, blood pressure 120/74, pulse 72. She is a very pleasant elderly female in no acute distress. Her gait reveals that she limps on the right leg. The left has a range from 0-100 degrees with medial line tenderness and small effusions.. The right has a range from 0-100 degrees with medial line tenderness and a moderate-sized effusion.

IMPRESSION:
1. OA of the knees, severe on the right. She is going to go ahead and get a knee replacement. On the left side, I think it is reasonable to try another injection as surgery is not for six weeks. I have also told her that two weeks before the surgery, she should stop the Aleve. I have given her prescription for Darvocet-N 100. She can take up to one tablet t.i.d. p.r.n. for pain. If needed when she stops the naproxen. She tells me she has tolerated it well in the past. She was given her prescription for 50 times one refill.

PROCEDURE:After sterile prep, the left knee was injected with 2 cc of 1% Xylocaine and 40 mg of Depo-Medrol. She tolerated the procedure well.

2. At this point, I will have her see me p.r.n. She knows to make an appointment once her surgery and postop course are resolved.

Date Transcribed: <02/08/2006>
Time Start: <1:04>
Time End: <01:25>

LC = 24.25

clinic a 90014

2006-02-23T11:25:00.000+08:00

Patient Name: Jews, Richard
MRNo: 556910

This is a 54-year-old patient I am seeing on behalf of Mr. Drexler, a physician’s assistant. The patient is here because of asymmetrical prostate. His current PSA is 0.8, all of his PSAs have been less than one. As we are talking, the patient denies any significant urinary symptoms. He states his stream might not be as strong as it was, but he could still write his name in the snow. He denies any nocturia, denies any frequency or urgency. He does narrate some problems with some erectile performance recently. He states that he did feel depressed when he will have problems on having an erection. However, when he self-stimulates he has no problems with attaining or maintaining an erection. He has been on a long-term relationship with his fiancée. He does not really have intentions of being married. He has been married in the past and was burnt. He does find that he is not as excited, but he is not interested in other people nor does he fantasize about other women. He does want to be with this person.

Today, we have discussed that this could be an issue related to low testosterone and libido. I will get a free and a total testosterone level on this patient. We have talked about the use of PDE5 inhibitors, but he states that he has been able to get erections without those without any difficulty and prove that he could. He does not feel that it is a problem with erectile functioning. I did talk about the role of sex therapist if he continues to have this problem and it is not related to testosterone.

The patient’s past medical history is significant for arthritis.

CURRENT MEDICATIONS: Motrin and Plaquenil.

ALLERGIES TO MEDICATIONS: None.

PAST SURGICAL HISTORY: Back surgery 2001 and 2002 for herniated L4-L5 disk. He does have another L3-L4 bulging disk.

SOCIAL HISTORY: The patient is engaged to long-term relationship. He smokes approximately four cigarettes a day. He uses alcohol once a week.

Family HISTORY: Not significant for any bladder, prostate, or renal cancers. His father died at the age of 89 with natural causes. Mother died at 84. She did have arthritis. He has a sister living and well. He states that his grandfather was an alcoholic as well as his father.

PAST UROLOGICAL HISTORY: None.

REVIEW OF SYSTEMS: Significant only for the chronic back pain. He does have some left toe numbness and left foot numbness which is the result of his L4-L5 disk herniation. He denies any fecal incontinence. He denies any urinary incontinence.

PHYSICAL EXAM: A male in no acute distress. Abdomen: Benign, no masses, organomegaly, or bruit. Prostate exam reveals a normal-sized prostate. Right lobe might be slightly larger than the left, but is not significant. The patient does clench down very tightly during a rectal exam, but the gland is free of any nodules or any areas of induration.

ASSESSMENT AND PLAN:
1. Mildly asymmetric prostate, a PSA of less than 1; minimal risk of cancer of the prostate with a PSA this low. No further evaluation is necessary at this time except for annual digital rectal exams.
2. Decreased libido. Free testosterone and testosterone level. I will contact the patient with the results. If abnormal, we will consider then treatment with exogenous testosterone. The patient is in agreement with this plan.

Date Transcribed: <02/10/2006
Time Start: <01:19>
Time End: <02:18>

LC = 51.4

clinic 60028

2006-02-22T14:19:00.000+08:00

Patient Name: Weagle, Doris
MRNo: 637737

Doris is an 84-year-old patient of Dr. Nancy Phillip referred for evaluation of chronic worsening bilateral knee pain. She says that her knees have bothered her for about 30 years. She has been noticing much worsening discomfort for the last few months. She says they swell; it is hard to walk up and down stairs due to pain. She has given up shopping in large supermarkets because of the distance that has to be walked. She does have some nocturnal pain. Tylenol or using Bengay helps. She has not tried physical therapy or glucosamine. NSAIDs are avoided because of her chronic warfarin. She also complains that her ankles and feet hurt mostly around the stocking line where she tends to get swelling. Dr. Phillip recently gave her a diuretic which helps.

PAST MEDICAL HISTORY: Hypertension, A-fib.

REVIEW OF SYSTEMS: Her wrist occasionally ache. Few years ago, the left revealed degenerative disease.

FAMILY MEDICAL HISTORY: Her mother had arthritis in her legs.

PERSONAL/SOCIAL HISTORY: She is a retired office worker. She does not smoke and rarely drinks alcohol.

MEDICATIONS: Atenolol 25 mg q.d.; furosemide 20 mg q.d.; warfarin 2.5 mg Mondays, Wednesday, and Friday or as directed; lisinopril 10 mg q.d.; HCTZ as needed for edema; Digitek 0.125 mg per day.

PHYSICAL EXAM: Weight 169, blood pressure 154/72, pulse 96. She is a very pleasant elderly female in no acute distress.
CHEST: Clear.
CARDIAC EXAM: Normal first and second heart sound.
HANDS: Revealed Heberden’s nodes, but they are nontender. The base joint of both thumbs have marked flaccid motion. The wrists, elbows, and shoulders have full range without pain. Hips have good range. Knees have small effusions range from 0-100 degrees with slight crepitus. The area has minimal medial line tenderness. There are small effusions. The ankles and feet are edematous, but there is no loss of motion and the joints are nontender.

IMPRESSION: Complaints of bilateral knees pain and swelling. Most likely this represents osteoarthritis.

PLAN:
1. I have suggested that given her contraindication to NSAIDs due to the warfarin, then we try corticosteroid injections. If that is not effective, then we could try glucosamine here. In addition, I think it would be good to get x-rays to confirm her diagnosis. She is in agreement with this plan.

Procedure: After discussing the relative risks, benefits, and alternatives, each knee was injected with 2 cc of 1% Xylocaine and 40 mg of Depo-Medrol following sterile prep. She tolerated the procedure well.

2. Check bilateral standing knee x-rays today.
3. See me again in three months or sooner if needed.

Date Transcribed: <02/08/2006>
Time Start: <02:25>
Time End: <04:10>
Break 15 min
xc: Nancy Phillip, M.D.

LC = 41.77

clinic a 60024

2006-02-22T13:58:00.000+08:00

Patient Name: Hollace, Ralph
MRNo: 215660

Mr. Hollace returns for followup of inflammatory arthritis and osteoarthritis of the hands. He also has severe lumbar spinal stenosis. He has been taking the Darvocet up to every six hours occasionally for the pain in his legs which is worse with standing. He finds that the arthritis in his hands is under good control. He thinks that the current medication program works well for that. This includes the following: Prednisone 2.5 mg q.o.d., hydroxychloroquine 200 mg every other day, propoxyphene with acetaminophen 3 per day.

He has also been taking Fosamax 70 mg once a week times six per day, two glasses of milk, and a multiple vitamin for prevention of bone loss while on prednisone. He wonders if he could get off the Fosamax.

Additional medicines:
1. Aspirin 325 mg q.d.
2. Digitek 0.25 mg q.d.
3. Ibuprofen 400 t.i.d.
4. Prednisone 2.5 q.o.d.
5. Lipitor 10 mg q.d.
6. Hydroxychloroquine 200 mg every other day.
7. Sulfamethoxazole 160 mg b.i.d.
8. Meclizine 2.5 mg q. p.r.n.
9. Propoxyphene 3 per day.
10. Metoprolol 50 mg b.i.d.
11. Fosamax 70 mg once a week.
12. Tums six.

PHYSICAL EXAM: Weight: 130, blood pressure 124/60, pulse 66. He is a delightful elderly male who walks slowly with a walker. Hands revealed Heberden’s and Bouchard’s nodes, but there is no active joint swelling. The wrists, elbows, and shoulders has full range without pain. Hips have good range without pain. Knees, ankles, and feet are nontender. Reflexes are absent at the knees, trace at the ankles.

IMPRESSION:
1. History of inflammatory arthritis. This remains stable. Plan is to continue the prednisone 2.5 q.o.d and Plaquenil 200 mg q.o.d.
2. Osteoarthritis of the hands and diffuse degenerative disk disease and OA of the lumbar spine. He will continue the ibuprofen 400 mg t.i.d. p.r.n.
3. Severe lumbar spinal stenosis. Unfortunately this is causing considerable alteration of his lifestyle. He has to use a walker. He cannot stand very long. He cannot walk very far. He is not been up and deemed to be a surgical. Consequently, there are no any other additional recommendations for this. I will see him again in six months.
Osteoporosis prevention while on prednisone. At this point, his dose is so low. I used 2.5 q.o.d. then I think he can stop the Fosamax. His bone density in the past revealed a normal bone density. The, the osteopenia even.

Date Transcribed: <02/07/2006>
Time Start: <03:15>
Time End: <04:45>

{END}
LC = 36.72

Clinic b 0029

2006-02-13T21:45:00.000+08:00

Patient Name: Dube, Sarah
MRNo: 000665552
Date of Service: 06/15/2005

LABORATORY RESULTS:

I am in receipt of recent CT scan of sinuses showing a possible retention cyst or polyp in the left maxillary atrium. I spoke with her father; he is quite interested in having an evaluation by ENT to see if this is the source of her problems. She has not been doing the Rhinocort. I have encouraged him to get her to do it one spray twice a day in each nostril because if this is indeed a polyp, Rhinocort may assist in its reduction.

Lob/sde
Date Transcribed: 01/26/06
Time Start: 3:40
Time End: 4:04

clinic b 0028

2006-02-13T21:42:00.000+08:00

Patient Name: Iman, Sharon
MRNo: 000817767
Date of Service: 06/15/2005

OFFICE VISIT

The patient is a 36-year-old white female who returns at the allergy department, after having last been seen on 12/06/2004. She has been spoken to several times in this process regarding her issues with allergies, allergic rhinitis, and allergic conjunctivitis. She was also seen on June 8, 2005 because she was received some chest tightness after immunotherapy. After that visit, it was decided that we will do a pulmonary function test and she would take Claritin prior to any injections. We also dropped her down a level.

CURRENT MEDICATIONS: She is now back on Advair 50/500 and Claritin. She has an EpiPen. She also has Patanol eye drops. She also takes ranitidine, Lorazepam, HCTZ, hydrocodone p.r.n., Celexa, and nasal saline.

REVIEW OF SYSTEMS:
The patient states she is not pregnant. She is followed for hypertension, GERD, depression, back pain, and obesity.

ALLERGIES: DOXYCYCLINE CAUSES DIFFICULTY BREATHING. SHE HAD AN ALLERGIC REACTION TO BEE STINGS, AND, THEREFORE, HAS AN EPIPEN.

SOCIAL HISTORY: Her grandmother is no longer smoking in the home. Home now has 2 dogs and no cats. She is now working in a restaurant that has a wood stove and she does find that at times it will irritate her.

PHYSICAL EXAMINATION:
The patient is alert in no apparent distress. Height 66 inches, weight 255 lbs., respirations 20. TMs: Within normal limits. Pupils: Equal and reactive to light. Conjunctivae: Slightly injected. Nasal septum midline, moderately boggy bilaterally, light pink, no heme bulge or obvious discharge noted. No frontal or maxillary sinus tenderness. Throat: Grossly clear. Teeth present. Oral mucosa: Pink and moist. Neck: Supple, no masses and nodes at present. Lungs: Clear to auscultation bilaterally with no rales, rhonchi or wheeze. Heart: Regular rate and rhythm, no gross murmur. No clubbing, cyanosis or edema noticed in extremities.

PRIOR ALLERGY TESTING:
Prick/intradermal positive for trees, dogs, weeds, rag, dust mites, feathers, grasses, cockroach, and mold.

LABORATORY:
Pulmonary function test: FEV 105%, FVC 102%, FEF 25-75 120% resulting in normal spirometry with medication.

ASSESSMENT:
1. Asthma.
2. Allergic rhinitis.
3. Allergic conjunctivitis.
4. Bee sting reaction.

PLAN:
1. Continue with Advair 500/50 one inhalation b.i.d.
2. Continue with Patanol eye drops.
3. Continue with Claritin OTC.
4. Advised not to replace any of the dogs when they are no longer with her. She has noticed she is better when she is not around dogs.
5. The patient has an albuterol inhaler, which she does use with an aerochamber.
6. She has a Peak flow with a height she said recently is 340. She will be on monitoring for her personal best. We have discussed that I would like her always above 80%. If she notices there is a decrease, I would like her to call me.
7. Continue to have an EpiPen available.
8. The patient is to return in 2 months for review of symptoms and medications. At that time, I will repeat the PFT. If she is doing well, I would like to decrease her Advair to get her to a lower dosage, but it is important she monitors herself closely.

Lob/sde
Date Transcribed: 01/26/06
Time Start: 11:15
Time End: 3:38
Break: 11:45-1:25

clinic b 0027

2006-02-13T21:37:00.000+08:00

Patient Name: Supinar, Michelle
MRNO: 000562570
Date of service: 06/15/2005

OFFICE VISIT

The patient is a 36-year-old white female who returns to the allergy department after having last been seen on May 23, 2005 for allergic rhinitis. We tried Rhinocort Aqua; she is still trying to use it. We have also tried Clarinex. She says it makes her much too drowsy to even work. She has gotten dust mite-proof covers. Prior Prick testing showed her positive to trees, grasses, rag, weeds, cat, dust, dust mites, and cockroach. She was previously given printed materials regarding immunotherapy, which she had as a child. She returns today because of a question of food allergies and for testing.

REVIEW OF SYSTEMS: The patient states she is currently not pregnant.

ALLERGIES: Sensitivity to BENADRYL.

SOCIAL HISTORY: She drives a school bus. There are no pets. She does not smoke.

PHYSICAL EXAMINATION:
The patient is alert in no apparent distress. Height 63 inches, weight 145 lbs., blood pressure 94/60. TMs: Within normal limits. Pupils: Equal and reactive to light. Conjunctivae: Noninjected. Nose: Nasal septum is midline, moderately boggy bilaterally. A small amount of clear mucus drainage is seen, light pink, congestion noted. No frontal or maxillary sinus tenderness. Throat: Grossly clear. Teeth: Present. Oral mucosa: Pink and moist. Neck: Supple. No masses or nodes present. Lungs: Clear to auscultation bilaterally with no rales, rhonchi or wheeze. Heart: Regular rate and rhythm. No rubs or murmur. No clubbing, cyanosis or edema noticed in extremities. Tongue is pierced.

LABORATORY:
Prick testing to foods after informed consent per usual. After correlation with history, the patient is positive for whole milk, soy, peanut, shrimp, string beans, celery, peas, hazelnut, and black walnuts. She was negative for apple. Nectarine is not part of this, but she was also positive to almond, which is part of the family that nectarine is composed of. She does not eat almonds, so she has no history.

ASSESSMENT:
1. Allergic rhinitis.
2. Food allergies.

PLAN:
1. Avoidance of certain foods including legumes, milk, shellfish, peanuts, and tree nuts. She is able to eat cashews without difficulty.
2. Continue trying to use Rhinocort Aqua 1-2 sprays in each nostril q.d.
3. Trial of Zyrtec 10 mg 1 tab q.d., dispensing 30 with yearly refills.
4. The patient has decided she would like pursue immunotherapy for her seasonal allergies. She will return in 2-4 weeks for intradermals. I have advised her to call with any questions or concerns prior to that visit.

ADDENDUM: Her son gets bee sting shots her.

Lob/sde
Date Transcribed: 01/25/06-01/26/06
Time Start: 3:50
Time End: 4:40
Time Start: 9:45
Time End: 11:13

clinic b 0026

2006-02-13T21:33:00.000+08:00

Patient Name: Hunt, Dalton
MRNo: 000857289
Date of Service: 06/15/2005

Telephone call/Laboratory Results:

I spoke with mother and relayed recent results of blood work. RAST testing all came back with negative results. Rheumatoid factor, antithyroid globulin, antibodies, and TSH: Within normal limits. CBC: Within normal limits except for minimal elevation of neutrophil percent and minimal depression of lymphocyte percent which would be inconsequential. His ANA came back positive with less than 1:40. I have recommended to mother that she does speak to his primary care for further evaluation of this, but then I expected that this was well within the normal range given his age and his sex. Mother will speak with Dr. Parker in approximately 3 days and I will be e-mailing him with the results of this laboratory report.

Lob/sde
Date Transcribed: 01/23/06
Time Start: 12:55
Time End: 1:30

clinic b 0127

2006-02-13T21:31:00.000+08:00

Patient Name: Wobble, Vincent Jr.
MRNo: 401912

Follow-up OV requested by the patient for bilateral knee pain.

S: Mr. Wrobel is an 80-year-old male who had resolution of his right shoulder pain with the injections in November. His knees were feeling fine until several months ago. He now experiences bilateral ambulatory knee pain, right greater than the left. He notes mild swelling. He denies acute injury, fever, chills, rash, nocturnal pain, significant pain, stiffness, locking, and buckling. He would like to consider surgery.

MEDICATIONS: Antibiotics for H. pylori, propranolol, tetrazosin, amlodipine, felodipine, amiloride, KCl, fluvastatin, and iron pills.

ALLERGIES: NKDA.

O: BP 90/52, pulse 72, weight 194 lbs. The patient is a very pleasant obese white male who is A&O x3 and in NAD. Bilateral knees: Valgus deformity of the right; none on the left. He has small effusions bilaterally without redness, warmth, localized tenderness, and pain with full flexion to 210 degrees. Gait: Normal, nonantalgic.

IMPRESSION: Bilateral knee OA.

PLAN:
1. After sterile skin prep, 1.5 cc of 1% lidocaine were injected, and 11 cc of clear yellow fluid was removed from the left knee and 22 cc of clear yellow fluid was removed from the right knee, then 20 mg were suspended and 2 cc of 1% lidocaine were injected into each knee. The patient tolerated the procedures well without complications.
2. Refer to orthopedics to consider TKR.
3. Obtain bilateral standing knee x-rays before the orthopedics consult.
4. Follow up with me p.r.n.

Lob/sde
Date Transcribed: 01/25/06
Time Start: 11:35
Time End: 2:40
Break: 11:45-1:15

clinic b 0126

2006-02-13T21:25:00.000+08:00

Patient Name: Gordon, Malcolm
MRNo: 136469

Primary rheumatologist is Dr. Heud. I am seeing the patient since he is on vacation.

Malcolm came in today for his methotrexate injection. The nurse brought his recent labs to me. He is slightly more anemic than previous labs several weeks ago. H&H is 12.2 and 37, and RDW is 16. He is on methotrexate 7.5 mg subcu q. week and no folic acid. He bought folic acid 400 mcg over-the-counter. I advised him to take 3 tablets a day and when he finishes that bottle, to fill the prescription given to him today of folic acid 1 mg q.d., #30 with a year’s refill. I will add on to his next drug monitoring labs a TIBC, iron, folate, and B12. I wanted to get stool guaiac but he does not want to do that nor does he want any rectal exams. “I’m too old for that.” I advised him to call me if he starts to feel dizzy or weak.

He does, on physical exam, have a slight bluish discoloration to his fingernails but the nail beds do blanch and they are warm. Lungs: Full, clear to percussion and auscultation. Cardiac: Normal S1, S2. No S3 or S4. No murmurs or rubs, RRR. Ankles: 1+ pitting edema. He denies abdominal pain, nausea, or vomiting. He is unable to state if there is melena due to his blindness.

Lob/sde
Date Transcribed: 01/24/06
Time Start: 1:00
Time End: 2:10

xc: ROBERT HEUD

clinic127

2006-02-06T11:15:00.000+08:00

Patient Name: Wobble, Vincent Jr.
MRNo: 401912

Follow-up OV requested by the patient for bilateral knee pain.

S: Mr. Wobble is an 80-year-old male who had resolution of his right shoulder pain with the injections in November. His knees were feeling fine until several months ago. He now experiences bilateral ambulatory knee pain, right greater than the left. He notes mild swelling. He denies acute injury, fever, chills, rash, nocturnal pain, significant pain, stiffness, locking, and buckling. He would like to consider surgery.

MEDICATIONS: Antibiotics for H. pylori, propranolol, tetrazosin, amlodipine, felodipine, amiloride, KCl, fluvastatin, and iron pills.

ALLERGIES: NKDA.

O: BP 90/52, pulse 72, weight 194 lbs. The patient is a very pleasant obese white male who is A&O x3 and in NAD. Bilateral knees: Valgus deformity of the right; none on the left. He has small effusions bilaterally without redness, warmth, localized tenderness, and pain with full flexion to 210 degrees. Gait is normal, nonantalgic.

IMPRESSION: Bilateral knee OA.

PLAN:
1. After a sterile skin prep, 1.5 cc of 1% lidocaine were injected, and 11 cc of clear yellow fluid was removed from the left knee and 22 cc of clear yellow fluid was removed from the right knee, then 20 mg were suspended and 2 cc of 1% lidocaine were injected into each knee. The patient tolerated the procedures well without complications.
2. Refer to orthopedics to consider TKR.
3. Obtain bilateral standing knee x-rays before the orthopedics consult.
4. Follow up with me p.r.n.

clinic126

2006-02-06T11:14:00.000+08:00

Patient Name: Gordon, Malcolm
MRNo: 136469

Primary rheumatologist is Dr. Heud. I am seeing the patient since he is on vacation.

The patient came in today for his methotrexate injection. The nurse brought his recent labs to me. He is slightly more anemic than previous labs several weeks ago. H&H is 12.2 and 37, and RDW is 16. He is on methotrexate 7.5 mg subcu q. week and no folic acid. He bought folic acid 400 mcg over-the-counter. I advised him to take three tablets a day and when he finishes that bottle, to fill the prescription given to him today of folic acid 1 mg q.d., #30 with a year’s refill. I will add on to his next drug monitoring labs a TRBC, iron, folate, and B12. I wanted to get stool guaiac but he does not want to do that nor does he want any rectal exams. “I am too old for that.” I advised him to call me if he starts to feel dizzy or weak.

He does, on physical exam, have a slight bluish discoloration to his fingernails but the nail beds do blanch and they are warm. LUNGS: Full, clear to percussion and auscultation. CARDIAC: Normal S1, S2. No S3 or S4, no murmurs, or rubs, RRR. ANKLE: 1+ pitting edema. ABDOMEN: He denies abdominal pain, nausea, or vomiting. He is unable to state if there is melena due to his blindness.

Ebc/sde
Date Transcribed: 01/25/06
Time Start: 2:42
Time End: 3:09

xc: Dr. Robert Heud

clinic125

2006-02-06T11:13:00.000+08:00

Patient Name: Mulcany, Elizabeth
MRNo: 45602

Follow-up OV for right hip OA and greater trochanter bursitis.

S: History is obtained from her son since the patient has moderate dementia. He reports that his mother is limping while ambulating on flat surfaces. She does not climb stairs. He states that the injection in November only helped for two weeks. He denies acute injury, redness, warmth, swelling, rash, fever, chills, significant difficulty with other joints, nocturnal pain. Regular Tylenol 2 tablets b.i.d. is mildly effective.

MEDICATIONS: Cartia, Aricept, Lopressor, Maxzide, aspirin, Lipitor.

ALLERGY: CODEINE.

O: BP 130/62, pulse 64, current weight 165 lbs. Mrs. Mulcany is a delightful white female who is alert and in NAD. Right hip decreased internal and external rotation without pain. Moderate pain over the greater trochanter without redness, warmth, swelling, and rash. Left hip, knees, ankles, subtalar joints, and MCPs moved well and are negative for erythema, warmth, synovitis. Gait is normal, nonantalgic.

IMPRESSION: Right hip OA with greater trochanter bursitis.

PLAN:
1. After sterile skin prep, 80 mg of Depo-Medrol and 3 cc of 1% lidocaine were injected in the area of maximal tenderness near the right greater trochanter. The patient tolerated the procedure well without complications.
2. I advised her to increase the Tylenol to three times a day.
3. She will follow up with me in three months or sooner if needed.

Ebc/sde
Date Transcribed: 01/25/06
Time Start: 1:07
Time End: 1:58

clinic124

2006-02-06T11:11:00.001+08:00

Patient Name: Rannikko, Marjorie
MRNo: 128179

Follow-up OV requested by the patient for bilateral CMC pain.

patient for bilateral CMC pain,
S: Mrs. Rannikko is a 74-year-old female who has known OA. Her pain became severe in April but fortunately it has slowly improved with rest and heat. The pain is now tolerable. Initially, the right CMC was swollen. She denies acute injury, redness, warmth, swelling, fever, chills, rash, paresthesias, locking, significant difficulty with other joints. The copper/magnetic bracelet is helpful. Despite the thumb splint, it caused too much pain. She is unable to take NSAIDs including COX-2 inhibitors due to history of peptic ulcer disease and GI upset. She has not tried glucosamine, and chondroitin sulfate full strength was ineffective after three months, so she discontinued it. She has not tried Tylenol or paraffin wax treatments. She is nervous about trying injections.

MEDICATIONS: Levothyroid, oxycodone (used for chronic low back pain), calcium, MVI, Zantac.

ALLERGIES: SULFA CAUSES HER RASH.

O: BP 126/62, pulse 80, weight 187 lbs. The patient is a delightful white female,who is A&O x3 and in NAD. Bilateral CMCs have marked squaring with crepitus and mild joint line tenderness on the left, none on the right. No redness, warmth, or synovitis. Wrists, MCPs, PIPs, DIPs are normal.

IMPRESSION: Right bilateral CMC OA.

PLAN:
1. Recommended Extra Strength Tylenol 1-2 tablets before aggravating activities p.r.n. Maximum dose 8 tablets a day.
2. She tried paraffin wax treatments many years ago and liked it, so she plans on buying a machine.
3. She will prefer to defer injection since the pain is tolerable. I certainly agree with this. However, she may want to consider them next fall/winter when the arthritis may be aggravated. Since she had difficulty obtaining this appointment, she would like to schedule an appointment. Since I will not be here at that time, I will have her schedule an appointment with Dr. Hosey in November. She was advised to cancel this appointment if she did not want the injections so that it could be used for someone else. She verbalized understanding.

Ebc/sde
Date Transcribed: 01/25/06
Time Start: 10:40
Time End: 11:19

clinic123

2006-02-06T11:11:00.000+08:00

Patient Name: Torrey, Katie
MRNo: 838101

Follow-up OV for psoriatic arthritis:

S: Ms. Torrey is a 27-year-old female who reports significant improvement in her joint pain/swelling and stiffness with prednisone 10 mg q.o.d. and 7.5 mg q.o.d., and initiating sulfasalazine. She will reach the maximum dose of sulfasalazine on Saturday. She is sleeping better and able to function better in the morning. She feels slightly stiff after working and on rainy days. She reports some scalp psoriasis but no other rashes, fever, chills, nausea, vomiting, diarrhea, CP, or SOB.

MEDICATIONS: Flovent, albuterol, birth control pills, Claritin, sulindac 200 mg b.i.d., Nasarel, calcium with vitamin D 600 mg t.i.d., MVI, sulfasalazine 1000 mg q. a.m. and 500 q. p.m., prednisone 7.5 mg q.o.d. and 10 mg q.o.d., Plaquenil 200 mg q.d., and Ditropan.

ALLERGIES: BACTRIM AND PENICILLIN.

O: BP 98/62, pulse 60, weight 124 lbs. Ms. Torrey is a delightful white female who is A&O x3 and in NAD. HANDS: Mild synovitis of the bilateral second and right third MCPs, and bilateral second PIPs. Shoulders, elbows, wrists, all other MCPs, PIPs, DIPs, hips, knees, ankles, and patellar joints are normal. LUNGS: Full. Clear to percussion and auscultation. Cardiac: Normal S1, S2. No S3 or S4. No murmurs or rubs, RRR.

IMPRESSION: Psoriatic arthritis.

PLAN:
1. Continue sulindac 200 mg b.i.d. Prescription for #60 with 6 refills given.
2. She will increase the sulfasalazine this weekend to 1000 mg b.i.d. Prescription for 500 mg tablets, 2 tablets b.i.d. #120 with six refills given. With this medication, I advised her to wear at least 30 SPF sunscreen to prevent sunburns.
3. Continue prednisone 7.5 mg q.o.d. and 10 mg q.o.d. She will attempt to taper this if she starts to feel better. Prescription for 5 mg tablets #60 with 2 refills given.
4. Continue Plaquenil 200 mg q.d. She has enough medicine at home.
5. Obtain drug monitoring laboratories, CBC, ALT, AST, CR.
6. She will follow up with me in 8-10 weeks or sooner if needed.

Ebc/sde
Date Transcribed: 01/24/06
Time Start: 3:37
Time End: 4:21

xc: Dr. John Hosey.

clinic081

2006-02-06T11:09:00.000+08:00

Patient Name: Rodriguez, Blanca
MRNo: 804031

FOLLOW-UP OFFICE VISIT

PROBLEMS:
1. Left trochanteric bursitis.
2. Iliopsoas bursitis.

SUBJECTIVE:
The patient returns with recurrence of left hip pain. She reports having had marked improvement but not resolution of the pain with an injection in the area of the greater trochanter at our initial appointment in December. She reports she has had injections done twice in the meantime, once by Dr. Sudae and once by Mr. Drexler. She reports each time, she had significant improvement by two weeks after the injection and recurrence within two months. She continues to report significant pain lying on the left side at night interfering with sleep.

OBJECTIVE:
The patient is a well-developed female in no apparent distress. Musculoskeletal examination: She has marked tenderness over the left greater trochanter. Hip mobility was not evaluated.

ASSESSMENT: Recurrent left trochanteric bursitis. The patient has past injections in the area on three separate occasions. It indicates that the trochanteric bursa area is the source of her symptoms. She has had recurrence in a short time each time she had an injection. Therapy had been recommended in December, but she reports she was never contacted about a specific date and time for therapy.

PLAN:
The nature of trochanteric bursitis was discussed with the patient. Limitation and frequency of injection was discussed. It was elected to inject at this time. After a sterile skin prep and ethyl chloride anesthesia, the left trochanteric bursa was injected with 40 mg of Depo-Medrol and 2 cc of 1% lidocaine. The patient tolerated the procedure without complications. I would consider repeat injection but not for at least three months. If she is markedly worse before that, I would consider trying a local anesthetic injection alone. She also will be rescheduled for physical therapy, and if she does not have a specific appointment date by the end of next week, it was recommended that she contact my office to further resolve the breakdown in communication. She was also given a prescription for Percocet 30 pills to be used one to two at bedtime on a p.r.n. basis.

Ebc/sde
Date Transcribed: 01/24/06
Time Start: 2:04
Time End: 3:34

xc: Dr. Sudae

clinic080

2006-02-06T11:08:00.001+08:00

Name: Gervais, Hester
MRNo: 821326

FOLLOW-UP OFFICE VISIT

PROBLEMS:
1. Giant cell arteritis.
2. Osteoarthritis of the knees.

SUBJECTIVE:
The patient reports significant recurrence of pain in the left knee since her last injection three months ago. She also reports some new problem of pain in the left foot on the dorsomedial aspect. She reports that it has been present for several days to possibly much of the week. She had pain primarily with bearing weight on the left foot. She is not aware of any specific exciting activity or event. She does report having some swelling in the area. She has decreased her prednisone from 5 mg to 3 mg without an occurrence of headaches, cough, or aching in her shoulders or hips. She is currently on Celebrex 200 mg a day as well as the prednisone.

OBJECTIVE:
The patient is a well-developed, frail, elderly female, in a wheelchair. Musculoskeletal exam, she has moderate tenderness on palpation on the medial aspect of the midtarsal joint with no significant pain with range of motion in the tarsal joints. She has no tenderness at the posterior tibial tendon, the joint line of the ankle, or the Achilles tendon. She has minimal swelling with no redness or warmth. She has crepitus on range of motion of motion of both knees. Range of motion was not fully tested with the patient in the wheelchair. She has no effusions. She has minimal tenderness on the right and moderate tenderness on the left.

ASSESSMENT:
1. Osteoarthritis of the knees with exacerbation on the left knee.
2. New left foot pain. The patient may have some low-grade inflammation from gout crystal but do not have a definite gouty attack. She denies any previous history of gout. It is possible the symptoms are purely on a mechanical basis. They are not in the location where it is typical to develop a tendonitis.
3. Giant cell arteritis. The patient’s last notation was 4 mm/hr. She has tapered her prednisone from 5 to 3 mg without any significant exacerbation or recurrence of symptoms.

PLAN:
1. After discussing potential risks and benefits, she elected to inject the left knee joint only at this time. After a sterile skin prep and ethyl chloride skin anesthesia, the left knee joint was injected with 40 mg of Depo-Medrol and 2 cc of 1% lidocaine. The patient tolerated the procedure without complications.
2. Management for the left foot pain was discussed. She is already on an anti-inflammatory and has not considered a higher dose of Celebrex. She is also on some prednisone, and we are trying to eliminate the prednisone or at least keep it at the lowest possible dose. She will be started on colchicine 0.6 mg twice a day. If she has any cramps or diarrhea, she will discontinue the medication. If she has improvement in the foot over the next 1-3 weeks, she will continue the colchicine for about 5 days. After she feels like it is back to normal, then try discontinuing the colchicine. She was scheduled for follow-up appointment in three months. She will contact the office sooner if needed. She will continue the 3-mg prednisone dose through the month of July. Beginning of August, if things have been stable, she will try stopping the Celebrex and see if she is significantly worse without it. If she is worse, she would resume it.
3. She will try decreasing the prednisone from 3 mg to 2 mg in September.

Ebc/sde
Date Transcribed: 01/24/06
Time Start: 11:07
Time End: 1:59

xc: Dr. Javacar
{END}

Break: 11:45–In:12:59

clinic079

2006-02-06T11:08:00.000+08:00

Patient Name: Twohy, James
MRNo: 1638840

FOLLOW-UP OFFICE VISIT

PROBLEM:
1. Gout.
2. Inflammatory arthropathy.

SUBJECTIVE:
The patient reports having had increased pain primarily in his elbow but also on his right knee with trying to taper prednisone to 1 mg a day. He reports he has gone back up to 5 mg and tried tapering back down several times and always has increased symptoms on the 1-mg dose. He has continued taking allopurinol 20 mg a day and 0.6 mg of colchicine once a day. He reports no problems tolerating the medications.

OBJECTIVE:
The patient is a well-developed male in no apparent distress. Musculoskeletal Exam: He has mild swelling of second and third MCP and wrist on the left. No definite swelling on the right. He has no swelling or tenderness at the joint line of the elbows. He has palpable nodules in the olecranon bursa bilaterally, larger and more firm on the left with no redness or tenderness on palpation. He has no tenderness on palpation on the shoulders, knees or ankles. He has decreased range of motion to the right ankle. He reports that right ankle also has increased pain with lower prednisone dose and improved pain with a higher dose.

ASSESSMENT:
1. Inflammatory arthropathy.
2. Gout. The patient does not have any typical acute gouty flare-ups. I suspect the increased symptom involved with the prednisone is chronic inflammatory synovitis independent of gout.

PLAN:
The patient will continue the colchicine and allopurinol. He will continue with 3 mg of prednisone for at least three months and as much as six months. At some point at three or six months, he will try decreasing to two a day and if he is able to go for months without any obvious increase in pain symptoms, he will try to stay at the lowest possible baseline. He did have a bone density study done on day of the visit, which showed normal bone density in the spine and hip including a normal bone density in the femoral neck.

Ebc/sde
Date Transcribed: 01/23/06
Time Start: 2:39
Time End: 10:40

xc: Dr. Cooks
{END}

Cont.: 9:30am

clinic028

2006-02-06T11:07:00.000+08:00

Patient Name: Iman, Sharon
MRNo: 000817767
Date of Service: 06/15/2005

OFFICE VISIT

The patient is a 36-year-old white female who returns to the allergy department after having last been seen on 12/06/2004. She has been spoken to several times in this process regarding her issues with allergies, allergic rhinitis, and allergic conjunctivitis. She was also seen on June 8, 2005 because she has received some chest tightness after immunotherapy. After that visit, it was decided that we will do a pulmonary function test and she will take Claritin prior to any injections. We also dropped her down a level.

CURRENT MEDICATIONS: She is now back on Advair 50/500 and Claritin. She has an Epipen. She also has Patanol eye drops. She also takes ranitidine, lorazepam, HCTZ, hydrocodone p.r.n., Celexa, and nasal saline.

REVIEW OF SYSTEMS: The patient said she is not pregnant. She is followed for hypertension, GERD, depression, back pain, and obesity.

ALLERGIES: DOXYCYCLINE CAUSES DIFFICULTY BREATHING. SHE HAD AN ALLERGIC REACTION TO BEE STINGS AND, THEREFORE, HAS AN EPIPEN.

SOCIAL HISTORY: Her grandmother is no longer smoking in the home. The home now has two dogs and no cats. She is now working in a restaurant that has a wood stove. And she does find that at times it will irritate her.

PHYSICAL EXAMINATION: The patient is alert in no apparent distress. Height 66 inches, weight 255 lbs. Respirations 20. TM is within normal limits. Pupils are equal, and reactive to light. Conjunctiva is slightly injected. Nasal septum midline, moderately boggy bilaterally, light pink, no heme bulge or obvious discharge noted. No frontal or maxillary sinus tenderness. Throat is grossly clear. Teeth present. Oral mucosa: Pink and moist. NECK: Supple, no masses and nodes present. LUNGS: Clear to auscultation bilaterally with no rales, rhonchi or wheeze. HEART: Regular rate and rhythm. No gross murmur. No clubbing, cyanosis or edema noticed in extremities.

PRIOR ALLERGY TESTING: Prick/intradermal positive for trees, dogs, wheat, ragweeds, dust mites, feathers, grasses, cockroach, and mold.

LABORATORY: Pulmonary function tests FEV 105%, FVC 102%, FEF 25-75 120% resulting in normal spirometry with medication.

ASSESSMENT:
1. Asthma.
2. Allergic rhinitis.
3. Allergic conjunctivitis.
4. Bee sting reaction.

PLAN:
1. Continue with Advair 500/50 one inhalation b.i.d.
2. Continue with Patanol eye drops.
3. Continue with Claritin OTC.
4. Advised not to replace any of the dogs when they are no longer with her. She has noticed she is better when she is not around dogs.
5. The patient has an albuterol inhaler, which she does use with an aerochamber.
6. She has a Peak flow with a height she said recently is 340. She will be on monitoring for her personal best. We have discussed that I would like her always above 80%. If she notices there is a decrease, I would like her to call me.
7. Continue to have an EpiPen available.
8. The patient is to return in two months for review of symptoms and medications. At that time, I will repeat the PFT. If she is doing well, I would like to decrease her Advair to get her to a lower dosage, but it is important she monitors herself closely.

Ebc/sde
Date Transcribed: 01/26/05
Time Start: 3:48
Time End: 4:34

cllinic026

2006-02-06T11:06:00.000+08:00

Patient Name: Hunt, Dalton
MRNo: 000857289
Date of Service: 06/15/2005

TELEPHONE CALL/LABORATORY RESULTS:

I spoke with mother and related recent results of blood work. RAST testing all came back with negative results. Rheumatoid factor, antithyroid globulin, antibodies, and TSH are within normal limits. CBC is within normal limits except for minimal elevation of neutrophil percent and minimal depression of lymphocyte percent, which would be inconsequential. His ANA came back positive with less than 1:40. I have recommended to mother that she does speak to his primary care for further evaluation of this, but then I expected that this was well within the normal range given his age and his sex. The mother will speak with Dr. Parker in approximately three days and I will be e-mailing him with the results of this laboratory report.

Ebc/sde
Date Transcribed: 01/26/06
Time Start: 11:25
Time End: 11:40

clinic025

2006-02-06T11:05:00.000+08:00

Patient Name: Gilger, Emmanuel
MRNo: 001565544
Date of Service: 06/15/2005

TELEPHONE CALL

The patient had called to state that her hives were not controlled. She is currently taking loratidine, ranitidine, and Benadryl. She has stopped the Benadryl and takes doxepin 25 mg one to four tablets a day, dispensing 120 to CVS in Park Ave. In speaking with the patient, I explained the purpose behind the doxepin. If this does not control the hives, she will call.

ebc
Date Transcribed: 01/26/06
Time Start: 10:45
Time End: 10:54

Operative 22

2006-02-01T21:19:00.000+08:00

THE OAKS SURGERY CENTER
40740 California Oaks Rd.
Murrieta, CA 92562

OPERATIVE REPORT

PATIENT NAME: DETASQUALE, LEWISDEPASQUALE, LUIS
PATIENT ID#: 13761
DATE OF OPERATION: 01/13/2006
SURGEON: Chris Alexander, M.D.
ASSISTANT: None.
ANESTHESIA: General.

PREOPERATIVE DIAGNOSIS:
Osteoarthritis, left elbow.

POSTOPERATIVE DIAGNOSES:
1. Osteoarthritis, left elbow.
2. Plus a sSubluxating annular ligaments, left elbow.

PROCEDURES PERFORMED:
1. Left elbow arhtroscopic partial debridement, annular ligament, and c.
2. Chondro plasty, radial head.
3. Osteophytectomy, coronoid process.
24. Open left elbow annular ligament reconstruction. .

ESTIMATED BLOOD LOSS:
Minimal.

FINDINGS:
There is a palpable snapping mass at the lateral elbow with flexion-extension maneuvers and pronation-supination. Arthroscopically, there is a prominent annular ligament edge would which subluxates end ofinto the radial radiocapitellar joint space. There is great threegrade 3 changes on the radial head and there is an osteo_____1.27phytic rigde ridge on the coronoid process. The trochlear cartilage is in good condition. The capitellar cartilage in good condition. Upon open procedure laterally, it is clear that the annular ligament snaps back and forth into the radial radiocapitellar joint from its own anatomic location around the radial neck

TOURNIQUET TIME: It is
33 minutes.

COMPLICATIONS:
None.

DRAINS:
None.

DETAILED DESCRIPTION OF PROCEDUREINTRODUCTION:
The patient is a 73-year-old male, who is complaining of snapping and pain in his left elbow from an injury, July of last year.

SUMMARY:
He is placed in a supine position under a general anesthetic. at tThe left upper extremity. S is sterilely, prepped, and draped within an overheard boom used to suspend the left upper extremity with the elbow at about 90 degrees of flexion. Arthroscopy is performed through medial and lateral portals to examine the anterior aspect of the left elbow joint. Findings are described. Chondro plasty of the radial head is completed, osteophytectomy on a coronoid process is completed, and a partial debridement of the edge of the annular ligament was performed. An open procedure was then performed through a lateral incision over the elbow about 4 cm in length. Dissection is carried out down to the extensor conjoint tendon was usedwhich is divided longitudinally to both expose the annular ligament and radio-capitellar joint space. The annular ligament clearly snaps back and forth into the radio- capitellar space from the radial neck area. A reconstruction of the ligament was then completed so that the ligament no longer would snap back into the radio-capitellar space. The ligament was tightened by incising partially on the lateral aspect transversally transversely through the ligament and then, imbricating the ligament so that there is a greater hoop stress around the radial neck. T thus, not allowing the ligament to slip over the larger diameter radial head. Elbow range of emotion is full. P, pronation-supination are full. T, and thehe snapping phenomenon has been eliminated after reconstruction. The reconstructive reconstructed ligament was repaired with #0 _____4.49Ethibond. The conjoint tendon was repaired with #0 Vicryl and the subcutaneous tissue with 2-0 Vicryl. The skin was monochrome forwith Monocryl 4-0 subcuticular closure followed by Steri-Strips, Marcaine injection, dry gauze, soft roll, and an ace wrap. The patient is placed in a _____5.11sling and transferred out of the operating room in good condition.

___________________________
CHRIS ALEXANDER, M.D.

CA:ebc/sde

Date Transcribed: 01/23/2006
Time Start: 10:40
Time End: 1:00

Break 11:45- In: 12:45

Operative 19

2006-02-01T21:18:00.001+08:00

THE OAKS SURGERY CENTER
40740 California Oaks Rd.
Murrieta, CA 92562

OPERATIVE REPORT

PATIENT NAME: AGUILAR, LUIS
PATIENT ID#: 13763
DATE OF OPERATION: 01/13/2006
SURGEON: Richard Rouhe, M.D.
ASSISTANT: Dr. Burrows
ANESTHESIA: General.
ANESTHESIOLOGIST: Dr. Jackson.

PREOPERATIVE DIAGNOSIS:
1. Internal derangement, the right knee.
2. ACL disruption.
3. Meniscal tears.

DETAILED DESCRIPTION OF PROCEDURE:
Once the patient was anesthetized under general anesthetic, the tourniquet was applied to the proximal thigh of the right leg. The right leg was elevated and exsanguinated with an ACE bandage and the tourniquet inflated to anesthetic level. The leg was then placed on a leg holder, prepped, draped, and arthroscopy is carried out in the usual fashion. At arthroscopy, first, the medial compartment was visualized. There is noted to be a macerated tear of the posterior horn. Grades 1 and 2 chondromalacia of the medial femoral condyle but no subchondral bone noted. The lateral compartment was visualized. Then, there was a small radial tear of the membranous margin of the lateral meniscus but generally the meniscus was intact as well as the medial condyle. The ACL appeared to be intact, but the knee had a very positive drawer and Lachman test. I introduced the turbo trimmer and debrided the tissue around the ACL up to its femoral attachment and checked out the PCL. The PCL was intact. There was a significant laxity of the ACL by using the probe. We proceeded with ACL reconstruction. Once the macerated horn of the medial meniscus was resected and the medial from the condyle was smoothed with a turbo reamer. Then, I removed the arthroscopic instruments and we proceeded with the harvesting of the patellar tendon graft with a linear incision anteriorly on the knee. Dissection down to the subcutaneous tissue to the patellar tendon was done. The peritenon was then incised and the patellar tendon was exposed beneath the peritenon. The margins of the patellar were identified and then, a 1 x 3 cm bone plug was harvested from the patella, and a 1-cm strip of patellar tendon through the center portion of the tendon down to the tibial tuberosity. A 1 x 3 cm bone graft from the tibial portion of the tibial attachment of the patellar tendon was then harvested. While the graft was being prepared on the back table by the assistant, arthroscopy was carried outfurther debriding the medial meniscus and the medial femoral condyle. Then, doing debridement of the deficient ACL tendon using the bulk and the turbo trimmer and using a bur for the notchplasty of the medial side of the lateral femoral condyle. Once the knee was prepared, instrumentation was then inserted. The graft was ready and we then, introduced the guide pin for the tibial tunnel. Once the guide pin was in place, the reaming of the tibial tendon was done with an 11-mm reamer. Once that was completed, then the knee was debrided of the debris from the reamings, then the over-the-top guide was then placed on the femoral side, 7 mm over the top guide. Then, the beef needle was used to introduce into the femoral side from the femoral tunnel. And once it exited the anterior aspect of the thigh, the reaming of the femoral side was done with a 10-mm reamer. We have 11-tibial and 10-femoral tunnel. Once that was debrided, the notchplasty was done. The graft was then introduced and just prior to fittiing the graft, the guide pin for the BioScrew was introduced. Once in place, the graft was fitted. The Bioscrew then entrapped the femoral fragment into position. Once the screw was fitted, tension on the tibial side of the graft was done and there was no motion of the femoral side, in other words, it was sufficiently fixed. The knee was then extended and tension placed on a tibial graft, then the Bioscrew was introduced through over -guide pin and fixing the tibial graft and placed the knee at about 15 degrees flexion. Just prior to fixing with the screw, we brought attention on the tibial side, the probe was introduced. The tibial graft is noted to have a sufficient tension, and so once the tibial graft was fitted, the knee was checked again. Pictures were taken. Then drawer and Lachman tests were negative now. At this point, the knee was thoroughly irrigated and the instrumentation was removed and the wound was closed using 2-0 Vicryl on the peritenon in a continuous fashion, 2-0 Vicryl subcutaneously, and staples on the skin. Sterile dressing was applied and placed in a knee brace, so the knees have 30 degrees extension mark and as well as a 90 degrees flexion mark. Then the patient was then taken to recovery room for postoperative care. The patient tolerated the procedure well. No complications were encountered nor anticipated. The prognosis is is good.

___________________________
RICHARD ROUHE, M.D.

RSB:ebc/sde

Date Transcribed: 01/20/2006
Time Start: 11:00
Time End: 10:32

Break:12:02p- In: 1:20p
Go out: 1:51p – In: 2:14p
Started: 9:07am

Operative 15

2006-02-01T21:18:00.000+08:00

THE OAKS SURGERY CENTER
40740 California Oaks Rd.
Murrieta, CA 92562

OPERATIVE REPORT

PATIENT NAME: JENCHIS, VICTOR
PATIENT ID#: 13767
DATE OF OPERATION: 01/13/2006
SURGEON: Chris Alexander, M.D.
ASSISTANT: None.
ANESTHESIA: General.

PREOPERATIVE DIAGNOSIS:
Left ankle distal fibular fracture.

POSTOPERATIVE DIAGNOSIS:
Left ankle distal fibular fracture.

PROCEDURES PERFORMED:
Open reduction and internal fixation, left distal fibular fracture.

ESTIMATED BLOOD LOSS:
Minimal.

FINDINGS:
The distal fibula is fractured in an oblique fashion and displaced lateral and proximalward. There are some fibrous connections at the fracture site. It was able to be reduced to an anatomic position. Fixation is stable.

DISPOSITION:TOURNIQUET TIME:
Tourniquet time is aAbout 45 minutes.

COMPLICATIONS:
None.

DRAINS:
None.

DETAILED DESCRIPTION OF PROCEDUREINTRODUCTION:
The patient is a 28-year-old male, complaining of left ankle pain after falling off of a ladder about 2-1/2 weeks ago.

SUMMARY:
He is placed supine on an operating room table under general anesthetic with the left lower extremities extremity sterilely prepped and draped. A tourniquet on a the thigh turned up to 275 mm Hg. An incision was made longitudinally across the lateral aspect of the distal fibula exposing the distal fibular periosteal tissues which are incised to expose the fracture site. The fibrous connection had to be taken down using curettes and the fracture fragments were then reduced. A 5-hole semitubular plate was fixated across the fracture. A serum C-arm was used to image the hardware and reduction was found to be acceptable. The wound was then irrigated, closing closed witha 2-0 Vicryl for the subcutaneous layer and staples for the skin. _____2.22Xeroform form, dry gauze, and a posterior spleen splint is applied. The patient has beenis then transferred out of the operating room in good condition.

___________________________
CHRIS ALEXANDER, M.D.

CA:ebc/sde

Date Transcribed: 01/19/2006
Time Start: 11:46
Time End: 2:35

Break: 12:06pm In: 2:04p

operativ 10

2006-02-01T21:16:00.000+08:00

THE OAKS SURGERY CENTER
40740 California Oaks Rd.
Murrieta, CA 92562

OPERATIVE REPORT

PATIENT NAME: RENDALE, CLAREN BICK KLAARENBEEK, RENDELL
PATIENT ID#: 13764
DATE OF OPERATION: 01/13/2006
SURGEON: Hedrick Keding, M.D.
ASSISTANT: Jackson, M.D.
ANESTHESIA: General.

PREOPERATIVE DIAGNOSIS:
Impingement syndrome--rule out rotator cuff tear, left shoulder.

POSTOPERATIVE DIAGNOSES:
Impingement syndrome, plus partial rotator cuff tear.

PROCEDURES PERFORMED:
1. Open subacromial decompression.
2. Rotator cuff repair.

DETAILED DESCRIPTION OF PROCEDURE:
Once the patient was anesthetized, he is placed in a beach-chair bizchair position, t. Then, a bolster underneath the left shoulder. , Tthe left upper extremity shoulder was then prepped and draped and an incision was made from over the AC joint to the disk of the tip of the acromion and distally 2 cm. Dissection down to subcutaneous tissue to the acromion was done with the cutting curette Aaron Bovie. Self-retaining retractors were put them in placed leaving with control initially by injecting the intended incision by works of Marcaine and epinephrine. And then once the incision was made, the bleeding was controlled with coagulated Bovie. Once the acromion was identified, it was further delineated subperiosteallytowards the _____1.23 using the cutting curette Aaron Bovie to detach the deltoid proximally and posteriorly around the tip of the acromion. Once that was established, the deltoid first will be very thickened, that was excised and the subacromial space, then they are evaluated and there was noted to be some partial tears of the rotator cuff , not through and through but there was small acromion abrasive type of abrasive thinning of the _____supraspinatus tendon1.57 and then the acromion. _____ An oscillating saw was 2.02 than we used to do a partial acromionectomy. The cuff surface of this _____2.07 was then smoothed with a power ____rasp2.10. Then, the shoulder joint was evaluated. The archenteric rotator cuff was evaluated and no through and through tears noted but there was some abrasive tears as mentionedinfection. So, there were some linear areas. There wereand some of the real _____thin2.35 redundant tissue was excised and then, this area of excision once repaired but I did not incised it through and through into the articular surface. It was more superficial, so I have superficial repair of the partially torn rotator cuff. Once that was accomplished, the wound was then closed we would return _____2.59 approximating the deltoid over the acromion from the posterior andto the anterior aspect of #1 Vicryl ruptured suture. The deltoid fascia of the tip of the acromion was approximated with #1 Vicryl continuous suture and then, the subcutaneous tissues were closed with 2-0 Vicryl subcutaneously and the skin approximated with 3-0 Nnylon of subcuticularsubticular suture. That would have then injected with Marcaine and epinephrine and the sterile dressings was appliedas the _____3.29 of the pipe, and once the sterile dressing was appliedof the pipe, he was placed in an ____arm sling3.34 plane and takes him to the recovery room for appropriate medication demonstrations.

___________________________
Hedrick Keding, M.D.

HK:ebc/jmm

Date Transcribed: 01/19/2006
Time Start: 09:20
Time End: 11:42

0-8 ops

2006-02-01T15:10:00.000+08:00

THE OAKS SURGERY CENTER
40740 California Oaks Rd.
Murrieta, CA 92562

OPERATIVE REPORT

PATIENT NAME: FISCHER, ERIN
PATIENT ID#: 13766
DATE OF OPERATION: 01/13/2006
SURGEON: Chris Alexander, M.D.
ASSISTANT: None.
ANESTHESIA: General.

PREOPERATIVE DIAGNOSIS:
Left knee medial meniscus tear.

POSTOPERATIVE DIAGNOSIS:
Left knee plica/synovial impingement lesion, patellofemoral joint.

PROCEDURE PERFORMED:
Left knee arthroscopy plica excision.

FINDINGS:
There is a large mass of tissue that is easily displaceable between the patellar and the femoral sulcus with the knee extended. The remainder of the knee joint surfaces and meniscal tissues are found to be entirely normal. The anterior cruciate ligament is intact. There is possibly some partial injury to the proximal portion of the ligament where it appears somewhat thinned, but Lachman and pivot shift testing are negative. The PCL is intact.

TOURNIQUET TIME: About 25 minutes.

COMPLICATIONS:
None.

DRAINS:
None.

DETAILED DESCRIPTION OF PROCEDURE:
The patient is an 18-year-old female who is complaining of popping and pain in her left knee from a gymnastic tumbling injury about 7 months ago. Symptoms have not improved.

In summary, placed in a supine position under general anesthetic. The left lower extremities sterile prepped and draped. A tourniquet on the thigh turned up to 275 mm Hg. Arthroscopy is performed through anteromedial, anterolateral, and superomedial portals. The internal notches are examined initially where the cruciate ligaments are carefully probed. She has findings as described. The patellofemoral compartment is that described of cartilage surfaces are in good condition. There is a large prominent synovial mass based off of the retropatellar fat pad and it is displaceable in the patellofemoral joint. Examination of the medial lower compartments reveals entirely normal appearing cartilage surfaces and meniscus tissues. Probing of the condyles was carried out carefully to look for any OCD lesions, none were identified. The patellofemoral joint was then viewed through this superomedial portal and a debridement of the synovial mass was carried out through the anteromedial portal using a shaver tip. Finally, the knee is irrigated and drained through a large _____a large IV cannula.. Instrumentation is removed. Wounds are repaired with Steri-Strips, Marcaine injection, dry gauze, soft roll, and the knee is wrapped from the toes to the thigh. The patient was transferred out of the operating room in good condition.

___________________________
CHRIS ALEXANDER, M.D.

CA:ebc/jmm

Date Transcribed: 01/18/2006
Time Start: 1:00
Time End: 3.01

Go out 2:07p – in: 2:10p

05 Ops

2006-02-01T14:42:00.000+08:00

148993

2006-02-01T13:29:00.000+08:00

Patient Name: McCarthy, Susan
MRNo: 148993

The patient is seen in consultation as requested by Dr. Metkos.

CHIEF COMPLAINT:
The triggering of the right second finger.

HISTORY OF PRESENT ILLNESS:
Ms. McCarthy is a 46-year-old female who reports developing aching in all the fingers in both hands about six weeks ago. She was still on naproxen at that time. She reports the ache in her fingers has resolved, and she has stopped the naproxen. But she has developed triggering of the right second finger. She reports having used a splint that she obtained, I believe at a pharmacy, for about three nights and finds it helpful. She does do some repetitive activities with the hands primarily doing keyboard work on the family landscaping business. She occasionally does some of the light landscaping work.

PAST MEDICAL HISTORY:
1. Status post breast cancer diagnosed five years ago. She is coming to the end of her course of tamoxifen.
2. Status post one pregnancy with normal delivery.
3. Status post tonsillectomy.
4. Status post surgery for ovarian cysts.

PERSONAL AND SOCIAL HISTORY:
The patient reports having adverse reactions to penicillin and sulfa, both of which cause her rashes. She does not smoke or use alcohol regularly.

CURRENT MEDICATIONS:
Tamoxifen, calcium, multivitamin, and vitamin E.

PHYSICAL EXAMINATION:
GENERAL: The patient is a well-developed femalenormal in no apparent distress.
MUSCULOSKELETAL EXAMINATION: She has minimal hypertrophy of the several DIP joints but no tenderness. She has no swelling or tenderness in the PIPs, MCPs, or wrists. She has a palpable nodule with moderate tenderness in the flexor tendon of the right second finger.

ASSESSMENT:
Right second flexor tendinitis with trigger finger. Teh patient does not have any significant ongoing symptoms in the joints. She has findings for minimal osteoarthritis in some DIPs and no definite synovitis on exam.In May, she had a negative lime titer, normalnormal TSH, normal sedimentation rate,normal CPK. It is possible the patient has had some inflammatory joint symptoms recently, but no definite findings on exam at this time and no lab abnormalities to suggest an inflammatory disease process.

PLAN:
The nature of flexor tendonitis was discussed. Management options were discussed and elected to inject at this time. After a sterile skin prep and ethyl chloride skin anesthesia, the right second flexor tendon was injected at the site of the A1 pulley with 10 mg of Depo-Medrol and 0.25 cc of 1% lidocaine. The patient tolerated the procedure. No complications. She will contact to the office for followup if she has any significant ongoing problem.

Ebc/sde
Date Transcribed: 01/23/06
Time Start: 1:20
Time End: 2:35

xc: Dr. Metkos
{END}

derma08

2005-12-20T16:10:00.000+08:00

HISTORY: The patient is an elderly pleasant female who is quite cooperative. She was admitted to the hospital because of cellulitis of the right lower extremity. There has been blistering of the area on the dorsum of the foot, as well as higher up towards the ankle. She has redness extending all the way up to the mid-pretibial area. There is no history of lymphadenopathy, and judging from the chart, she has been afebrile. She was started, after finding out that her white count was abnormal, on Cefobid and tobramycin and infectious disease consultation was sought.

PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature of 37°C, blood pressure of 130/70, respiratory rate of 20, pulse rate of 80.
GENERAL APPEARANCE: Elderly female in no acute distress.
HEENT: Grossly negative.
NECK: Supple.
LUNGS: Clear and resonant.
HEART: Grade 1 systolic murmur, otherwise negative.
ABDOMEN: Scars of surgery. The abdomen is not obese but protruding. She has some left lower quadrant discomfort that is mild.
VAGINAL AND RECTAL: Not done.
LYMPH NODES: No enlargement.
EXTREMITIES: Reveals blistering cellulitis over the dorsum of the foot with swelling and extension of the abnormal coloration to the mid-pretibial area. The foot feels warmer than the other. After sterile preparation, the 2 blisters were aspirated. A 0.2 cc of fluid was taken out, and this was sent for Gram stain and culture.

IMPRESSION: Probable strep cellulitis.

DISCUSSION: The patient has had a Gram stain done yesterday and it does show gram-positive cocci. This may well be staph, but I think we should give her penicillin until the culture reports are out. The blistering is typical of strep. I would go ahead and give her 2 million q. 6 hours of this penicillin and modify therapy according to culture report.

I thank you for allowing me to participate in the care of this pleasant elderly female, and will re-assess p.r.n.

oto09

2005-12-20T15:46:00.000+08:00

PRE-OPERATIVE DIAGNOSIS: Greatly hypertrophied tonsils with chronic recurring tonsillitis.

POST-OPERATIVE DIAGNOSIS: Same with hypertrophic adenoids.

PROCEDURE PERFOMED: T&A.

PROCEDURE: Under general anesthesia, the same procedure was carried out bilaterally. The tonsil was grasped with Allis forceps and incision made around the anterior tonsillar pillar, and the tonsillar capsule was identified, and tonsil bluntly dissected free, and all bleeding controlled with pressure sponges, and several small bleeding areas were touched with electrocoagulation. At the close of the tonsillectomy, there was no bleeding present. The nasopharynx was viewed indirectly. There was considerable amount of adenoid tissue which was removed with multiple application of adenotome, and under direct visualization, it was curated curetted and all evidence of adenoid tissue was removed and all bleeding was controlled with pressure sponges. And at the close of the procedure, there was no bleeding present.

The post-operative condition of the patient was good.

PATHOLOGY06

2005-12-13T13:30:00.000+08:00

CLINICAL HISTORY: A 39-year-old white female with a 2-day history of right breast mass.

TISSUE SPECIMEN: Right breast mass.

NAME OF OPERATION: Needle biopsy, right breast.

PREOPERATIVE DIAGNOSIS: Rule out carcinoma of the breast.

The specimen labeled "needle biopsy, left breast" is received. Fresh frozen section in gauze consists of 2 single pieces of tissue measuring 1.0 x 0.1 x 0.1 cm cylindrical tannish, soft, pliable tissue. It is submitted in its entirety.

radio26

2005-12-12T14:01:00.000+08:00

1726

RADIO OVARIES ULTRASOUND

ULTRASOUND OF THE OVARIES:

A multiple transverse transfers of sagittal sections were obtained with the _the use of real-time examination. There is a demonstration of 2 dominant follicles within the right ovary, with the largest measuring 18 x 18 mm. Those dominant follicles can be identified in the left ovary. The _remainder of the visualized pelvis is unremarkable.

IMPRESSION: A demonstration of 2 dominant follicles within the right ovary with the largest measuring 18 x 18 mm.

radio21

2005-12-12T14:00:00.001+08:00

1721

RADIO IV PYELOGRAM

INTRAVENOUS PYELOGRAM:

Scout film prior to procedure shows no evidence of abnormal calcification or other abnormality. After intravenous administration of 100 cc of meglumine diatrizoate, multiple overhead oblique and AP views, as well as tomograms are obtained. There is prompt equal excretion of contrast by both kidneys which are within normal limits of size, shape and location. Collecting systems are normal and there is no evidence of intrarenal hypodense or hyperdense mass. Ureters are of normal caliber and course. Urinary bladder is of normal size, shape and empties essentially completely upon voiding. No evidence of stasis is present in the upper tracts.

IMPRESSION: Normal Intravenous pyelogram (IVP).

On final perusal, there is some change about vertebral bodies of L1 and L2 compatible with old laterally wedged compression fracture

radio20

2005-12-12T14:00:00.000+08:00

1720

RADIO MYELOGRAM

COMPLETE MYELOGRAM, STERILE CONDITIONS:

A 22-gauge spinal needle was placed at the C1-2 level by single dural puncture and 3.5 cc CSF withdrawn. Ten cc of Iohexol was then introduced with good filling of the dural sac. There was no immediate complications.

There is a right posterior lateral bulge of the disk at L1-2 which indents the contrast column but does not displace nerve roots. There is thoracic scoliosis convex to the right at T9-10. There is no other abnormality such as nerve root edema, nerve root sheath effacement, dural impingement, intrarmedullary lesion, or destructive osseous lesion.

IMPRESSION:
1. Scoliosis.
2. Bulging L1-2 disk.

radio19

2005-12-12T13:59:00.000+08:00

1719

RADIO MAMMOGRAM

BILATERAL LOW DOSE MAMMOGRAM:

Two views of each breasts are obtained with low dose _screen_____ <0.04> film technique. There is extremely denseds, sheathlike retroareolar dysplasia present bilaterally. Although there is no mammographic finding specific for malignancy. The presence of this severe dysplasia significantly increases patient’s risk for developing malignancy. In particular, no new suspicious mass or change in _old density of suspicious nature has occurred. No clustered microcalcifications, skin thickening or nipple retraction are present.

IMPRESSION: Severe dysplasia involving major portion of both breasts.

radio18

2005-12-12T13:57:00.000+08:00

1718

RADIO UPPER GASTROINTESTINAL (GI) SERIES

Preliminary film of the abdomen reveals residual contrast of material in the descending, colon, and rectum from recent contrast study. There is a generalized osteopenia.

There was prompt initiation of the swallowing mechanism. On today’s examination, there was a demonstrated evidence of the soft esophageal dysmotility. Tertiary contractions were seen throughout the thoracic portion of the esophagus. There is a small hiatal hernia and evidence of gastroesophageal reflux with slow clearance of the reflux contrast material. The folds in the distal 3rd of the esophagus appear thickened suggesting esophagitis. The stomach, duodenal bulb, and duodenal sweep appeared normal. The viewed portion of small bowel likewise appeared normal. A couple of diverticula are seen in the duodenal sweep which represent normal variants.

IMPRESSION:
1. Esophageal dysmotility.
2. Small hiatal hernia, gastroesophageal reflux and esophagitis.

radio17

2005-12-12T13:56:00.000+08:00

1717

RADIO KIDNEY, URETERS, BLADDER (KUB)

KUB was done in this patient with history of intrauterine pregnancy. Twin fetuses are seen The fetus with its head located more inferiorly has its spine on the maternal left. The more superior fetus has its spine located in the maternal right. No evidence of the overlapping sutures were seen.

IMPRESSION: Twin pregnancy as described above.

radio11

2005-12-12T13:55:00.002+08:00

1711

RADIO SINUSES

A SINUS SERIES:

The patient has opacification of a 2/3 of the left maxillary sinus consistent with sinusitis. On the Towne’s view of the ethmoid sinuses are somewhat thickened The frontal sinuses and sphenoid sinuses are intact.

IMPRESSION: Sinusitis of the maxillary sinus and also possibily ethmoid sinus.

radio09

2005-12-12T13:55:00.001+08:00

1709

RADIO THORACIC

THORACIC SPINE ANTEROPOSTERIOR: Lateral swimmer’s views demonstrated mild degenerative changes in the lower thoracic spine. The height of the vertebral bodies and disk spaces are maintained. The pedicles are intact. No paraspinal soft tissue masses are noted.

IMPRESSION: Radiographically normal dorsal spine except for mild degenerative changes.

LUMBAR SPINE AP: lateral and oblique views demonstrate mild dextrorotoscoliosis of the lumbar spine. The height of vertebral bodies and disk space are maintained. The pedicles are intact. There is no evidence of spondylolisthesis or spondylolysis.

IMPRESSION:
1. Demonstration of mild dextorotoscoliosis of the lumbar spine.
2. No other soft tissue or bony abnormalities identified.
3. There is no evidence of spondylolisthesis or spondylolysis.

radio08

2005-12-12T13:55:00.000+08:00

1708

RADIO TIBIA

RIGHT TIBIAL AND FIBULA, TWO VIEW

Two views are obtained and they show multiple metallic screws transfixing a distal right fibular fracture. There has been no change in the number, position, or appearance of the transfixing screws. Oblique fracture of the proximal fibula is present and is also unchanged. Considerable demineralization of the distal right tibia is present, as well as some demineralization of the distal fibula. No definite evidence of osteomyelitis is present.

IMPRESSION: Status, open reduction and internal fixation (ORIF), distal right tibial fracture with no significant change. Oblique fracture proximal right fibula. No change about it either. Considerable demineralization compatible with disuse Recheck

radio07

2005-12-12T13:54:00.001+08:00

1707

RADIO ANKLE

ANKLE FILMS

There appears to be an old healed calcaneal fracture. In addition,, prominent spurs were seen at the anterior surface of the talus in the navicular . Spurring is often seen on the posterior lip of the tibia. The ankle mortise is intact.

IMPRESSION: Old healed calcaneal fracture with degenerative changes.

radio06

2005-12-12T13:54:00.000+08:00

1706

RADIO KNEES

ANTEROPOSTERIOR BILATERAL KNEES

KNEE: Right knee is normal in appearance.

KNEE: Left knee shows a subchondral sclerosis in the medial compartment of the femur and tibial plateau. There is a surrounding lucency in the area of sclerosis of the medial femoral chondyle and the medial portion of the tibial plateau that could represent area of osteochondrosis dissecans. There is some minimal spurring medially of the femur and tibia at the joint space. Mild genu varus is noted.

IMPRESSION: Degenerative changes of the left knee with possible osteochondrosis disseicans.

radio05

2005-12-12T13:53:00.001+08:00

1705

RADIO SHOULDER

FILMS OF THE LEFT SHOULDER:

There are minimal degenerative changes consisting of slight irregularity of the humeral head and small subchondral cystic changes seen particularly about the greater tuberosity. However, the joints space’s itself is relatively well maintained. I see no fractures or dislocations, or soft tissue abnormalities.

IMRESSION: Mild degenerative changes about the left shoulders described above without evidence for a fracture or dislocation.

radio05

2005-12-12T13:53:00.000+08:00

radio12

2005-12-12T13:52:00.000+08:00

1712

RADIO CHEST

CHEST: An alveolar consolidative process in the left basilar region, partially obscures in the left diaphragmatic contour. Strandy infiltrate is also seen but to a lesser degree in the medial basisarl region on the right lung base. Peribronchial cuffing is present in both hilar regions. A 2-cm cervical rib is seen on the left.

IMPRESSION:
1. Bilateral basilar pneumonitis with the left predominantly involved is identified.
2. A small 2-cm cervical rib is incidentally noted on left.

radio04

2005-12-12T13:34:00.000+08:00

1704

RADIO HAND

RIGHT HAND: Multiple views of right hand obtained and it showed a sclerotic area above the base of the metacarpals of the thumb, which is compatible with a benign change such as a bony island or enchondroma. There is no evidence of an acute fracture or disclocation.

IMPRESSION: Essentially normal study as described. Checked

radio02

2005-12-12T13:33:00.000+08:00

1702

THE LEFT FOOT THREE VIEWS: There is a transverse fracture of the proximal portion of the first digit phalanx. A comminuted fracture is noted at the middle phalanx of the second digit and an increased deintensity is seen medially at the joint space of the middle phalanx of the third digit. On the oblique films, there appears to be a displaced fragment of bone between the second and third digits of the PIP. No other bony abnormalities are noted.

IMPRESSION:
1.: Fracture of distal phalanx first digit.
2. Phalangeal fractures of second and third digits .

radio01

2005-12-12T13:29:00.000+08:00

RADIO PELVIS

PORTABLE PELVIS:

Portable AP study now shows the femoral prosthesis to be in place and in normal relationships with the acetabular prosthesis. The total hip replacement prosthesis is also noted to be in place on the left. There is no evidence of osseous destructive process.

IMPRESSION: Total hip replacement prosthesis is now in place on the right and in normal relationships with the acetabulum. Total hip replacement prosthesis on the left.redone.

Cardiology Key Terms

2005-12-12T13:14:00.001+08:00

Cardiology Key Terms

a.c.
ADA diet
adenopathy
afebrile
akinesis
aminophylline
anatomosis
Ancef
anemia
angiodysplasia
angiography
anoxic
antianginal
anticoagulant
aortic root
apical aneurysm
arrhythmia
arteriotomy
artery
left anterior
descending (LAD)
left circumflex coronary
left internal mammary
main circumflex
coronary
right coronary
Atarax
atrial fibrillation
atrial rate
atropine
auscultation
AV (atrioventricular) block
axis deviation
balloon angioplasty
Betadine
bibasilar
bradycardia
branch of (artery)
diagonal
first obtuse marginal
second obtuse marginal
bundle branch block
bypass surgery
CABG (coronary artery bypass graft)
cannulated
Capoten
captopril
Carafate
cardiac arrest
cardiac catheterization
cardiac enzyme
cardiomegaly
cardioplegia solution
cardiopulmonary bypass
cardioverted
Cardizem
carotid pulse
CBC (complete blood count)
central venous pressure (CVP)
chemistry panel
CHF (congestive heart failure)
chronic lead placement
Clinoril
clonidine
Colace
collateral flow
conduit
congestive heart failure
congestive cardiomyopathy
Coumadin
CPI Astra bipolar generator
CPK enzyme
CPR (cardiopulmonary resuscitation)
cranial nerves II-XII
crescendo angina pectoris
CVA (cerebrovascular accident)
cyanosis
D5W (5% dextrose in water)
Dalmane
Dc countershock
decannulation
deep venous thrombosis
Dexon
diaphoresis
diastolic rumble
differential (on CBC)
digoxin
dipyridamole
disoriented
dorsal
dysfunction
dyspneic
ectopy
ejection fraction
encephalopathy
epinephrine
ET (endotracheal) tube
exudate
fingerbreadths
flat line EKG
friction rub
fundi
grade 2 hypertensive change
grade 2-3/6 blowing systolic heart murmur (grade two to three over six)
heart disease
arteriosclerotic
atherosclerotic
coronary artery
hypertensive
valvular
hemiparesis
hemodynamic
hemogram
hypercholesterolemia
hypertension
hypotension
idioventricular rhythm
Inderal
infarct
inferolateral
inflammatory
interstitial pulmonary edema
inversion
irregularly irregular rhythm
ischemia
Isordil
joule
jugular venous distention (JVD)
kyphosis
Lanoxin
Lasix
LDH
lead III on EKG
lead ("leed")
anterolateral
inferior
lindocaine
lymphadenopathy
MB fraction
Metamucil
MI (myocardial infarction)
Micro-K
midsystole
MM fraction
neoplasm
nitro patch
nitroglycerin
nitroglycerin SL
nonproductive cough
NPH insulin
O2
occult blood
orthopnea
P wave
pacemaker failure to capture
pCO2, pCO2
percussion
perfusion
pericardial
Persantine
pH
pitting edema
platelets
pleural effusion
PND (paroxysmal nocturnal dyspnea)
pneumonitis
pO2, PO2
potassium
PR interval
premature ventricular beat
Procardia
psychosis
PT (prothrombin time)
PTT (partial thrombiplastin time)
pulmonary artery vent
pulsatile perfusion
Q wave
QRS
Quinaglute
quinidine
rales
reciprocal change of EKG
reflexes
deep tendon
pathological
regimen
regular insulin
Restoril
resumption
resumption
resuscitation
retracted
revascularization procedure
reversible ischemia
right atrium
S3 (heart sound)
S4 (heart sound)
saphenous vein graft
selective coronary
arteriogram
side-bitting clamp
Silastic tapes
sinus tachycardia
sinus rhythm
SMAC panel
ST segment
ST wave
ST-T wave changes
stenosis
sternal notch
subendocardial myocardial infarction
sublingual
substernal
subtherapeutic
supravalvular aortogram
suture
3-0 ("three oh" or "three zero")
4-0
6-0
7-0
Dexon
Prolene
Vicryl
Swan-Ganz catheter
syncope
Synthroid
systemic hypertension
T wave
telemetry
Tenex
thallium treadmill stress test
third-degree complete heart block
thoracotomy
thyromegaly
tibia
TKO (to keep open)
total CPK
toxic digoxin level
transdernal
treadmill stress test
triglycerides
tube
right-angle
straight chest
type 2 diabetes mellitus
unlabored
unstable angina
bein harvesting
venogram
ventricular fibrillation
ventricular rate
ventricular tachycardia
ventriculogram
vibratory sense
Voltaren
watt-second shock
wide-complexed rhythm
Xyclocaine
Zantac

Endocrinology Key Terms

2005-12-12T13:14:00.000+08:00

Endocrinology Key Terms

ACE (angiotensin-converting enzyme) inhibitors
Addison disease
adenoma
follicular
Hurthle cell
androgen level
bibasilar
cold nodule
congenital
Cortef
cortisone acetate
Cytomel
DiaBeta
diabetes mellitus
type 1
type 2
diaphoresis
discoid atelectasis
Dazide
emesis
escuthceon
euthyroid
exophthalmus
extraocular movements
ferrous sulfate
fine-needle aspiration
Florinef Acetate
furosemide
goiter
colloid
nontoxic
Graves disease
Humulin insulin
hyperkalemia
hyperthyroid
hypoglycemia
hypothyroidism
I.M.,IM
Inderal
Kayexalate
lobectomy
metabolic acidosis
oral hypoglycemic agent
periareolar
pneumonitis
prerenal azotemia
PTU
Quinidex Extentabs
sodium bicarbonate
Solu-Cortef
surgical staples
Synthriod
tetracycline
thryoid function test
T3
T4
TSH
thyroidectomy
Ultralente insulin
uptake scan
Vasotec

Pathology Key Terms

2005-12-12T13:13:00.000+08:00

Pathology Key Terms

accumulation
adjacent
adrenal gland
aerted
aggregates
antecubital fossae
apocrine
aspiration trocar
atypical biliary ductules
autolytic
autopsy
bisected
bosselated
calices
calvarium
cancerization
carcinoma
bronchogenic
duct-cell
large-cell
oat-cell
small-cell
undifferentiated
cell
infiltrating
inflammatory
plsma
cerebellum
cerebral hemispheres
cerebrum
chromatin
clefting
columns of Bertin
concretions
cone biopsy
configuration
coronal sections
cortex, cortices
curettings
cytologic features
cytoplasm
description
gross
microscopic
diffuse
desseminated intravascular coagulation
dura
ectasis
embedded
embolus
endocardium
endocervical
endometrial
eosinophilic
ependymal lining
epicardium
excisional biopsy
fascicles (muscle)
fibrillar
fibrocartilage
foce
follicular
formalin
free foamy fluid
frothy
frozen section
germinal center
Glisson capsule
gyrus, gyri
hemoperitoneum
hemothorax
H&E stain
hilar aspect
hyperchromatic
incision
thoracoabdominal
Y-shaped
infiltrate
interventricular septum
keratinization
kidney architecture
leptomeninges
lobular parechyma
lumen
medulla, medullae
medullary zone
meniscus
mesenteric soft tissue
mesocolonic fat
metaplasia
mitotic rate
mucous cyst
muscularis propria
nonkeratinizing
nuclear-cytoplasmic ratio
nucleolus
nucleus
opacified
opaque
orbital aspect
ovoid
pachymeninges
Pap smear
papillary
parafollicular
paravertebral
parenchyma
parietal pericardium
pelves
pelvic brim
pericardial sac
perisplenic
pleomorphic
pleural
polymorphonuclear leukocytes
portal triads
postmortem
proliferation
psoas ("so-us")
pulmonary edema
refractile material
scaphoid
splenic flexure
squamous epithelium
stratified
striated
subarachnoid space
subendocardial
subepithelial
subjacent
symphysis pubis
synovitis
synovium
tension pneumothorax
thrombus
tissue
fibrofatty
fibrous
grumous
tonsillar crypt
toxicology
transepithelial migration
trocar plug
umbilicus
valve cusps
valve leaflet
Virchow-Robin spaces
viscid

Pulmonary Key Terms

2005-12-12T13:12:00.000+08:00

Pulmonary Key Terms

1-second forced expiratory volume (FEV1)
22-gauge needle
A2
accessory respiratory muscles
adrenals
AFB (acid-fast bacilli)
Aldoril
Alupent
anteroposterior diameter
asbestos
bronchial brushings and washings
bronchoscopy
bronchospasm
bronchovesicular breath sounds
Bronkometer
carbon black
cardiomegaly
carina
cautery
cavitary mass
coarse rhonchi
consolidative change (on chest x-ray)
cor
CT scan
cytology
diaphoresis
dyspnea
end-inspiratory wheeze
endobronchial
equivocal
equivocal
expiratory
extrinsic
exudative
FEF25-75
fiberoptic
fibrosis
fine-needle aspiration
first tracheal ring
friable
FVC (forced vital capacity)
Gram stain
hilar
hyperreactivity
IgE antibody
Inderal
infiltrate
ligating
lobes of lung
longitudinally
main stem bronchi
main stem carina
mediastinum
metastasis, metastases
metacholine challenge
mucoid
nebulizer
nonproductive cough
noxious inhalants
orifice
P2
Panel A
percussion note
perfusion
pleural effusion
pleural friction rub
productive cough
promethazine
pulmonary function studies
radioallergosorbent test (RAST)
radiographs
reactive airway disease
refractory
respiratory excursions
serosanguineous
sibilant
small-cell carcinoma
SOB (shortness of breath)
space-occupying lesion
strap muscles
suprastrenal notch
suture
1-0
silk
tetracycline
Theo-Dur
thoracentesis
thorax
TDI (toluene di-isocyanate)
tracheal look
tracheostomy tube
tracheotomy
trancsverse
Vanceril
ventilatory perfusion lung scan
vital capacity
well-differentiated lesion

Radiology Key Terms

2005-12-12T13:11:00.000+08:00

1. 8 Frech introducer catheter
2. 8-mm sections
3. 22-gauge spinal needle
4. 99m-technetium sodium pertechnetate
5. acoustical shadowing
6. adenopathy
7. air-fluid level
8. alveolar
9. aneurysm
10. angiogram
11. ankle mortise
12. aortic dissection
13. avascular necrosis
14. axial
15. basilar pneumonitis
16. blood pool images
17. bone window
18. bony island
19. bony thorax
20. bronchiectasis
21. bulging L1-2 disk
22. C1-2 level
23. calcifies granulomata
24. cardiac gating
25. cardiac silhouette
26. cardiomegaly
27. catheter introducer
28. celiac
29. cervical rib
30. choroids plexus
31. cistern
32. clavicular level
33. clustered microcalcifications
34. collecting system of kidneys
35. condyle
36. consolidative process
37. contiguous
38. contrast column
39. COPD (chronic obstructive pulmonary disease)
40. coronal images
41. cortex, cortices
42. costophrenic angle
43. CVP (central venous pressure) line
44. demineralization
45. density
46. dextrorotoscoliosis
47. diaphragmatic contour
48. disk space
49. distention
50. disuse
51. dominant follicles
52. duodena bulb
53. duodenal sweep
54. dural impingement
55. dural puncture
56. dural sac
57. dysmotility
58. dysplasia
59. echo pattern
60. effacement
61. enchondroma
62. epidural
63. esophageal dysmotility
64. esophagitis
65. evolving hematoma
66. falx
67. femur
68. fibrotic changes
69. filling defect
70. focal abnormality
71. fracture
a. acute
b. calcaneal
c. comminuted
d. compression
e. fibula
f. oblique
g. phalangeal
h. transverse
72. free air
73. gaseous distention
74. gastroenteritis
75. gastroesophogeal reflux
76. genu varum
77. granulomata
78. greater tuberosity
79. hematoma
80. hemidiaphragm
81. hemithorax
82. heparin
83. hiatal hernia
84. hilar region
85. humeral head
86. hydronephrosis
87. hyperdense
88. hyperinflation
89. hypodense
90. Hypaque-76
91. hyperdense
92. I-123
93. ileus
94. iliac
95. iliofemoral graft
96. immunoblastic lymphoma
97. impingement
98. infarct
99. intramedullary lesion
100. intrauterine pregnancy
101. Iohexol
102. liver-spleen scan
103. low-dose mammogram
104. low-dose screen
105. lucency
106. mammogram
107. mass effect
108. mCi (millicuries)
109. medial compartment (of knee)
110. mediastinum
111. meglumine diatrizoate
112. metacarpal
113. microcalcification
114. microcuries (mCi)
115. midline shift
116. midlung
117. morphologic
118. MRI (magnetic resonance imaging)
119. myelogram
120. nasogastric tube
121. navicular
122. nerve root
123. nipple retraction
124. nodular-like
125. oblique
126. obscure
127. obstructive lung disease
128. opacification
129. ORIF (open reductionand internal fixation)
130. osseous lesion
131. osteochondritis dissecans
132. osteomyelitis
133. osteopenia
134. overlapping sutures
135. paraspinal
136. patchy edema
137. patent lumen
138. pedicles
139. peribronchial cuffing
140. perihilar fibrosis
141. perusal
142. phalanx
143. pineal
144. PIP (proximal interphalangeal) joint
145. plane
i. coronal
j. sagittal
146. popliteal vein
147. preliminary film
148. prosthesis a. acetabular b. femoral
149. pubic symphysis
150. pulmonary artery
151. pulmonary embolus
152. radioiodine
153. real-time examination
154. region
k. basal
l. basilar
m. hilar
155. renal cortices
156. residual
157. retroareolar
158. ropy
159. sagittal section
160. sclerosis
161. sclerotic area
162. scoliosis
163. scout film
164. segmental defect
165. sheath effacement
166. sheetlike
167. short-arm Grollman catheter
168. sinus
n. ethmoid
o. frontal
p. maxillary
q. sphenoid
169. sinusitis
170. skin thickening
171. sodium iodide
172. soft tissue mass
173. sonography
174. spondylosthesis
175. spondylosis
176. spurring
177. stasis
178. static (adjective)
179. strandy infiltrate
180. subchondral
181. subdural
182. sulci
183. swimmer’s view
184. T1-weighted images
185. T20weighted-images
186. T9-10
187. talus
188. tarsal
189. technetium-99mm albumin colloid
190. tertiary
191. thoracic portion of esophagus
192. tibial plateau
193. tomograms
194. Towne view
195. tract
196. transfixing screw
197. tube
r. ET (endotrancheal)
s. nasogastric
t. thoracotomy
198. twin fetuses
199. upper GI series
200. vascularity
201. vertebral body
202. vertex
203. view
u. swimmer’s
v. Towne
204. V/Q (ventilation/perfusion) scan (Q=quotient)
205. white matter

Neurology Key Terms

2005-12-09T14:07:00.000+08:00

Neurology Key Terms

10-channel EEG
abducens muscle
affect (psychiatry)
albeit
alpha activity on EEG
Alzheimer disease
annulotoly
annulus
anticonvulsant
aphasia
articulate
aseptically
ataxia
attenuation
Babinksi reflex
basilar skull fracture
bursts (dysrhythmic)
C5-6
cervical myelogram
circumlocutory
cognition
coherent
contrast media
cortical sensation
cranial nerves II-XII
cryptococcal antigen
CSF (cerobrovascular fluid)
CT scan
CVA (cerebrovascular accident)
cycles per second (6 to 7)
deja vu
dementia
Dilantin
diminution
diplopia
disk bulge
dura
dysrhythmic bursts
EEG
elicits
emesis
epileptic seizure
etiology
extradural defect
fontanelle
foramen
glioblastome multiforme
glioma
Hastings frmae
hemilaminectomy
hemiparesis
hyaline membrane disease
hydrocephalus
hyperventilation
infight and judgement
intractable
intraventicular
hemorrhage
intrinsic brain stem lesion
jamais vu
L3-4 interspace
L4-5 interspace
l5 disk
L5-S1 interspace
lamina
lethargy
lightheadedness
lumbar puncture
meningitis
mental status
monotone
motor examination
MRI (magnetic resonance imaging)
muscle
sternomastoid
trapezius
myasthenia gravis
myelography
myoclonic-type movements
nerve root
neuropathy
neuroradiologist
NP leads
nuchal stimuli
palate
parkinsonian
PEI (pulmonary interstitial emphysema)
peripheral neuropathy
phenobarbital
position
kneeling
lateral decubitus
prone
postion sense
postprandial blood sugar
reflex
deep tendon
plantar
seizure
absence
generalized
grand mal
sensory examination
sign
Brudzinski
Kernig
sleep-deprived EEG
SMAC
stereognosis
tandem walking
tangential
Tegretol
test
finger-to-nose
heel-to-shin
Prostigmin
psychometric
Romberg
Tensilon
urine catecholamines
vertigo

Gastro Key Terms

2005-12-08T13:27:00.000+08:00

Key Terms

abdominal series
abscess
acid regurgitation
acute abdomen series
adenopathy
adherent
adhesions
air-contrast barium enema
air-fluid level
ANA (antinuclear antibody)
anal sphincter
antacid
antibiotic
antireflux
AP diameter of chest
appendectomy
appendicitis
appendicolith
appendix
gangrenous
retrocecal
approximated
ASHD (arteriosclerotic heart disease)
atrophic gastritis
auscultation
bands (banded neutrophils)
barium edema
belching
bethanechol
bile
bile reflux
biliary colic
bloating
bowel sounds
breath sounds
C. (Clostridium) difficile
cecum
cholecystiti
cholelithiasis
clamped
codeine
colon
ascending
descending
proximal
sigmoid
transverse
colonoscopy
constipation
COPD (chronic obstructive pulmunary disease)
copious
Crohn disease
curvilinear incision
cystic artery
cystic duct
debris
dehydration
Demerol
diabetes mellitus
diarrhea
diet
BRAT
clear liquid
high-bulk
low-fat
difficulty swallowing
diffusely
discrete
dissection
blunt
finger
general endotracheal anesthesia
GERD
Gram stain
grasper
guaiac-positive tool
gutter
Hasson retractor
Hasson trocar
hematemesis
Hemoccult card
hemorrhage
hemorrhoids
external
internal
hemostasis
hernia
hiatal
indirect
inguinal
sliding-type hiatal
herniorrhaphy
hilar clip
hyaline casts
hyperactive
hypoactive
ileus
incision
indigestion
induced
inflammatory bowel disease
inflamed
infraumbilical incision
intraoperative
irritable bowel syndrome
jugular venous distention
Kocher clamp
KUB x-ray
laparoscopic cholecystectomy
lap pad (laparotomy)
left lower quadrant
left upper quadrant
left shift (on differential WBC count)
ligate, ligated
ligature
liver panel
long-standing
McBurney's point
mesoappendix
midepigastric
muscle layers
muscle-splitting technique
multisystem
nausea
necrosis, necrotic
NG (nonsteriodal anti-inflammatory drug)
obliquely
obstipated
Olympus GIF-K gastroscope
omentum
operative cholangiogram
operative field
organic disease
palpitations
paralytic
parrot scissors
paternal
pending
peptic ulcer disease
perforation
peripheral edema
peritoneal cavity
peritoneal fluid
peritonealized
periumbilical area
phlegm
pleural effusion
pleurisy
pneumoperitoneum
port
epigastric
lateral
umbilical
profuse
prothrombin time (PT, pro time)
protrusion
purulent debris
pylorus
radiating
rebound constipation
rebound tenderness
rectum
referred tenderness
reflux
regurgitation
retrocecal
rheumatiod factor
rhythm
right lower quadrant
right upper quadrant
rugal folds
serum protein
sigmoidoscopy
sinus bradycardia
small bowel obstruction
small bowel series
sphincter
spillage
sponge and needle counts
Steri-Strips
stool culture
subcostal plane
subcutaneous tissue
subcuticular
substernal
superficial tenderness
supine
surgical clips
suture
0 (zero "oh")
2-0 (two "oh")
3-0 (three "oh")
catgut
dermal
interrupted
PDS
plain
Vicryl
Z-type
suture removal
synptomatic
tinkling bowel sounds
transit time
tympanitic
upper GI x-ray
upper GI with small bowel series
X 3 (times three)
viral gastroenteritis
vomiting

gstro15

2005-12-07T16:31:00.000+08:00

PREOPERATIVE DIAGNOSIS: Acute abdomen, rule out acute appendicitis.

POSTOPERATIVE DIAGNOSIS: Acute gangrenous appendicitis.

OPERATION PERFORMED: Appendectomy.

INDICATIONS: A 41-year-old male with a progressively increasing right lower quadrant abdominal pain associated with fever, chills, and elevated white count. Emergent exploration was done after preoperative intravenous antibiotics are given.

OPERATIVE PROCEDURE: The patient is brought to the operating suite after receiving Cefobid and Flagyl intravenously. He is placed supine upon the operating table and general endotracheal anesthesia is induced and maintained. His abdomen is then prepped with Betadine scrub and solution and draped in a sterile fashion. A slightly obliquely oriented right lower quadrant incision is made and carried deep to the external muscular fascia, hemostasis controlled with electrocautery. The external oblique is opened in the direction of its fibers and then muscle splitting technique is used to enter the peritoneal cavity. There is no excessive free peritoneal fluid. The thick omentum is noted to be adherent to the right lower quadrant and blunt finger dissection removed the omentum from a very inflamed necrotic appendix which is in a slightly retrocecal position although it is peritonealized. There are areas of patchy gangrene, there is no full-thickness perforation, there is no obvious fecalith, there is no abscess. The mesoappendix is clamped, divided, and ligated with interrupted 2-0 Vicryl sutures. The base of the appendix is somewhat inflamed but the necrosis is in the midportion and the cecum itself is relatively normal. The base of the appendix is crushed and ligated with a 3-0 plain catgut. The appendix is then excised and removed from the operative field. The base is electrocoagulated and then inverted into the cecum using a Z-type suture of 3-0 Vicryl. The mesoappendix is inspected for hemostasis, no bleeding is noted. The area locally is irrigated with normal saline solution. It should be noted that the wound was protected with laparotomy pad covers. The cecum is replaced within the peritoneal cavity and then irrigation in the right gutter, the right lower quadrant, and pelvis with copious amounts of sterile saline is then accomplished. There is no purulent debris. Abdominal wall closures are done in layers. Continuous 2-0 Vicryl is used to close the posterior peritoneum and fascia and running 0 Vicryl is used to close the oblique muscle layers. Irrigation with saline solution is carried out at each level. Subcutaneous tissues are loosely approximated with interrupted 4-0 Vicryl and the skin is closed with running dermal suture of 4-0 Vicryl. Steri-Strips and a dry sterile dressing are applied and he is awakened and returned to the recovery area in satisfactory condition. Estimated blood loss is approximately 5-10 cc. Sponge and needle counts are correct x3.

gastro14

2005-12-07T16:30:00.000+08:00

FINAL DIAGNOSES:
1. Diverticulosis in the colon.
2. Severe constipation.
3. Small bowel obstruction, ruled out.

HISTORY: The patient is an 80-year-old male. He began vomiting up gastric contents following the onset of pain in the periumbilical area.

LABORATORY FINDINGS: Barium enema diverticulosis in the sigmoid and descending colon with possibility of diverticulitis of the proximal sigmoid. WBCs 9600, hemoglobin 16.8. Urinalysis 8-10 wbc’s per high-powered field.

HOSPITAL COURSE: An NG tube was inserted. Quite a bit of gastric contents was suctioned. His condition gradually improved. No specific gastrointestinal lesion was diagnosed other than the diverticulosis or diverticulitis noted on the barium enema.

gastro10

2005-12-07T16:29:00.000+08:00

Dear Doctor,

I have seen the above named patient for several visits since her colonoscopy and I wanted to update you about what has transpired for you. After the colonoscopy, I increased the AzulfidineEsophadine to 2 q.i.d. I also sent stool for C.difficile ________ which was negative and ordered an upper GI G.I. with a small bowelbell series. This showed a small sliding type hiatal hernia with rapid transit time through the small bowelon ___small bell. The remainder of the exam was normal.

I saw this patient again 3 months later, at which time she had a fever and sweats with temperature of 103 degrees. I referred her to your office after to further assess whether the Azulfidine Esophadine or Crohn’s _______ is the source of her fever. Also, when she took Lomotil for loose stools, she became obstipated. Metamucil Mademoiselle may help avoid rebound constipation.

Thank you for allowing me to participate in this very lovely patient’s care and management.

Very truly yours,

LC: 13.52
Error: 5.75
Quality: 57.47%

gastro05

2005-12-07T16:28:00.000+08:00

This patient returns to the office today for routine followup with the diagnosis of liver dysfunction with multisystem complaints. He also may have irritable bowel syndrome, but inflammatory bowel disease should be ruled out. A protime, liver panel, ceruloplasmin, serum protein electrophoresis, ANA, rheumatoid factor, sed rate, and total serum protein were obtained and the results are pending. Next followup scheduled in 2 weeks to discuss results of lab tests where the patient will be seen p.r.n. as his complaints warrant.

LC: 8.29
Error: 0.75
Quality: 90.95

Otorhino Key Terms

2005-12-07T13:24:00.001+08:00

Key Terms

A.S.A.
adenoidectomy
adenoids
adenotome
Allis forceps
anterior pack
asymmetry
Betadine-impregnated
Blue Cross
bolus
Coumadin
counterpressure
dander
debridement
deviated nasal septum
electrocoagulation
epistaxis
external otitis media
exudate
flanged
fungus
Garamycin solution
genera
house dust mites
hydrogen peroxide
hypertrophied
immunotherapy
impedance
indirect visualization
infected (adjective)
iodoform gauze
irrigation
jugulodigastric area
liquefaction
lymohoid hyperplasia
lumphoid plaques
malodor
mastoid
micro ear forceps
mold spores
myringotomy
nasal septoplasty
nasopharynx
operating microscope
otitis media
penicillin V potassium
pharynx
PND (postnasal drainage)
postauricular
posterior cervical nodes (neck)
pressure sponges
quadrilateral drainage
rhinitis
rhinoplasty
S-shaped configuration
saline gargle
serous otitis media
silver nitrate
smell hallucination
Spectazole
strep screen
submocous resection
Teflon
tonsillar capsule
tonsillar fossa
tonsillitis
tympanic membranes
ventilation tube

Opthal Key Terms

2005-12-07T13:23:00.000+08:00

Key Terms

Abraham contact lens
anterior chamber
antiviral therapy
arteriolar narrowing
artificial tears
bacteriostatic water
bipolar cautery
BSS (balanced salt solution)
capsulotomy
cataract
mature
nuclear
secondary
Cavitron AIS irrigating-aspirating needle
coapted
corneal epithelium
corneoscleral scissors
cystitome
cytomegalovirus
dermatomyositis
ecchymosis
ectropion
episcleral
examination
ophthalmoscopic
slit-lamp
exotropia
extracapsular cataract
extraction with lens implant
extraocular motility
forceps
angulated
McPherson
Fox Shield
fundus of disk
funduscopy
ganciclovir
Garamycin
Healon
HIV antibody
IDDM
intraocular pressure
IOL (intraocular lens)
Iolab intraocular lens
Kenalog
laser
argon
coherent YAG
YAG
lens cortex
lid speculum
limbus
macular degeneration
macular edema
Marcaine
medial rectus recession
mJ (millijoules)
molluscum contagiosum
muscle
inferior oblique
inferior rectus
orbicularis
medial rectus
superior rectus
Nizoral
OU, O.U.
pentamidine aerosol
peripheral iridectomy
peritomy
photocaugulation
Pneumocystis carinii
posterior capsulotomy
postion
3 o’clock
9 o’clock
12 o’clock
prednisone
prism diopters
pseudoaphakia
papillary constriction
retinitis
retinopathy
retrobulbar block
rheumatoid arthritis
selenium
serum RPR
Sinskey hook
stereo acuity
strabismus
subconjunctivally
suture
10-0
nylon
silk
traction
temporally
test
four-dot
Snellen
Timoptic
Van Lint lid block
vision
20/20
20/30
20/40
20/50+
20/200
visual acuity
Wydase
Xylocaine
Zantac
Zeiss operating microscope

Dermatology Key Terms

2005-12-05T18:43:00.000+08:00

Dermatology Key Terms

acne
advancement flap
afebrile
amphotericin B
Augmentin
bacterial culture
Benzagel
Betadine
blackhead
blistering
Burow soaks
Candida albicans
Cefobid
cellulitis
Clarks’s level 3
cocci
coloration
comedo
confluent
contact sensitivity
cosmetic removal
crusting
cyst
demineralization
dermatitis
disfigurement
dorsum of foot
eczema
elective
eruption
ERYC
erythematous
Ethilon suture
excision
foreign body
freckle
frozen control
fungal culture
gelatinous material
gram-negative
gram-positive
Gram stain
griseofulvin
group D strep
HIbiclens soaks
infiltrated
inflammatory reaction
interdigital web space
jaw line

LCD
Keflex
Kenalog
ketoconazole
Komed
laceration
Lactobacillus
lesion
Lotrimin cream
malignant melanoma
mid-pretibial area
Neosporin
nonprurutic
oozing
palpable
Pernox
plaque
potassium
permanganate
pruritic
Pseudomonas
psoriasis
pustular lesion
scaly plaques
scapulae
secondarily infected
skin cancer
staph
strep
streptococcus cellulitis
synovial cyst
tobramycin
toe web
topically
triamcinolone cream
tumor
ulceration
unresectable tumor
Valisone cream
wartlike lesion
whitehead
wide-margin resection
Xylocaine
yeast

Urology Key Terms

2005-12-05T18:28:00.000+08:00

urology key terms

Achilles reflex
acute
ADH (antidiuretic hormone)
adnexa
ampicillin
amylase
anesthetic
general
spinal
anterior
antibiotic
antihypertensive
appendectomy
asymptomatic
atrophic
autologous
b.i.d.
band neutrophils
bartter syndrome
benign
bilaterally
biopsy
bladder floor
bladder outlet
bladder suspension
blind vaginal pouch
blood panel
borderline
BPH (benign prostatic hyperplasia or hypertrophy)
bruit
BUN (blood urea nitrogen)
calcium
calculus
calix
catheter
5 french
8 french
18 french
acorn-tipped
angle-tipped
foley
ureteral
cellulated
cervix
chloride
cholecystectomy
cholesterol
chronic
circumcision
clubbing
complexity
concentrating defect
constipation
constrict
creatinine
crevice
CT scan
CVA (costovertebral angle)
cyanosis
cyst
cystocele
cystogram
cystoscopy
debris
deficiency
deficit
diabetes insipidus
diagnostic
dialysis
diarrhea
diffuse
dilatation
disposition
distal
distention
diverticular
diverticulum
double-j stent
double-voided urine
dressing
2 x 2
collodion
steri-strips
dysuria
edema
elective
electrolytes
chloride
CO2
potassium
sodium
end-stage
endocrinologist
endoscopic
endotracheal
enlargement
enuresis
Ex-Lax
excretion
external oblique fascia
extracorporeal shockwave lithotripsy(ESWL)
extremities
extubate
fatigue
fellow
fibers
filling defect
flank (noun)
fluoroscopy
focal tenderness
foreskin
fragmentation
fulguration
fungal
gantry
glans penis
glucose
gm
granuloma
gravity drainage
gross examination
guaiac
heart gallop
heart rub
HEENT
hematocrit
hematoma
hematuria
heme
hemoglobin
hemostasis
hernia
herniorrhaphy
hydrocele
hydrocelectomy
hydrochlorothiazide
hydronephrosis
hydroureter
hypertrophy
hypoglycemia
hypokalemia
hyposthenuria
hysterectomy
incision
incontinence
internal inguinal ring
inverted
IVP (Intravenous pyelogram)
juvenile
JV (jugular venous)
kidney
KUB (kidneys, ureters, bladder)
KV reading
LDH
lithotripter
loading dose
localized
lower pole calix
malaise
manipulated
Marshall test
McBurney’s point
mEq/L
metastatic
mg
mg/dl or mg/dL
Minipress
murmur
nausea
neddle suspension
negligible
nephrolithiasis
nephrologist
nephrology
nephronophthisis
neurological
nocturia
nontender
objectives
obstruction
obstructive
orchiectomy
organomegaly
oriented X 3
orifice
osmolality
P&A (percussion and auscultation)
p.r.n.
palliative
pallor
palpable
patent
pathology
pediatric
periodic
phimosis
phosphorus
polydipsia
polyuria
position
dorsal lithotomy
lithotomy
posterior
postoperative
postvoid residual
potassium
preoperatuive
processus vaginalis
proctitis
prophylactic coverage
prostate, prostatic
prostatic bed
prostatic chips
proximal, proximally
q.a.m.
q.i.d.
quadrant
radiate
radiation cystitis
radiation therapy
radiopaque
reactive
recanalization
rectocele
recurrent
redundant
renal failure
renal pelvis
residual
retraction, retracting
retrograde pyelogram
rhythm
sac
scope
11.5 French
22 French
28 Storz
cystoscope
resectoscope
ureteroscope
scrotum
segmented neutrophils
Segure stone basket
Septra DS
SGOT
SMA-20
sodium
specific gravity
spermatocytic
spun hematocrit
sputum
stage D3 adenocarcinoma
stone basketing
stool
stress incontinence
subcutaneous tissue
submucosal tunnel
sulfa
supple
suture
4-0
5-0
subcutaneous
subcuticular
Vicryl
symptom
testicle and cord
TFT’s (thyroid function test)
trabeculated
transected
transitional cell carcinoma
triglycerides
trilobar
TURP (transuretheral resection of prostate)
ultrarasonography
unremarkable
uptake
uremia
ureter
uretheral
urge incontinence
uric acid
urinalysis
urinary force
urinary hesitancy
urinary stream
urinary terminal dribbling
urinary urgency
urine dipstick
urologic
UTI (urinary tract infection)
varices
vasectomy
verumontanum
vesical neck
vessel loop vital signs
void (verb)
yeast infection