What do you need Angel?

I am new to this group/site. I am working on quiz 20. Is there anyone out there, who can proofread my quiz for me? I have been very discouraged by the instructors.



Name: Mary Charles DISCHARGE SUMMARY
# 040303
Dr. Sung Pak

DISCHARGE SUMMARY

ADMITTING DIAGNOSIS
Intrauterine gestation at the term of in active labor.

PRESENT ILLNESS
The patient is a 14-year-old gravida 1, para 0, who presented in active labor without prior prenatal care.

LABORATORY FINDINGS
Urine culture positive for Escherichia coli. Lochia culture negative for aerobic and anaerobic cultures.

HOSPITAL COURSE
Spontaneous vaginal delivery produced a viable male infant, weighing 3,450 g, with Apgar scores of 7 at five minutes and 9 at ten minutes. There were twenty units of Pitocin administered postpartum. No tocolysis was administered. Delivery was complicated by the presence of a nuchal cord, which probably accounted for the early low Apgar scores. There was 4 + meconium present. The pediatrician attended to the neonatal postpartum. Following normal vaginal delivery of a viable infant, the placenta was delivered intact. Three cord vessels were identified. Cord blood samples were sent to Pathology. A midline episiotomy was performed for the delivery after using local anesthesia. Two days postpartum, the patient developed a temperature of 105 ̊F, with dysuria and foul lochia. On Gantrisin, patient defervesced and dysuria resolved.

DISPOSITION
Discharged to home with infant.

FOLLOW-UP
Return in two weeks’ time for repeat urine culture and six weeks’ for routine postpartum care.

CONDITION ON DISCHARGE
Stable.

DISCHARGE DIAGNOSIS
1. Normal spontaneous vaginal delivery with midline episiotomy.



CONTINUED
Name: Mary Charles DISCHARGE SUMMARY
# 040303
Page 2

2. Cystitis. Puerperal infection not evident at present time.

PLAN
Repeat clean-void urine culture and lochia culture in two weeks. Tubal ligation had been planned but will be deferred until infection is completely resolved.

DISCHARGE MEDICATIONS
Medications none.

Name: Merry Rogers DISCHARGE SUMMARY
#040364
Ali Ibrahami
DISCHARGE SUMMARY

ADMITTING DIAGNOSIS
1. Genuine stress urinary incontinence.
2. Symptomatic grade II sister cell and rectal cell. (neopartka?)
3. Mental metraogia.

HISTORY OF PRESENT ILLNESS
The patient has a six month history of loss of urine with coughing, sneezing, running, lifting objects requiring pad at all times. There is no history of increasing frequency or dysuria. There is vaginal laxity with sister cell. The patient also had history of mental metrologia for approximately six months, ending four months ago at which time cervical conization showed cystic hyperplasia. This was treated with Provera 10 mg for ten days x 3 months. The conization was repeated and showed benign under cervical polifratia. The patient was admitted for definitive treatment.

PERTINENT PAST HISTORY
Drug I V estradiol for two.

LABORATORY FINDINGS
Hematocrit 36%. Melagrophin showed no dominant mass or cluster masses or cluster classification.
Calcifications: The breast. The breasts consist of dense fibrograndular tissue.

HOSPITAL COURSE
Upon admission, the patient underwent a vaginal hysterectomy posterial colporrhaphy and vault procedure without complications and without significant blood loss. The procedure was performed under general anesthesia. At surgery, a carpus lutein cyst was incidentally found at the left adnexa. The post-operative course was uneventful.

DISPOSITION
The patient was discharged to home.

FOLLOW-UP
The patient is to return to clinic in two weeks.

CONDITION ON DISCHARGE
Good.

DISCHARGE DIAGNOSIS


CONTINUED
Name: Merry Rogers DISCHARGE SUMMARY
# 040364
Page 2

1. Status post vaginal hysterectomy for undermitrial hyperplasia, hyperplasia, and minermitrialasia .
2. Geniun stress urinary incontinence.
3. Symptomatic grade 2 sister cell and rectal cell.

PROGNOSIS
Good.

DISCHARGE MEDICATIONS
Morthin 600 mg p.o. q. 4 h p.r.n. for pain.

Name: Cindy Charming
# 040364


PROBLEM #2 Secondary amenorrhea.


SUBJECTIVE
The patient presents with a four-week history of secondary amenorrhea. LNMP one month ago. Menses are normally at 28 days with a duration of 3-5 days. Gravida 0, para 0, ab 0. Patient has had one week of fatigue. No history of fever, chills, nausea, vomiting, or diarrhea. No history of abdominal pain. The patient is sexually active.

OBJECTIVE
The pelvic exam reveals a normal vulva and vaginal vault. The cervix is cyanotic and nontender. The endocervical canal is closed. The uterus is enlarged to 6 weeks’ size to anteverted. There is a 4 cm left adnexal mass that is nontender and freely moveable. The right adnexa is unremarkable. There is no evidence of cystocele or rectocele or cul-de-sac fullness.

ASSESSMENT
The findings are consistent with an early intrauterine gestation. The left adnexal mass maybe a corpus luteum cyst but a follicular cyst or dermoid cannot be excluded at the present time.

PLAN
1. Alpha-fetoprotein and beta-HCG pregnancy test.
2. Repeat pelvic examination at 12 weeks to look for resolution of left adnexal mass.

I am new to the MT gab group, and having trouble with quiz 23. Is there anyone that can proof read it for me? Thanks, Cheryl

Name: Billie Tree DISCHARGE SUMMARY
# 040401
Dr. Sung Pak

DISCHARGE SUMMARY

ADMITTING DIAGNOSIS:
1. Hypertension.
2. Polyuria.
3. Muscular weakness.

HISTORY OF PRESENT ILLNESS
This is a 44-year-old woman with a 20-year history of hypertension, controlled with medications with increasing doses. She has had a two-year history of (polyuria) and progressive muscular weakness.

LABORATORY FINDINGS:
Serum potassium 2.6. Aldosterone level is 112. Open front is normal 12-36 cross frontess. CT scan showed a mass in the right adrenal gland measuring 3 x 4 cm.

HOSPITAL COURSE:
After admission and initial evaluation, the patient was referred for elective right adrenalectomy, which she underwent without complications. Her postoperative course has been remarkable for fluctuations in her serum potassium, which has been mostly hyperkalemia and which has responded well to supplementation. Additionally, she has had polyuria. Urine osmolality and electrolytes are pending. This is decreasing, and with return of bowel functions yesterday, she is being started back on oral intake today. Discussion centered on differential of polyuria, and possibility of obligatory polyuria, secondary to chronic potassium loss. Hospital obligatory.

DISPOSITION
Discharge to home on fifth postoperative day.

FOLLOW-UP
Return to clinic in two weeks’ for blood pressure check.

CONDITION ON DISCHARGE
Improving.

DISCHARGE DIAGNOSIS
1. Conn’s Syndrome.
2. Aldosterone secreting adrenal corticoid adenoma, status post right adrenalectomy.



CONTINUED

Name: Billie Tree DISCHARGE SUMMARY
# 040401
Dr. Sung Pak Page 2


PROGNOSIS
Good.

DISCHARGE MEDICATIONS
Vicodin 1 tablet every p.o. q.4 h for pain.



____________________________________
Sung Pak, MD


D: 1/18/2012
T: 1/19/2012
SP: CRH






























Name: Lidia Cruz DISCHARGE SUMMARY
# 040403
Dr. Dilip Patel

DISCHARGE SUMMARY

ADMITTING DIAGNOSIS
1. Diabetes mellitus, Type 2 out of control.
2. Rule out cholecystitis.

HISTORY OF PRESENT ILLNESS
The patient is a 59-year old Latin female with Type 2 diabetes mellitus for eight years, admitted to the general surgery service with a one-day history of right upper quadrant pain.

PERTINENT PAST HISTORY? Ask about this whole paragraph
The patient has had Type II diabetes mellitus for eight years and until the recent admission was controlled with Tolbutamide 500 mg t.i.d. and diet. No prior surgeries. NO ALLERGIES TO MEDICATIONS.

LABORATORY FINDINGS
Tolbutamide 500 mg t.i.d.
Admitting blood sugar 324. Urinalysis: Glucose 4+ by Dextrostix.
ABDOMINAL: Sonograph demonstrated normal glyburide without evidence of cholecystitis. Abdominal CT within the normal limits.

HOSPITAL COURSE
Following the patients’ admission and the normal sonography and CT, the patients’ right upper quadrant pain resolved. Endocrinology consultation was obtained for the patients abdominal glucose. The patient was switched to glyburide 10 mg b.i.d. and showed a gradual return to normal of her blood sugars over 72 hours. In the interim, the patient was placed on a short acting insulin, but this was discontinued as the glyburide became effective.

DISPOSITION
Discharge to home.

FOLLOW-UP
Return in for fasting, blood sugar, and dripped blood pressure after morning medications. Return to clinic in two days.

CONDITION ON DISCHARGE
Good.


CONTINUED

Name: Lidia Cruz DISCHARGE SUMMARY
#040403
Dr. Dilip Patel Page 2

DISCHARGE DIAGNOSIS
Diabetes mellitus, Type 2.

PROGNOSIS
Improving.

DISCHARGE MEDICATIONS:
Glyburide 10 mg b.i.d.



____________________________________
Dilip Patel, MD


D: 10/31/2011
T: 11/01/2011
DP:CRH
























Name: Sonya Wells ENDOCRONOLOGY CONSULTATION REPORT
#040409
Dr. Anne Jones

CONSULTATION REPORT

HISTORY OF PRESENT ILLNESS
The patient is a 70-year-old black female who was previously healthy until 2 weeks prior to admission when she noticed increased shortness of breath and orthopnea, 2-3 pillows, and pedal edema. There was evidence of fever or chills. The patient had diarrhea for two days. No chest pain, cough. No history of hypertension, stroke, or other cardiovascular abnormalities. Denies heat intolerance, weight change, or palpitations.

PAST HISTORY
ALLERGIES: NKDA.
Illnesses: Arthritis of right knee.
Medications: Took sulfa drugs three weeks ago for a rash.

PHYSICAL EXAMINATION
GENERAL: Well nourished, black female who is in moderate distress, fidgety, does not always answer questions, scratches constantly.
HEENT: Normal cephalic. A traumatic perla. Upper and lower dentures.
Neck: Supple with positive JVD. No bruits. The thyroid is enlarged with normal texture, no nodules, and non-tender.
VITAL SIGNS: Pulse: 130. Blood Pressure: 122/88. Respiratory rate: 50. Temperature: 100.6 ̊F.
CHEST: Clear. Heart: Irregular rhythm, no murmurs or gallops. There is a grade II/ six systolic injection murmur.
ABDOMEN: Negative.
EXTREMITIES: No clubbing or cyanosis 1+ edema in both ankles.
NEUROLOGIC: There is a fine trimmer.

IMPRESSION
1. Thyroid toxicosis.
2. Congestive heart failure with atrial flutter.

It may be that the patients’ cardiac symptoms are secondary to her thyroid toxicosis since she has no history of prior heart disease or cardiac symptoms. As her thyrotoxicosis resolves, we want to monitor her digoxin closely as she will be metabolizing it quite rapidly until she is no longer toxic.

PLAN
1. Begin digoxin 1 quarter mg p.o. q.d.
2. Lasix 20 mg p.o. q.d.

CONTINUED
Name: Sonya Wells ENDOCRONOLOGY CONSULTATION REPORT
#040409
Dr. Anne Jones Page 2


3. Tapazole 10 mg p.o. b.i.d.

REASON FOR REFERRAL
Abnormal thyroid function tests and congestive failure.



____________________________________
Anne Jones, MD


D: 11/08/2011
T: 11/09/2011
AJ:CRH

Glad to be back after a long vacation. Now struggling with Quiz 25.

What is up ??
What are you struggling with in quiz 25?

Can anyone proof read Sharon LaPalma Psychiatric Consultation Report for me; Quiz 25?

You can email me @ delilahsweetpea@aol.com

Thanks,
Cheryl

Name: Sharon LaPalma PSYCHIATRY CONSULTATION REPORT
#040604
Dr. Sansuk Sudsai

CONSULTATION REPORT

REASON FOR REFERRAL
The patient is a 43-years-old Caucasian female with a Master Degree who recently left her apartment and is presently homeless. She has worked as an MFCC and teacher in the past. She (is (dictated) or was (b/c of context used in paragraph)) brought in by the Brooklyn city police after exhibiting bizarre behavior in the restaurant, refusing to leave when asked to do so by the management.

HISTORY OF PRESENT ILLNESS
The patient has a long history of psychiatric illness with symptoms of both mood disorder and {bizarre/odd} disorder in the past. Most recent diagnosis was bipolar disorder, manic. The patient has been in {Weston} hospital twice, and also in {Orange hospital} twice this year on 72 hour hold for bizarre behavior. The reasons for previous admission resemble remarkable reasons for this admission. On the day of admission, the patient was in a sushi restaurant. She found the lavatory, because she caused extreme heat, to go to the bathroom, disrupt, soaked her clothes in the sink, and put the clothing back on and returned to the restaurant. The restaurant owners said that she had been there all day already and as it was 4:30 p.m., they asked her to leave, and she refused to do so and the police were called. She was violent with the police and was brought to the psychiatric emergency area.

PHYSICAL EXAMINATION
GENERAL: The patient had a physical exam, which revealed no acute physical findings.
NEUROLOGIC: Mental status: {Mental status exam was significant only for certain (____) un kept appearance perhaps secondary to her being soaking wet and hostile effect and very irritable mood. Also, remarkable in her mental status exam claimed that she was actually the result of genetic manic depression plutonian scientists and that she had come to earth from that planet. The patient was given a mental diagnosis of Psychosis NOS,} rule out bipolar disorder, rule out schizo-effective disorder, and was admitted.

ASSESSMENT
Axis I Psychosis or Organic Disease: Bipolar disorder, manic. Ethanol abuse.
Axis II Personality Disorder: None.
Axis III Medical Condition or Diseases: None.
Axis IV Psychosocial Stressor Level: Mild.
Axis V Global Assessment of Function Scale: Fifteen. The six-month prediction is 40. The twelve-month prediction is 40. Past-year prediction was 60.




CONTINUED
Name: Sharon LaPalma PSYCHIATRY CONSULTATION REPORT
#040604
Dr. Sansuk Sudsai Page 2


RECOMMENDATIONS
Thorazine 100 mg p.o. b.i.d. and 200 mg p.o. h.s.s.



_____________________________________
Sansuk Sudsai, MD


D: 02/21/2012
T: 02/22/2012
SS: CRH