id,source,target,specialty,document_type,complexity
1,CT Head without contrast: No mass effect. Chronic lacunar infarcts in bilateral basal ganglia. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There are signs of small old strokes in the deep parts of the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
2,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. C5-C6 disc herniation with cord compression. Multilevel degenerative disc disease.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
3,Procedure: PCI with DES to LAD. Pt 48 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 48-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4,"BMP: Na 129 (L), K 3.9 (N), BUN 7, Cr 2.8 (H), Glucose 325.","Your blood chemistry results: Sodium is low at 129 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.9. Creatinine is elevated at 2.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 325 (high).",Nephrology,Lab Result,high
5,CXR PA: Bilateral hilar lymphadenopathy. No cardiomegaly. Hyperinflated lungs consistent with COPD. Right middle lobe atelectasis. Right-sided pneumothorax.,"Chest X-ray results: There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The heart is a normal size. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax].",Pulmonology,Radiology Report,high
6,"US Abdomen: Moderate right hydronephrosis. Ascites moderate amount. Right kidney 10.5cm, no hydronephrosis. Left kidney 8cm, cortical thinning consistent with CKD. CBD 12mm, dilated.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. There is a moderate amount of fluid in the belly [ascites]. Right kidney is normal size with no blockage. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
7,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
8,"Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab clopidogrel 75mg daily. Adv: high fiber diet, adequate hydration. F/U INR in 3 days.","Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
9,"48 y/o M with PMH of anemia, A-fib, OA, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on montelukast 10mg QHS, metformin 1000mg BID, furosemide 40mg daily, ibuprofen 400mg Q6H PRN with food, Eliquis 5mg BID. F/U neurology in 2 weeks.","A 48-year-old man with a history of low blood count [anemia], irregular heartbeat [atrial fibrillation], and arthritis [osteoarthritis] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (5) Eliquis 5mg twice daily [blood thinner]. Follow-up with the brain/nerve doctor in 2 weeks.",Psychiatry,Discharge Summary,high
10,"Rx: Tab atorvastatin 80mg QHS. Tab calcium + vitamin D 600/400 daily. Adv: elevate affected limb, compression stockings. F/U 2 weeks.",Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) calcium plus vitamin D once daily [bone strengthening]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back for a check-up in 2 weeks.,Pediatrics,Prescription,medium
11,CT Head without contrast: No acute intracranial hemorrhage. No midline shift. 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is no bleeding in the brain. The brain is centered normally. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
12,"43 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 43-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
13,"Rx: Tab escitalopram 10mg daily. Tab Xarelto 20mg daily with dinner. Tab ibuprofen 400mg Q6H PRN with food. Do not stop abruptly, taper as directed. F/U 2 weeks with INR.",Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 2 weeks for a blood thinner level check [INR].,Psychiatry,Prescription,medium
14,"BMP: Na 147 (H), K 3.9 (N), BUN 57, Cr 4.0 (H), Glucose 207.","Your blood chemistry results: Sodium is high at 147, meaning you may be dehydrated. Potassium is normal at 3.9. Creatinine is elevated at 4.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 207 (high).",Nephrology,Lab Result,high
15,"Thyroid panel: TSH 14.3 (H), Free T4 0.6.","Your thyroid test results: TSH is elevated at 14.3 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is low — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
16,"87 y/o M with PMH of DM1, PAD, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Low potassium diet. D/C on atorvastatin 80mg QHS, furosemide 40mg daily, Xarelto 20mg daily with dinner. F/U nephrology in 1 week.","A 87-year-old man with a history of type 1 diabetes, and poor blood flow in the legs [peripheral artery disease] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
17,"Rx: Tab escitalopram 10mg daily. albuterol MDI 2 puffs Q4-6H PRN. Adv: DASH diet, daily BP monitoring. F/U 1 week with CBC, CMP.","Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Pulmonology,Prescription,medium
18,"89 y/o M with PMH of HTN, anxiety, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on carvedilol 12.5mg BID, atorvastatin 80mg QHS, amlodipine 10mg daily, ASA 81mg daily. F/U endocrine in 1 week.","A 89-year-old man with a history of high blood pressure, and anxiety was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the hormone/diabetes doctor in 1 week.",Nephrology,Discharge Summary,high
19,"56 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 56-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
20,"32 y/o F with PMH of s/p CABG, HLD, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on tramadol 50mg Q6H PRN pain, losartan 50mg daily, methotrexate 15mg weekly. F/U PCP in 1 week.","A 32-year-old woman with a history of prior heart bypass surgery, and high cholesterol was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) losartan 50mg once daily [blood pressure medicine]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the primary care doctor in 1 week.",Gastroenterology,Discharge Summary,high
21,"LFTs: AST 439 (H), ALT 287 (H), ALP 47, T.Bili 1.8 (H), Albumin 4.8.","Your liver blood test results: Liver enzymes (AST 439, ALT 287) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.8. Albumin is normal at 4.8.",Gastroenterology,Lab Result,high
22,"31 y/o M with PMH of A-fib, seizure disorder on Keppra, DM2, RA on MTX, COPD, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Strict I&O, daily weights. D/C on amoxicillin 500mg TID x 10 days, amlodipine 10mg daily, entresto 49/51mg BID, rosuvastatin 10mg QHS. F/U cardiology in 2 weeks.","A 31-year-old man with a history of irregular heartbeat [atrial fibrillation], seizure disorder [on Keppra], type 2 diabetes, rheumatoid arthritis [on immune-suppressing medicine], and chronic lung disease was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) Entresto 49/51mg twice daily [heart failure medicine]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the heart doctor in 2 weeks.",Endocrinology,Discharge Summary,high
23,Procedure: ORIF L distal radius. Pt 84 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 84-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
24,"79 y/o M with PMH of RA on MTX, DM2, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on amlodipine 10mg daily, losartan 50mg daily, warfarin 5mg daily, metformin 500mg BID. F/U hematology in 2 weeks.","A 79-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], and type 2 diabetes was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) losartan 50mg once daily [blood pressure medicine]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (4) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
25,"64 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 64-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
26,"MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. Conus medullaris at L1, normal. L5-S1 disc desiccation with mild bulge.","MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The spinal cord ends at a normal level. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
27,"MRI Lumbar Spine: Central canal stenosis at L3-L4. Conus medullaris at L1, normal. L5-S1 disc desiccation with mild bulge.","MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. The spinal cord ends at a normal level. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
28,Rx: Tab montelukast 10mg QHS. Tab Xarelto 20mg daily with dinner. Tab ASA 81mg daily. Tab sertraline 50mg daily. Avoid grapefruit juice. F/U 1 month with repeat imaging.,Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) baby aspirin 81mg once daily [prevents blood clots]. (4) sertraline 50mg once daily [antidepressant/anxiety medicine]. Do not drink grapefruit juice as it interferes with this medication. Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,high
29,"Rx: Tab entresto 49/51mg BID. Tab atorvastatin 80mg QHS. prednisone taper. Adv: elevate affected limb, compression stockings Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
30,HbA1c: 6.5% (H). FBS: 332 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.5%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 332, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
31,"76 y/o M with PMH of A-fib, Parkinson's disease, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on lisinopril 20mg daily, atorvastatin 40mg QHS, escitalopram 10mg daily. F/U neurology in 2 weeks.","A 76-year-old man with a history of irregular heartbeat [atrial fibrillation], and Parkinson's disease was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Neurology,Discharge Summary,high
32,"84 y/o M with PMH of HLD, CKD Stage 4, hypothyroidism, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Low potassium diet. D/C on metformin 1000mg BID, amoxicillin 500mg TID x 10 days. F/U nephrology in 5 days.","A 84-year-old man with a history of high cholesterol, advanced kidney disease, and underactive thyroid was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the kidney doctor in 5 days.",Pulmonology,Discharge Summary,high
33,"54 y/o F with PMH of CKD Stage 3, s/p CABG, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on amlodipine 5mg daily, hydroxychloroquine 200mg BID, potassium chloride 20mEq daily, warfarin 5mg daily, Humalog per SSI. F/U PCP in 2 weeks.","A 54-year-old woman with a history of moderate kidney disease, and prior heart bypass surgery was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (5) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the primary care doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
34,"46 y/o F with PMH of gout, HTN, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Xarelto 20mg daily with dinner, omeprazole 20mg AC breakfast, losartan 50mg daily. F/U neurology in 2 weeks.","A 46-year-old woman with a history of gout, and high blood pressure was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) losartan 50mg once daily [blood pressure medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Pulmonology,Discharge Summary,high
35,CT Head without contrast: No acute intracranial hemorrhage. No mass effect. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,CT scan of the head results: There is no bleeding in the brain. There are no tumors or masses pushing on the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.,Neurology,Radiology Report,high
36,"CBC: WBC 24.3 (H), Hgb 6.0 (L), Plt 313 (N).","Your blood count results: White blood cells are 24.3 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 6.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 313, which is normal.",Hematology,Lab Result,high
37,Procedure: TURP for BPH. Pt 48 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 48-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
38,"40 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 40-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
39,"61 y/o M with PMH of GERD, s/p CABG, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on prednisone taper, montelukast 10mg QHS. F/U nephrology in 5 days.","A 61-year-old man with a history of acid reflux, and prior heart bypass surgery was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the kidney doctor in 5 days.",Cardiology,Discharge Summary,high
40,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,high
41,"82 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 82-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
42,"Lipid panel: TC 157, LDL 43, HDL 42, TG 218.",Your cholesterol results: Total cholesterol is 157. LDL (bad cholesterol) is at goal (43). HDL (good cholesterol) is good at 42. Triglycerides are high at 218.,Cardiology,Lab Result,high
43,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
44,"55 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 55-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
45,Procedure: TURP for BPH. Pt 79 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 79-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
46,"85 y/o M with PMH of s/p TKR, s/p THR, BPH, PAD, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on ciprofloxacin 500mg BID x 5 days, amlodipine 5mg daily, losartan 50mg daily. F/U endocrine in 1 week.","A 85-year-old man with a history of prior knee replacement, prior hip replacement, enlarged prostate, and poor blood flow in the legs [peripheral artery disease] was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) amlodipine 5mg once daily [blood pressure medicine]; (3) losartan 50mg once daily [blood pressure medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",General Surgery,Discharge Summary,high
47,"LFTs: AST 81 (H), ALT 460 (H), ALP 70, T.Bili 1.9 (H), Albumin 2.7.","Your liver blood test results: Liver enzymes (AST 81, ALT 460) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.9. Albumin is low at 2.7 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
48,"Rx: Tab atorvastatin 80mg QHS. Tab metoprolol succinate 50mg daily. Tab methotrexate 15mg weekly. Tab empagliflozin 10mg daily. Tab tramadol 50mg Q6H PRN pain. Adv: fall precautions, home safety evaluation Adv: high fiber diet, adequate hydration. F/U 1 month with repeat imaging.","Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
49,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,high
50,Procedure: Port-a-cath placement. Pt 78 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 78-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
51,"78 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 78-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
52,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
53,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
54,HbA1c: 9.3% (H). FBS: 149 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.3%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 149, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
55,"33 y/o F with PMH of OSA on CPAP, COPD, obesity (BMI 38), PAD, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Strict I&O, daily weights. D/C on potassium chloride 20mEq daily, levothyroxine 75mcg daily on empty stomach, timolol 0.5% OU BID, pantoprazole 40mg AC breakfast, tramadol 50mg Q6H PRN pain. F/U GI in 1 week.","A 33-year-old woman with a history of sleep apnea [uses a breathing machine at night], chronic lung disease, obesity, and poor blood flow in the legs [peripheral artery disease] was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (4) pantoprazole 40mg before breakfast [acid-reducing medicine]; (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the stomach doctor in 1 week.",Gastroenterology,Discharge Summary,high
56,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
57,"MRI Lumbar Spine: Central canal stenosis at L3-L4. Conus medullaris at L1, normal. L5-S1 disc desiccation with mild bulge.","MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. The spinal cord ends at a normal level. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
58,Procedure: EGD with biopsy. Pt 84 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 84-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
59,"54 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 54-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
60,"30 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 30-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
61,CT Head without contrast: No acute intracranial hemorrhage. Subarachnoid hemorrhage in bilateral sylvian fissures. Chronic lacunar infarcts in bilateral basal ganglia. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is no bleeding in the brain. There is bleeding around the brain surface, particularly in the grooves on both sides. There are signs of small old strokes in the deep parts of the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
62,"Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab Xarelto 20mg daily with dinner. Tab ferrous sulfate 325mg BID. Adv: high fiber diet, adequate hydration Avoid NSAIDs. F/U 2 weeks.","Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back for a check-up in 2 weeks.",General,Prescription,medium
63,"CBC: WBC 16.0 (H), Hgb 15.8 (N), Plt 459 (H).","Your blood count results: White blood cells are 16.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 15.8. Platelets are 459, which is high — your blood may clot too easily.",Hematology,Lab Result,high
64,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,medium
65,"50 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 50-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
66,"36 y/o F with PMH of DVT/PE on warfarin, PAD, anxiety, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on acetaminophen 650mg Q6H PRN, metformin 500mg BID, montelukast 10mg QHS, timolol 0.5% OU BID. F/U orthopedics in 6 weeks with X-ray.","A 36-year-old woman with a history of blood clots [on blood thinner warfarin], poor blood flow in the legs [peripheral artery disease], and anxiety was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) metformin 500mg twice daily with meals [blood sugar medicine]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]; (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
67,"89 y/o F with PMH of DVT/PE on warfarin, s/p THR, CKD Stage 3, ESRD on HD, asthma, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on Xarelto 20mg daily with dinner, spironolactone 25mg daily, methotrexate 15mg weekly, lisinopril 20mg daily, rosuvastatin 10mg QHS. F/U oncology in 1 week.","A 89-year-old woman with a history of blood clots [on blood thinner warfarin], prior hip replacement, moderate kidney disease, kidney failure requiring dialysis, and asthma was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (4) lisinopril 20mg once daily [blood pressure medicine]; (5) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the cancer doctor in 1 week.",Nephrology,Discharge Summary,high
68,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
69,"CBC: WBC 3.5 (L), Hgb 8.4 (L), Plt 39 (L).","Your blood count results: White blood cells are 3.5 (low, meaning your immune system may be weakened). Hemoglobin is low at 8.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 39, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
70,Delivery Note: G?P? at 37+3 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
71,"Rx: Tab latanoprost 0.005% OU QHS. Lantus 20U QHS. Tab hydroxychloroquine 200mg BID. Tab pantoprazole 40mg AC breakfast. Tab warfarin 5mg daily. Adv: low salt low sugar diet, regular exercise. F/U 1 month with repeat imaging.","Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) Lantus insulin 20 units at bedtime [long-acting insulin]. (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. (5) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 month — a repeat scan will be ordered.",Gastroenterology,Prescription,high
72,"35 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 35-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
73,"38 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 38-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
74,"85 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 85-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
75,"67 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 67-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
76,Procedure: R TKA. Pt 42 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 42-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
77,Delivery Note: G?P? at 38+2 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
78,"68 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 68-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
79,"70 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 70-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
80,"24 y/o M with PMH of A-fib, SLE, DVT/PE on warfarin, OA, cirrhosis, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on clopidogrel 75mg daily, amlodipine 5mg daily, Spiriva 18mcg daily, methotrexate 15mg weekly. F/U neurology in 2 weeks.","A 24-year-old man with a history of irregular heartbeat [atrial fibrillation], lupus, blood clots [on blood thinner warfarin], arthritis [osteoarthritis], and liver scarring [cirrhosis] was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) amlodipine 5mg once daily [blood pressure medicine]; (3) Spiriva inhaler once daily [long-acting lung medicine]; (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the brain/nerve doctor in 2 weeks.",General Surgery,Discharge Summary,high
81,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab potassium chloride 20mEq daily. Humalog per SSI. Adv: elevate affected limb, compression stockings. F/U 1 week with CBC, CMP.",Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) Humalog insulin before meals as directed [fast-acting insulin]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,General,Prescription,medium
82,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab Xarelto 20mg daily with dinner. Tab Eliquis 5mg BID. Tab methotrexate 15mg weekly. Avoid grapefruit juice Adv: elevate affected limb, compression stockings. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) Eliquis 5mg twice daily [blood thinner]. (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Do not drink grapefruit juice as it interferes with this medication Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Hematology,Prescription,high
83,Rx: Tab pregabalin 75mg BID. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab Dulcolax 10mg QHS PRN. Tab escitalopram 10mg daily. Adv: wound care with daily dressing changes. F/U 1 week with wound check.,"Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week to have the wound checked.",Neurology,Prescription,high
84,"35 y/o M with PMH of GERD, OSA on CPAP, PPM in situ, CKD Stage 4, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on metformin 1000mg BID, methotrexate 15mg weekly. F/U INR check in 3 days.","A 35-year-old man with a history of acid reflux, sleep apnea [uses a breathing machine at night], implanted pacemaker, and advanced kidney disease was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up for a blood thinner level check in 3 days.",General Surgery,Discharge Summary,high
85,"58 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 58-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
86,"49 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 49-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
87,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
88,"83 y/o F with PMH of depression, h/o TIA, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on furosemide 40mg daily, Xarelto 20mg daily with dinner. F/U nephrology in 1 week.","A 83-year-old woman with a history of depression, and history of mini-stroke was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (2) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the kidney doctor in 1 week.",Nephrology,Discharge Summary,high
89,Rx: Tab Xarelto 20mg daily with dinner. Tab pregabalin 75mg BID. Tab Eliquis 5mg BID. Tab methotrexate 15mg weekly. Tab spironolactone 25mg daily. Avoid grapefruit juice. F/U 2 weeks.,Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) Eliquis 5mg twice daily [blood thinner]. (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (5) spironolactone 25mg once daily [heart-protecting water pill]. Do not drink grapefruit juice as it interferes with this medication. Come back for a check-up in 2 weeks.,Hematology,Prescription,high
90,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
91,"52 y/o F with PMH of HFpEF, DM1, seizure disorder on Keppra, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on Augmentin 875/125 BID x 7 days, latanoprost 0.005% OU QHS, rosuvastatin 10mg QHS. F/U INR check in 3 days.","A 52-year-old woman with a history of heart failure with stiff heart muscle, type 1 diabetes, and seizure disorder [on Keppra] was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
92,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab amlodipine 5mg daily. Tab levothyroxine 75mcg daily on empty stomach. Tab furosemide 40mg daily. albuterol MDI 2 puffs Q4-6H PRN. Adv: low salt low sugar diet, regular exercise. F/U 2 weeks with INR.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (5) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,low
93,"Lipid panel: TC 128, LDL 207, HDL 48, TG 137.","Your cholesterol results: Total cholesterol is 128. LDL (bad cholesterol) is very high at 207 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 48. Triglycerides are normal at 137.",Cardiology,Lab Result,high
94,"65 y/o M with PMH of CKD Stage 4, ESRD on HD, OSA on CPAP, osteoporosis, DM1, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on ibuprofen 400mg Q6H PRN with food, calcium + vitamin D 600/400 daily, empagliflozin 10mg daily, gabapentin 300mg TID. F/U endocrine in 1 week.","A 65-year-old man with a history of advanced kidney disease, kidney failure requiring dialysis, sleep apnea [uses a breathing machine at night], weak bones [osteoporosis], and type 1 diabetes was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (4) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the hormone/diabetes doctor in 1 week.",Endocrinology,Discharge Summary,high
95,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
96,"24 y/o F with PMH of cirrhosis, anemia, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on entresto 49/51mg BID, prednisone taper, amlodipine 10mg daily, timolol 0.5% OU BID, sertraline 50mg daily. F/U surgery in 10 days.","A 24-year-old woman with a history of liver scarring [cirrhosis], and low blood count [anemia] was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
97,Procedure: Laparoscopic appendectomy. Pt 71 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 71-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
98,"90 y/o F with PMH of depression, DVT/PE on warfarin, CKD Stage 4, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Low potassium diet. D/C on lisinopril 20mg daily, Spiriva 18mcg daily, pantoprazole 40mg AC breakfast, montelukast 10mg QHS, atorvastatin 80mg QHS. F/U hematology in 2 weeks.","A 90-year-old woman with a history of depression, blood clots [on blood thinner warfarin], and advanced kidney disease was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]; (4) montelukast 10mg at bedtime [asthma/allergy medicine]; (5) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the blood disorder doctor in 2 weeks.",General Surgery,Discharge Summary,high
99,"81 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 81-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
100,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,low
101,"US Abdomen: No focal hepatic lesion. Spleen 16cm, splenomegaly. Pancreas unremarkable. Right kidney 10.5cm, no hydronephrosis.",Abdominal ultrasound results: No tumors or masses were found in the liver. The spleen is enlarged [splenomegaly]. The pancreas looks normal. Right kidney is normal size with no blockage.,Gastroenterology,Radiology Report,high
102,"69 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 69-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
103,"36 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 36-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
104,"Rx: Tab Dulcolax 10mg QHS PRN. Tab entresto 49/51mg BID. Tab gabapentin 300mg TID. Tab carvedilol 12.5mg BID. Adv: weight bearing exercise, calcium/vit D supplementation Adv: fall precautions, home safety evaluation. F/U 6 weeks with LFTs.","Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) carvedilol 12.5mg twice daily [heart medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
105,CXR PA: No pneumothorax. Left lower lobe consolidation. Moderate right pleural effusion. Hyperinflated lungs consistent with COPD. Pacemaker leads in appropriate position.,"Chest X-ray results: There is no collapsed lung. There is an area in the lower left lung that appears infected. There is a moderate amount of fluid around the right lung. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The pacemaker wires are in the correct position.",Pulmonology,Radiology Report,high
106,"BMP: Na 148 (H), K 4.2 (N), BUN 74, Cr 2.7 (H), Glucose 226.","Your blood chemistry results: Sodium is high at 148, meaning you may be dehydrated. Potassium is normal at 4.2. Creatinine is elevated at 2.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 226 (high).",Nephrology,Lab Result,high
107,"53 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 53-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
108,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,low
109,Procedure: R TKA. Pt 78 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 78-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
110,HbA1c: 8.7% (H). FBS: 324 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.7%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 324, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
111,"US Abdomen: Pancreas unremarkable. Ascites moderate amount. Spleen 11cm, normal.",Abdominal ultrasound results: The pancreas looks normal. There is a moderate amount of fluid in the belly [ascites]. The spleen is a normal size.,Gastroenterology,Radiology Report,high
112,"77 y/o M with PMH of cirrhosis, A-fib, CHF, RA on MTX, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on Augmentin 875/125 BID x 7 days, ferrous sulfate 325mg BID, omeprazole 20mg AC breakfast, metformin 500mg BID, potassium chloride 20mEq daily. F/U wound care in 3 days.","A 77-year-old man with a history of liver scarring [cirrhosis], irregular heartbeat [atrial fibrillation], heart failure, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]; (4) metformin 500mg twice daily with meals [blood sugar medicine]; (5) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up at the wound care clinic in 3 days.",Gastroenterology,Discharge Summary,high
113,"30 y/o F with PMH of seizure disorder on Keppra, ESRD on HD, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on lisinopril 10mg daily, pregabalin 75mg BID, acetaminophen 650mg Q6H PRN, omeprazole 20mg AC breakfast. F/U orthopedics in 6 weeks with X-ray.","A 30-year-old woman with a history of seizure disorder [on Keppra], and kidney failure requiring dialysis was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
114,HbA1c: 6.2% (H). FBS: 101 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.2%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 101, which is high (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,high
115,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
116,Rx: Tab metformin 1000mg BID. Tab levothyroxine 75mcg daily on empty stomach. Tab ASA 81mg daily. Tab metoprolol 25mg BID. Tab acetaminophen 650mg Q6H PRN. Adv: low potassium diet. F/U 2 weeks with INR.,"Your medicines: (1) metformin 1000mg twice daily with meals [blood sugar medicine]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) baby aspirin 81mg once daily [prevents blood clots]. (4) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
117,"CBC: WBC 10.9 (N), Hgb 14.9 (N), Plt 164 (N).","Your blood count results: White blood cells are 10.9 (normal). Hemoglobin is normal at 14.9. Platelets are 164, which is normal.",Hematology,Lab Result,medium
118,"BMP: Na 123 (L), K 4.3 (N), BUN 69, Cr 3.0 (H), Glucose 248.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.3. Creatinine is elevated at 3.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 248 (high).",Nephrology,Lab Result,high
119,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
120,"53 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 53-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
121,HbA1c: 11.2% (H). FBS: 336 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.2%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 336, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
122,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,medium
123,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
124,Delivery Note: G?P? at 40+0 weeks. SVD. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
125,"91 y/o F with PMH of obesity (BMI 38), GERD, DVT/PE on warfarin, CHF, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Low potassium diet. D/C on ASA 81mg daily, calcium + vitamin D 600/400 daily, Dulcolax 10mg QHS PRN, atorvastatin 80mg QHS. F/U endocrine in 1 week.","A 91-year-old woman with a history of obesity, acid reflux, blood clots [on blood thinner warfarin], and heart failure was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) Dulcolax 10mg at bedtime as needed [for constipation]; (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
126,"72 y/o F with PMH of gout, CHF, A-fib, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on levothyroxine 75mcg daily on empty stomach, losartan 50mg daily, atorvastatin 80mg QHS. F/U nephrology in 1 week.","A 72-year-old woman with a history of gout, heart failure, and irregular heartbeat [atrial fibrillation] was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) losartan 50mg once daily [blood pressure medicine]; (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the kidney doctor in 1 week.",Cardiology,Discharge Summary,high
127,"Rx: Tab metoprolol succinate 50mg daily. Tab potassium chloride 20mEq daily. Tab metformin 500mg BID. Tab losartan 50mg daily. Tab atorvastatin 80mg QHS. Do not stop abruptly, taper as directed Adv: fall precautions, home safety evaluation. F/U 1 week with wound check.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. (4) losartan 50mg once daily [blood pressure medicine]. (5) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week to have the wound checked.",Pediatrics,Prescription,high
128,Procedure: Colonoscopy with polypectomy. Pt 87 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 87-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
129,"79 y/o M with PMH of ICD in situ, s/p TKR, Parkinson's disease, ESRD on HD, asthma, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on spironolactone 25mg daily, metoprolol succinate 50mg daily. F/U hematology in 2 weeks.","A 79-year-old man with a history of implanted heart defibrillator, prior knee replacement, Parkinson's disease, kidney failure requiring dialysis, and asthma was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",General Surgery,Discharge Summary,high
130,"29 y/o F with PMH of DM2, s/p TKR, OA, depression, CKD Stage 4, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on acetaminophen 650mg Q6H PRN, atorvastatin 80mg QHS, amlodipine 5mg daily, calcium + vitamin D 600/400 daily, ASA 81mg daily. F/U nephrology in 1 week.","A 29-year-old woman with a history of type 2 diabetes, prior knee replacement, arthritis [osteoarthritis], depression, and advanced kidney disease was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
131,"MRI Lumbar Spine: Conus medullaris at L1, normal. C5-C6 disc herniation with cord compression. Facet joint hypertrophy at L4-L5. No compression fracture.","MRI of the lower back results: The spinal cord ends at a normal level. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The small joints in the spine at L4-L5 are enlarged from arthritis. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
132,"66 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 66-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
133,"35 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 35-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
134,MRI Lumbar Spine: Central canal stenosis at L3-L4. No compression fracture.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
135,"LFTs: AST 232 (H), ALT 198 (H), ALP 191, T.Bili 5.5 (H), Albumin 2.6.","Your liver blood test results: Liver enzymes (AST 232, ALT 198) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is high at 5.5 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.6 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
136,"58 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 58-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
137,CXR PA: Port-a-cath in appropriate position. ET tube 3cm above carina. Pacemaker leads in appropriate position. Increased interstitial markings suggesting pulmonary edema. Widened mediastinum.,"Chest X-ray results: The implanted medication port is in the correct position. The breathing tube is in good position. The pacemaker wires are in the correct position. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
138,"76 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 76-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
139,Procedure: TURP for BPH. Pt 25 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 25-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
140,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,low
141,"45 y/o F with PMH of HFrEF (EF 30%), anemia, SLE, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on prednisone taper, ASA 81mg daily, omeprazole 20mg AC breakfast. F/U GI in 1 week.","A 45-year-old woman with a history of heart failure with weak pumping (30%), low blood count [anemia], and lupus was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
142,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
143,"66 y/o M with PMH of s/p CABG, obesity (BMI 38), HFpEF, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on metoprolol 25mg BID, ondansetron 4mg Q8H PRN N/V, metoprolol succinate 50mg daily. F/U endocrine in 1 week.","A 66-year-old man with a history of prior heart bypass surgery, obesity, and heart failure with stiff heart muscle was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Pulmonology,Discharge Summary,high
144,"MRI Lumbar Spine: Conus medullaris at L1, normal. Facet joint hypertrophy at L4-L5. L4-L5 disc herniation with moderate bilateral foraminal stenosis.","MRI of the lower back results: The spinal cord ends at a normal level. The small joints in the spine at L4-L5 are enlarged from arthritis. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
145,"Lipid panel: TC 288, LDL 182, HDL 25, TG 339.","Your cholesterol results: Total cholesterol is 288. LDL (bad cholesterol) is very high at 182 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is too low at 25 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 339 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
146,"52 y/o F with PMH of DVT/PE on warfarin, BPH, COPD, s/p CABG, anxiety, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on ASA 81mg daily, metoprolol 25mg BID, clopidogrel 75mg daily, furosemide 40mg daily, carvedilol 12.5mg BID. F/U PCP in 2 weeks.","A 52-year-old woman with a history of blood clots [on blood thinner warfarin], enlarged prostate, chronic lung disease, prior heart bypass surgery, and anxiety was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]; (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (5) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
147,"87 y/o F with PMH of OA, HLD, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Compression stockings when ambulating. D/C on Spiriva 18mcg daily, pantoprazole 40mg AC breakfast, losartan 50mg daily, levothyroxine 75mcg daily on empty stomach, metoprolol succinate 50mg daily. F/U orthopedics in 6 weeks with X-ray.","A 87-year-old woman with a history of arthritis [osteoarthritis], and high cholesterol was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) losartan 50mg once daily [blood pressure medicine]; (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (5) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
148,"88 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 88-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
149,CXR PA: Clear lung fields bilaterally. No cardiomegaly. ET tube 3cm above carina. Patchy bilateral infiltrates. Elevated left hemidiaphragm.,Chest X-ray results: Both lungs look clear with no problems. The heart is a normal size. The breathing tube is in good position. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The left side of the breathing muscle [diaphragm] is sitting higher than normal.,Pulmonology,Radiology Report,high
150,"48 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 48-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
151,"CBC: WBC 6.6 (N), Hgb 16.6 (N), Plt 238 (N).","Your blood count results: White blood cells are 6.6 (normal). Hemoglobin is normal at 16.6. Platelets are 238, which is normal.",Hematology,Lab Result,medium
152,"73 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 73-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
153,CT Head without contrast: Paranasal sinuses clear. 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. No mass effect.,"CT scan of the head results: The sinuses are clear with no infection. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
154,CXR PA: No pneumothorax. Port-a-cath in appropriate position. Sternotomy wires intact.,Chest X-ray results: There is no collapsed lung. The implanted medication port is in the correct position. The wires from prior heart surgery are intact.,Pulmonology,Radiology Report,high
155,"57 y/o F with PMH of depression, CKD Stage 3, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on methotrexate 15mg weekly, latanoprost 0.005% OU QHS, entresto 49/51mg BID, furosemide 40mg BID, calcium + vitamin D 600/400 daily. F/U orthopedics in 6 weeks with X-ray.","A 57-year-old woman with a history of depression, and moderate kidney disease was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) Entresto 49/51mg twice daily [heart failure medicine]; (4) furosemide (Lasix) 40mg twice daily [water pill]; (5) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
156,"38 y/o F with PMH of asthma, HTN, COPD, PPM in situ, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on acetaminophen 650mg Q6H PRN, gabapentin 300mg TID, Xarelto 20mg daily with dinner. F/U GI in 1 week.","A 38-year-old woman with a history of asthma, high blood pressure, chronic lung disease, and implanted pacemaker was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the stomach doctor in 1 week.",Infectious Disease,Discharge Summary,high
157,"89 y/o M with PMH of A-fib, CKD Stage 3, asthma, COPD, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on Dulcolax 10mg QHS PRN, Spiriva 18mcg daily. F/U surgery in 2 weeks for drain removal.","A 89-year-old man with a history of irregular heartbeat [atrial fibrillation], moderate kidney disease, asthma, and chronic lung disease was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Psychiatry,Discharge Summary,high
158,CXR PA: ET tube 3cm above carina. Left lower lobe consolidation. Small left pleural effusion.,Chest X-ray results: The breathing tube is in good position. There is an area in the lower left lung that appears infected. There is a small amount of fluid around the left lung.,Pulmonology,Radiology Report,high
159,"CBC: WBC 17.6 (H), Hgb 13.2 (N), Plt 193 (N).","Your blood count results: White blood cells are 17.6 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 13.2. Platelets are 193, which is normal.",Hematology,Lab Result,high
160,Procedure: Laparoscopic cholecystectomy. Pt 22 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 22-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
161,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab warfarin 5mg daily. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 month with repeat imaging.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 month — a repeat scan will be ordered.",Infectious Disease,Prescription,medium
162,Procedure: Laparoscopic appendectomy. Pt 53 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 53-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
163,"76 y/o M with PMH of GERD, obesity (BMI 38), OSA on CPAP, PPM in situ, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Strict I&O, daily weights. D/C on montelukast 10mg QHS, omeprazole 20mg AC breakfast, amlodipine 10mg daily, ibuprofen 400mg Q6H PRN with food, lisinopril 20mg daily. F/U nephrology in 1 week.","A 76-year-old man with a history of acid reflux, obesity, sleep apnea [uses a breathing machine at night], and implanted pacemaker was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (5) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
164,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
165,"LFTs: AST 49 (H), ALT 45 (H), ALP 83, T.Bili 5.1 (H), Albumin 3.9.","Your liver blood test results: Liver enzymes (AST 49, ALT 45) are mildly elevated (normal is under 40). Bilirubin is high at 5.1 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.9.",Gastroenterology,Lab Result,high
166,"84 y/o F with PMH of ESRD on HD, A-fib, hypothyroidism, CKD Stage 4, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on glipizide 5mg BID AC, hydroxychloroquine 200mg BID, Spiriva 18mcg daily. F/U surgery in 10 days.","A 84-year-old woman with a history of kidney failure requiring dialysis, irregular heartbeat [atrial fibrillation], underactive thyroid, and advanced kidney disease was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the surgeon in 10 days.",Pulmonology,Discharge Summary,high
167,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,high
168,CXR PA: Small left pleural effusion. Widened mediastinum. Elevated left hemidiaphragm.,"Chest X-ray results: There is a small amount of fluid around the left lung. The space between the lungs appears wider than normal, which needs further evaluation. The left side of the breathing muscle [diaphragm] is sitting higher than normal.",Pulmonology,Radiology Report,high
169,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
170,"22 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 22-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
171,MRI Lumbar Spine: Multilevel degenerative disc disease. No compression fracture.,MRI of the lower back results: Multiple discs in the spine are showing wear and aging. No bones are broken or collapsed.,Orthopedics,Radiology Report,high
172,"47 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 47-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
173,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab metoprolol succinate 50mg daily. albuterol MDI 2 puffs Q4-6H PRN. Tab atorvastatin 80mg QHS. Tab amlodipine 10mg daily. Adv: smoking cessation, pulmonary rehab. F/U 1 week with CBC, CMP.",Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (5) amlodipine 10mg once daily [blood pressure medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,high
174,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
175,Procedure: R TKA. Pt 65 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 65-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
176,CT Head without contrast: No mass effect. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No midline shift.,CT scan of the head results: There are no tumors or masses pushing on the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The brain is centered normally.,Neurology,Radiology Report,high
177,"45 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 45-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
178,"31 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 31-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
179,"56 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 56-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
180,"85 y/o M with PMH of SLE, s/p CABG, s/p THR, BPH, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Strict I&O, daily weights. D/C on prednisone taper, levothyroxine 75mcg daily on empty stomach. F/U oncology in 1 week.","A 85-year-old man with a history of lupus, prior heart bypass surgery, prior hip replacement, and enlarged prostate was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the cancer doctor in 1 week.",Cardiology,Discharge Summary,high
181,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Tab warfarin 5mg daily. Tab amlodipine 5mg daily. Adv: low potassium diet Adv: DASH diet, daily BP monitoring. F/U 1 month with repeat imaging.","Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (3) amlodipine 5mg once daily [blood pressure medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
182,"60 y/o F with PMH of CKD Stage 3, DM1, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on sertraline 50mg daily, atorvastatin 40mg QHS, amlodipine 10mg daily, empagliflozin 10mg daily. F/U surgery in 2 weeks for drain removal.","A 60-year-old woman with a history of moderate kidney disease, and type 1 diabetes was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
183,"50 y/o F with PMH of anemia, Parkinson's disease, CAD, ESRD on HD, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on albuterol MDI 2 puffs Q4-6H PRN, prednisone taper. F/U nephrology in 1 week.","A 50-year-old woman with a history of low blood count [anemia], Parkinson's disease, coronary artery disease [heart artery blockages], and kidney failure requiring dialysis was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
184,"30 y/o M with PMH of s/p TKR, obesity (BMI 38), cirrhosis, OA, HFpEF, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Strict I&O, daily weights. D/C on hydroxychloroquine 200mg BID, potassium chloride 20mEq daily. F/U orthopedics in 6 weeks with X-ray.","A 30-year-old man with a history of prior knee replacement, obesity, liver scarring [cirrhosis], arthritis [osteoarthritis], and heart failure with stiff heart muscle was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Neurology,Discharge Summary,high
185,Procedure: Laparoscopic cholecystectomy. Pt 70 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 70-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
186,CXR PA: Bilateral pleural effusions. Cardiomegaly with CTR >0.5. Osseous structures intact.,Chest X-ray results: There is fluid collecting around both lungs. The heart appears larger than normal. The bones look normal with no fractures.,Pulmonology,Radiology Report,high
187,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab amoxicillin 500mg TID x 10 days. Tab metformin 500mg BID. Adv: weight bearing exercise, calcium/vit D supplementation Adv: fall precautions, home safety evaluation. F/U 6 weeks with LFTs.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 6 weeks for liver function blood tests.",Infectious Disease,Prescription,medium
188,"40 y/o M with PMH of HTN, s/p THR, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Low potassium diet. D/C on albuterol MDI 2 puffs Q4-6H PRN, Spiriva 18mcg daily, amlodipine 5mg daily, carvedilol 12.5mg BID, Lantus 20U QHS. F/U oncology in 1 week.","A 40-year-old man with a history of high blood pressure, and prior hip replacement was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) carvedilol 12.5mg twice daily [heart medicine]; (5) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the cancer doctor in 1 week.",Cardiology,Discharge Summary,high
189,CXR PA: Right middle lobe atelectasis. Left lower lobe consolidation. Compression fracture T12. Small left pleural effusion.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is an area in the lower left lung that appears infected. There is a compression fracture [collapsed bone] in the lower spine at T12. There is a small amount of fluid around the left lung.",Pulmonology,Radiology Report,high
190,"47 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 47-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
191,Procedure: TURP for BPH. Pt 38 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 38-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
192,"73 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 73-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
193,"25 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 25-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
194,"72 y/o M with PMH of ESRD on HD, h/o CVA, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on acetaminophen 650mg Q6H PRN, Dulcolax 10mg QHS PRN, Augmentin 875/125 BID x 7 days, calcium + vitamin D 600/400 daily, sertraline 50mg daily. F/U endocrine in 1 week.","A 72-year-old man with a history of kidney failure requiring dialysis, and history of stroke was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Neurology,Discharge Summary,high
195,"37 y/o F with PMH of CKD Stage 4, asthma, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Strict I&O, daily weights. D/C on clopidogrel 75mg daily, Xarelto 20mg daily with dinner, carvedilol 12.5mg BID, omeprazole 20mg AC breakfast, metformin 1000mg BID. F/U pulmonology in 2 weeks.","A 37-year-old woman with a history of advanced kidney disease, and asthma was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]; (5) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the lung doctor in 2 weeks.",Nephrology,Discharge Summary,high
196,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Tab pantoprazole 40mg AC breakfast. Do not stop abruptly, taper as directed Adv: weight bearing exercise, calcium/vit D supplementation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. See your primary care doctor in 1 week to recheck blood pressure.",Gastroenterology,Prescription,medium
197,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. No mass effect. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No midline shift.,CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There are no tumors or masses pushing on the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The brain is centered normally.,Neurology,Radiology Report,high
198,HbA1c: 11.9% (H). FBS: 155 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.9%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 155, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
199,"29 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 29-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
200,"Rx: Tab rosuvastatin 10mg QHS. Tab ibuprofen 400mg Q6H PRN with food. Humalog per SSI. Adv: high fiber diet, adequate hydration. F/U 1 week with wound check.","Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (3) Humalog insulin before meals as directed [fast-acting insulin]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
201,"44 y/o F with PMH of HFpEF, ESRD on HD, gout, depression, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on escitalopram 10mg daily, atorvastatin 40mg QHS, azithromycin 500mg day 1 then 250mg x 4 days. F/U hematology in 2 weeks.","A 44-year-old woman with a history of heart failure with stiff heart muscle, kidney failure requiring dialysis, gout, and depression was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the blood disorder doctor in 2 weeks.",Pulmonology,Discharge Summary,high
202,"55 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 55-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
203,"45 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 45-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
204,"84 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 84-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
205,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
206,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab metformin 500mg BID. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks.","Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back for a check-up in 2 weeks.",Pulmonology,Prescription,medium
207,"38 y/o F with PMH of SLE, h/o CVA, osteoporosis, OSA on CPAP, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on timolol 0.5% OU BID, lisinopril 10mg daily, lisinopril 20mg daily. F/U surgery in 2 weeks for drain removal.","A 38-year-old woman with a history of lupus, history of stroke, weak bones [osteoporosis], and sleep apnea [uses a breathing machine at night] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (3) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Nephrology,Discharge Summary,high
208,"66 y/o F with PMH of PPM in situ, A-fib, HLD, ESRD on HD, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on metformin 1000mg BID, Eliquis 5mg BID, timolol 0.5% OU BID, Dulcolax 10mg QHS PRN, ibuprofen 400mg Q6H PRN with food. F/U hematology in 2 weeks.","A 66-year-old woman with a history of implanted pacemaker, irregular heartbeat [atrial fibrillation], high cholesterol, and kidney failure requiring dialysis was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) Eliquis 5mg twice daily [blood thinner]; (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (4) Dulcolax 10mg at bedtime as needed [for constipation]; (5) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
209,"90 y/o F with PMH of ICD in situ, DM2, s/p THR, DM1, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on rosuvastatin 10mg QHS, warfarin 5mg daily, prednisone taper. F/U hematology in 2 weeks.","A 90-year-old woman with a history of implanted heart defibrillator, type 2 diabetes, prior hip replacement, and type 1 diabetes was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the blood disorder doctor in 2 weeks.",Orthopedics,Discharge Summary,high
210,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,high
211,CXR PA: ET tube 3cm above carina. Patchy bilateral infiltrates. Cardiomegaly with CTR >0.5. Sternotomy wires intact.,Chest X-ray results: The breathing tube is in good position. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The heart appears larger than normal. The wires from prior heart surgery are intact.,Pulmonology,Radiology Report,high
212,"Rx: Tab hydroxychloroquine 200mg BID. Tab potassium chloride 20mEq daily. Tab omeprazole 20mg AC breakfast. Tab metoprolol succinate 50mg daily. Adv: elevate affected limb, compression stockings Adv: DASH diet, daily BP monitoring. F/U 1 week with CBC, CMP.","Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) omeprazole 20mg before breakfast [acid-reducing medicine]. (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
213,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
214,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab ASA 81mg daily. Adv: fall precautions, home safety evaluation Adv: high fiber diet, adequate hydration. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) baby aspirin 81mg once daily [prevents blood clots]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
215,"Thyroid panel: TSH 14.83 (H), Free T4 2.9.","Your thyroid test results: TSH is elevated at 14.83 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
216,"46 y/o M with PMH of CKD Stage 3, cirrhosis, anemia, s/p THR, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on carvedilol 12.5mg BID, lisinopril 20mg daily. F/U nephrology in 5 days.","A 46-year-old man with a history of moderate kidney disease, liver scarring [cirrhosis], low blood count [anemia], and prior hip replacement was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the kidney doctor in 5 days.",General Surgery,Discharge Summary,high
217,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,high
218,"61 y/o F with PMH of A-fib, s/p THR, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on latanoprost 0.005% OU QHS, rosuvastatin 10mg QHS, furosemide 40mg BID, Dulcolax 10mg QHS PRN. F/U nephrology in 5 days.","A 61-year-old woman with a history of irregular heartbeat [atrial fibrillation], and prior hip replacement was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the kidney doctor in 5 days.",General Surgery,Discharge Summary,high
219,"Rx: Humalog per SSI. Tab clopidogrel 75mg daily. Tab sertraline 50mg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab pregabalin 75mg BID. Avoid grapefruit juice Adv: smoking cessation, pulmonary rehab. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (5) pregabalin 75mg twice daily [nerve pain medicine]. Do not drink grapefruit juice as it interferes with this medication Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,high
220,"Rx: Tab losartan 50mg daily. Tab escitalopram 10mg daily. Tab metformin 1000mg BID. Tab pregabalin 75mg BID. Tab furosemide 40mg BID. Avoid NSAIDs Adv: DASH diet, daily BP monitoring. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) pregabalin 75mg twice daily [nerve pain medicine]. (5) furosemide (Lasix) 40mg twice daily [water pill]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
221,"22 y/o F with PMH of HTN, HLD, asthma, CKD Stage 3, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Strict I&O, daily weights. D/C on hydroxychloroquine 200mg BID, escitalopram 10mg daily, acetaminophen 650mg Q6H PRN, methotrexate 15mg weekly. F/U surgery in 2 weeks for drain removal.","A 22-year-old woman with a history of high blood pressure, high cholesterol, asthma, and moderate kidney disease was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the surgeon in 2 weeks to remove the drain.",Gastroenterology,Discharge Summary,high
222,"84 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 84-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
223,"58 y/o M with PMH of hypothyroidism, asthma, HFrEF (EF 30%), h/o TIA, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on amlodipine 5mg daily, azithromycin 500mg day 1 then 250mg x 4 days. F/U orthopedics in 6 weeks with X-ray.","A 58-year-old man with a history of underactive thyroid, asthma, heart failure with weak pumping (30%), and history of mini-stroke was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
224,"Thyroid panel: TSH 2.6 (N), Free T4 0.5.",Your thyroid test results: TSH is normal at 2.6. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
225,"LFTs: AST 293 (H), ALT 358 (H), ALP 275, T.Bili 2.0 (H), Albumin 1.6.","Your liver blood test results: Liver enzymes (AST 293, ALT 358) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 2.0. Albumin is low at 1.6 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
226,"60 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 60-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
227,"Rx: Tab sertraline 50mg daily. Tab amlodipine 5mg daily. Tab warfarin 5mg daily. Adv: weight bearing exercise, calcium/vit D supplementation Adv: DASH diet, daily BP monitoring. F/U 2 weeks with INR.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
228,"25 y/o F with PMH of DVT/PE on warfarin, h/o CVA, anxiety, obesity (BMI 38), admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on losartan 50mg daily, potassium chloride 20mEq daily, lisinopril 20mg daily, metformin 500mg BID, gabapentin 300mg TID. F/U orthopedics in 6 weeks with X-ray.","A 25-year-old woman with a history of blood clots [on blood thinner warfarin], history of stroke, anxiety, and obesity was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) lisinopril 20mg once daily [blood pressure medicine]; (4) metformin 500mg twice daily with meals [blood sugar medicine]; (5) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
229,CXR PA: Widened mediastinum. Sternotomy wires intact. Elevated left hemidiaphragm. Osseous structures intact. Moderate right pleural effusion.,"Chest X-ray results: The space between the lungs appears wider than normal, which needs further evaluation. The wires from prior heart surgery are intact. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The bones look normal with no fractures. There is a moderate amount of fluid around the right lung.",Pulmonology,Radiology Report,high
230,"Rx: Tab calcium + vitamin D 600/400 daily. Tab timolol 0.5% OU BID. Tab methotrexate 15mg weekly. Adv: high fiber diet, adequate hydration. F/U 6 weeks with LFTs.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 6 weeks for liver function blood tests.",Rheumatology,Prescription,medium
231,"82 y/o M with PMH of CKD Stage 4, OA, HFpEF, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on empagliflozin 10mg daily, metformin 1000mg BID, ciprofloxacin 500mg BID x 5 days, potassium chloride 20mEq daily, lisinopril 10mg daily. F/U GI in 1 week.","A 82-year-old man with a history of advanced kidney disease, arthritis [osteoarthritis], and heart failure with stiff heart muscle was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the stomach doctor in 1 week.",Neurology,Discharge Summary,high
232,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
233,"Rx: Tab hydroxychloroquine 200mg BID. Tab acetaminophen 650mg Q6H PRN. Adv: elevate affected limb, compression stockings. F/U 1 week with wound check.",Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 week to have the wound checked.,Rheumatology,Prescription,medium
234,"33 y/o F with PMH of asthma, ESRD on HD, HLD, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Augmentin 875/125 BID x 7 days, furosemide 40mg daily, rosuvastatin 10mg QHS, amlodipine 5mg daily, Xarelto 20mg daily with dinner. F/U GI in 1 week.","A 33-year-old woman with a history of asthma, kidney failure requiring dialysis, and high cholesterol was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) amlodipine 5mg once daily [blood pressure medicine]; (5) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the stomach doctor in 1 week.",Endocrinology,Discharge Summary,high
235,Rx: Tab ASA 81mg daily. Tab furosemide 40mg daily. Tab azithromycin 500mg day 1 then 250mg x 4 days. Humalog per SSI. Avoid grapefruit juice. F/U 2 weeks with INR.,"Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (4) Humalog insulin before meals as directed [fast-acting insulin]. Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
236,"73 y/o F with PMH of s/p THR, s/p CABG, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on hydroxychloroquine 200mg BID, Lantus 20U QHS, ondansetron 4mg Q8H PRN N/V, lisinopril 10mg daily. F/U GI in 1 week.","A 73-year-old woman with a history of prior hip replacement, and prior heart bypass surgery was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the stomach doctor in 1 week.",Pulmonology,Discharge Summary,high
237,"84 y/o M with PMH of s/p TKR, Parkinson's disease, osteoporosis, GERD, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on Eliquis 5mg BID, calcium + vitamin D 600/400 daily, atorvastatin 80mg QHS, furosemide 40mg daily, lisinopril 10mg daily. F/U INR check in 3 days.","A 84-year-old man with a history of prior knee replacement, Parkinson's disease, weak bones [osteoporosis], and acid reflux was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Eliquis 5mg twice daily [blood thinner]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
238,"38 y/o F with PMH of h/o TIA, Parkinson's disease, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on pantoprazole 40mg AC breakfast, omeprazole 20mg AC breakfast, ibuprofen 400mg Q6H PRN with food. F/U hematology in 2 weeks.","A 38-year-old woman with a history of history of mini-stroke, and Parkinson's disease was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
239,"45 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 45-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
240,"LFTs: AST 115 (H), ALT 420 (H), ALP 65, T.Bili 7.3 (H), Albumin 4.8.","Your liver blood test results: Liver enzymes (AST 115, ALT 420) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 7.3 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.8.",Gastroenterology,Lab Result,high
241,"Rx: Tab calcium + vitamin D 600/400 daily. prednisone taper. Tab metformin 500mg BID. Tab amlodipine 10mg daily. Tab lisinopril 20mg daily. Adv: high fiber diet, adequate hydration Adv: elevate affected limb, compression stockings. F/U 2 weeks with INR.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. (4) amlodipine 10mg once daily [blood pressure medicine]. (5) lisinopril 20mg once daily [blood pressure medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
242,CT Head without contrast: No mass effect. Acute ischemic infarct in R MCA territory. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
243,"US Abdomen: GB sludge, no stones. Left kidney 8cm, cortical thinning consistent with CKD. Spleen 11cm, normal. Ascites moderate amount. No focal hepatic lesion. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The spleen is a normal size. There is a moderate amount of fluid in the belly [ascites]. No tumors or masses were found in the liver. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
244,CXR PA: Hyperinflated lungs consistent with COPD. Sternotomy wires intact. Widened mediastinum.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The wires from prior heart surgery are intact. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
245,CXR PA: No cardiomegaly. Cardiomegaly with CTR >0.5. Bilateral hilar lymphadenopathy. Moderate right pleural effusion.,"Chest X-ray results: The heart is a normal size. The heart appears larger than normal. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There is a moderate amount of fluid around the right lung.",Pulmonology,Radiology Report,high
246,"33 y/o M with PMH of gout, obesity (BMI 38), h/o CVA, anemia, HTN, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on calcium + vitamin D 600/400 daily, Xarelto 20mg daily with dinner, metoprolol 25mg BID. F/U neurology in 2 weeks.","A 33-year-old man with a history of gout, obesity, history of stroke, low blood count [anemia], and high blood pressure was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) calcium plus vitamin D once daily [bone strengthening]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
247,"84 y/o M with PMH of BPH, HTN, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Low potassium diet. D/C on spironolactone 25mg daily, latanoprost 0.005% OU QHS. F/U INR check in 3 days.","A 84-year-old man with a history of enlarged prostate, and high blood pressure was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Follow-up for a blood thinner level check in 3 days.",Endocrinology,Discharge Summary,high
248,"Rx: Tab timolol 0.5% OU BID. Tab metoprolol 25mg BID. Avoid grapefruit juice. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
249,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,high
250,CT Head without contrast: No acute intracranial hemorrhage. No mass effect. No midline shift.,CT scan of the head results: There is no bleeding in the brain. There are no tumors or masses pushing on the brain. The brain is centered normally.,Neurology,Radiology Report,high
251,"49 y/o M with PMH of s/p TKR, OA, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on prednisone taper, tramadol 50mg Q6H PRN pain. F/U orthopedics in 6 weeks with X-ray.","A 49-year-old man with a history of prior knee replacement, and arthritis [osteoarthritis] was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Urology,Discharge Summary,high
252,"Rx: Tab lisinopril 10mg daily. Tab furosemide 40mg BID. Tab Dulcolax 10mg QHS PRN. Tab ondansetron 4mg Q8H PRN N/V. Adv: elevate affected limb, compression stockings Adv: low salt low sugar diet, regular exercise. F/U 1 week with wound check.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
253,"64 y/o M with PMH of depression, HLD, OSA on CPAP, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on calcium + vitamin D 600/400 daily, clopidogrel 75mg daily, carvedilol 12.5mg BID, latanoprost 0.005% OU QHS, acetaminophen 650mg Q6H PRN. F/U GI in 1 week.","A 64-year-old man with a history of depression, high cholesterol, and sleep apnea [uses a breathing machine at night] was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) calcium plus vitamin D once daily [bone strengthening]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
254,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab potassium chloride 20mEq daily. Tab ibuprofen 400mg Q6H PRN with food. Tab carvedilol 12.5mg BID. Adv: high fiber diet, adequate hydration Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 month with repeat imaging.","Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (4) carvedilol 12.5mg twice daily [heart medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 month — a repeat scan will be ordered.",General,Prescription,high
255,"38 y/o F with PMH of s/p THR, HLD, s/p TKR, PAD, DVT/PE on warfarin, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on clopidogrel 75mg daily, furosemide 40mg daily. F/U cardiology in 2 weeks.","A 38-year-old woman with a history of prior hip replacement, high cholesterol, prior knee replacement, poor blood flow in the legs [peripheral artery disease], and blood clots [on blood thinner warfarin] was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Follow-up with the heart doctor in 2 weeks.",General Surgery,Discharge Summary,high
256,CT Head without contrast: Paranasal sinuses clear. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Chronic lacunar infarcts in bilateral basal ganglia.,CT scan of the head results: The sinuses are clear with no infection. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There are signs of small old strokes in the deep parts of the brain.,Neurology,Radiology Report,high
257,Rx: Tab metoprolol 25mg BID. Tab empagliflozin 10mg daily. Avoid NSAIDs. F/U INR in 3 days.,Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,medium
258,CXR PA: Port-a-cath in appropriate position. Widened mediastinum. Osseous structures intact.,"Chest X-ray results: The implanted medication port is in the correct position. The space between the lungs appears wider than normal, which needs further evaluation. The bones look normal with no fractures.",Pulmonology,Radiology Report,high
259,"Rx: Tab ferrous sulfate 325mg BID. Tab levothyroxine 75mcg daily on empty stomach. Adv: smoking cessation, pulmonary rehab Adv: SMBG BID, diabetic diet. F/U 2 weeks.",Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back for a check-up in 2 weeks.,Endocrinology,Prescription,medium
260,CXR PA: Pacemaker leads in appropriate position. Small left pleural effusion. No pneumothorax. Bilateral hilar lymphadenopathy. Hyperinflated lungs consistent with COPD.,"Chest X-ray results: The pacemaker wires are in the correct position. There is a small amount of fluid around the left lung. There is no collapsed lung. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema].",Pulmonology,Radiology Report,high
261,HbA1c: 6.9% (H). FBS: 139 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.9%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 139, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
262,"86 y/o M with PMH of depression, A-fib, COPD, CAD, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Low potassium diet. D/C on albuterol MDI 2 puffs Q4-6H PRN, glipizide 5mg BID AC. F/U neurology in 2 weeks.","A 86-year-old man with a history of depression, irregular heartbeat [atrial fibrillation], chronic lung disease, and coronary artery disease [heart artery blockages] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the brain/nerve doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
263,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Paranasal sinuses clear. No midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. The sinuses are clear with no infection. The brain is centered normally. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
264,Procedure: Colonoscopy with polypectomy. Pt 31 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 31-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
265,"US Abdomen: Simple renal cysts bilaterally. No focal hepatic lesion. Pancreas unremarkable. GB sludge, no stones. CBD 5mm, not dilated. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: Both kidneys have harmless fluid-filled cysts. No tumors or masses were found in the liver. The pancreas looks normal. The gallbladder contains thickened bile [sludge] but no stones. The bile duct is normal size [not blocked]. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
266,Procedure: ORIF L distal radius. Pt 47 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 47-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
267,"79 y/o M with PMH of DVT/PE on warfarin, h/o CVA, GERD, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on pregabalin 75mg BID, methotrexate 15mg weekly, spironolactone 25mg daily, ASA 81mg daily, escitalopram 10mg daily. F/U orthopedics in 6 weeks with X-ray.","A 79-year-old man with a history of blood clots [on blood thinner warfarin], history of stroke, and acid reflux was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (3) spironolactone 25mg once daily [heart-protecting water pill]; (4) baby aspirin 81mg once daily [prevents blood clots]; (5) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
268,HbA1c: 11.1% (H). FBS: 223 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.1%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 223, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
269,"22 y/o M with PMH of asthma, hypothyroidism, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Strict I&O, daily weights. D/C on Spiriva 18mcg daily, calcium + vitamin D 600/400 daily, Augmentin 875/125 BID x 7 days. F/U orthopedics in 6 weeks with X-ray.","A 22-year-old man with a history of asthma, and underactive thyroid was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
270,Procedure: EGD with biopsy. Pt 56 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 56-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
271,"34 y/o F with PMH of cirrhosis, asthma, BPH, CKD Stage 4, h/o CVA, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on amlodipine 5mg daily, omeprazole 20mg AC breakfast. F/U surgery in 10 days.","A 34-year-old woman with a history of liver scarring [cirrhosis], asthma, enlarged prostate, advanced kidney disease, and history of stroke was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
272,"US Abdomen: CBD 5mm, not dilated. GB wall thickening with stones, positive Murphy's sign. Pancreas unremarkable. Simple renal cysts bilaterally. Ascites moderate amount.","Abdominal ultrasound results: The bile duct is normal size [not blocked]. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The pancreas looks normal. Both kidneys have harmless fluid-filled cysts. There is a moderate amount of fluid in the belly [ascites].",Gastroenterology,Radiology Report,high
273,"Lipid panel: TC 271, LDL 68, HDL 59, TG 52.",Your cholesterol results: Total cholesterol is 271. LDL (bad cholesterol) is at goal (68). HDL (good cholesterol) is good at 59. Triglycerides are normal at 52.,Cardiology,Lab Result,medium
274,CXR PA: Right lower lobe consolidation. Cardiomegaly with CTR >0.5. No cardiomegaly.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. The heart appears larger than normal. The heart is a normal size.",Pulmonology,Radiology Report,high
275,"39 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 39-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
276,MRI Lumbar Spine: No compression fracture. Multilevel degenerative disc disease.,MRI of the lower back results: No bones are broken or collapsed. Multiple discs in the spine are showing wear and aging.,Orthopedics,Radiology Report,high
277,HbA1c: 5.9% (H). FBS: 258 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.9%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 258, which is high (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,high
278,"79 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 79-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
279,"77 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 77-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
280,HbA1c: 10.9% (H). FBS: 387 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.9%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 387, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
281,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,medium
282,"90 y/o M with PMH of asthma, HLD, DVT/PE on warfarin, s/p THR, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on ciprofloxacin 500mg BID x 5 days, Dulcolax 10mg QHS PRN, amlodipine 5mg daily. F/U surgery in 10 days.","A 90-year-old man with a history of asthma, high cholesterol, blood clots [on blood thinner warfarin], and prior hip replacement was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the surgeon in 10 days.",Endocrinology,Discharge Summary,high
283,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
284,"Rx: Tab omeprazole 20mg AC breakfast. Tab furosemide 40mg BID. Tab metformin 1000mg BID. Adv: fall precautions, home safety evaluation. F/U INR in 3 days.","Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
285,"23 y/o M with PMH of h/o CVA, BPH, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Low potassium diet. D/C on metformin 1000mg BID, lisinopril 10mg daily, Spiriva 18mcg daily. F/U orthopedics in 6 weeks with X-ray.","A 23-year-old man with a history of history of stroke, and enlarged prostate was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (3) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Endocrinology,Discharge Summary,high
286,"BMP: Na 138 (N), K 6.2 (H), BUN 22, Cr 2.9 (H), Glucose 164.","Your blood chemistry results: Sodium is normal at 138. Potassium is dangerously high at 6.2 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 2.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 164 (high).",Nephrology,Lab Result,high
287,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. 4cm right subdural hematoma with 5mm midline shift. Chronic lacunar infarcts in bilateral basal ganglia. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are signs of small old strokes in the deep parts of the brain. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
288,Procedure: ORIF L distal radius. Pt 39 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 39-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
289,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
290,"65 y/o F with PMH of DM1, CKD Stage 3, h/o CVA, CKD Stage 4, PAD, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on pregabalin 75mg BID, hydroxychloroquine 200mg BID, latanoprost 0.005% OU QHS, pantoprazole 40mg AC breakfast. F/U PCP in 1 week.","A 65-year-old woman with a history of type 1 diabetes, moderate kidney disease, history of stroke, advanced kidney disease, and poor blood flow in the legs [peripheral artery disease] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the primary care doctor in 1 week.",Psychiatry,Discharge Summary,high
291,"39 y/o F with PMH of ICD in situ, HFrEF (EF 30%), BPH, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Compression stockings when ambulating. D/C on lisinopril 20mg daily, ondansetron 4mg Q8H PRN N/V, clopidogrel 75mg daily, atorvastatin 80mg QHS. F/U hematology in 2 weeks.","A 39-year-old woman with a history of implanted heart defibrillator, heart failure with weak pumping (30%), and enlarged prostate was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]; (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Pulmonology,Discharge Summary,high
292,CT Head without contrast: No acute intracranial hemorrhage. No midline shift. 4cm right subdural hematoma with 5mm midline shift. No mass effect.,"CT scan of the head results: There is no bleeding in the brain. The brain is centered normally. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
293,"57 y/o F with PMH of CHF, DVT/PE on warfarin, depression, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Xarelto 20mg daily with dinner, lisinopril 10mg daily, furosemide 40mg BID, sertraline 50mg daily, ferrous sulfate 325mg BID. F/U nephrology in 5 days.","A 57-year-old woman with a history of heart failure, blood clots [on blood thinner warfarin], and depression was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) sertraline 50mg once daily [antidepressant/anxiety medicine]; (5) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the kidney doctor in 5 days.",Nephrology,Discharge Summary,high
294,"70 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 70-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
295,"Rx: Tab Xarelto 20mg daily with dinner. Tab furosemide 40mg BID. Adv: avoid alcohol, hepatotoxic drugs Adv: smoking cessation, pulmonary rehab. F/U 1 week with wound check.",Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) furosemide (Lasix) 40mg twice daily [water pill]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week to have the wound checked.,Cardiology,Prescription,medium
296,"Rx: Tab furosemide 40mg BID. Tab pregabalin 75mg BID. Tab Augmentin 875/125 BID x 7 days. Adv: low salt low sugar diet, regular exercise Adv: high fiber diet, adequate hydration. F/U 2 weeks with INR.","Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
297,"73 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 73-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
298,"Rx: Tab methotrexate 15mg weekly. Tab atorvastatin 40mg QHS. Tab empagliflozin 10mg daily. Tab ASA 81mg daily. Adv: SMBG BID, diabetic diet Adv: DASH diet, daily BP monitoring. F/U 2 weeks with INR.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (4) baby aspirin 81mg once daily [prevents blood clots]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
299,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. Facet joint hypertrophy at L4-L5. Multilevel degenerative disc disease. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. The small joints in the spine at L4-L5 are enlarged from arthritis. Multiple discs in the spine are showing wear and aging. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
300,"81 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 81-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
301,MRI Lumbar Spine: Central canal stenosis at L3-L4. L5-S1 disc desiccation with mild bulge. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Multilevel degenerative disc disease.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
302,"36 y/o M with PMH of osteoporosis, h/o TIA, h/o CVA, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on amoxicillin 500mg TID x 10 days, empagliflozin 10mg daily, glipizide 5mg BID AC, spironolactone 25mg daily, prednisone taper. F/U hematology in 2 weeks.","A 36-year-old man with a history of weak bones [osteoporosis], history of mini-stroke, and history of stroke was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) spironolactone 25mg once daily [heart-protecting water pill]; (5) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
303,"81 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 81-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
304,"60 y/o M with PMH of OA, DM1, HLD, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Strict I&O, daily weights. D/C on potassium chloride 20mEq daily, atorvastatin 80mg QHS, azithromycin 500mg day 1 then 250mg x 4 days, ondansetron 4mg Q8H PRN N/V. F/U INR check in 3 days.","A 60-year-old man with a history of arthritis [osteoarthritis], type 1 diabetes, and high cholesterol was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Follow-up for a blood thinner level check in 3 days.",Hematology,Discharge Summary,high
305,"BMP: Na 129 (L), K 6.0 (H), BUN 73, Cr 0.7 (N), Glucose 208.","Your blood chemistry results: Sodium is low at 129 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.0 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is normal at 0.7. Blood sugar is 208 (high).",Nephrology,Lab Result,high
306,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
307,"67 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 67-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
308,"65 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 65-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
309,"48 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 48-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
310,CXR PA: Osseous structures intact. Mild cardiomegaly. Pacemaker leads in appropriate position.,Chest X-ray results: The bones look normal with no fractures. The heart is slightly larger than normal. The pacemaker wires are in the correct position.,Pulmonology,Radiology Report,high
311,"48 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 48-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
312,"Thyroid panel: TSH 14.75 (H), Free T4 0.7.","Your thyroid test results: TSH is elevated at 14.75 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is low — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
313,"MRI Lumbar Spine: C5-C6 disc herniation with cord compression. Conus medullaris at L1, normal. Facet joint hypertrophy at L4-L5. Multilevel degenerative disc disease.","MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal cord ends at a normal level. The small joints in the spine at L4-L5 are enlarged from arthritis. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
314,"Rx: Tab methotrexate 15mg weekly. Spiriva 18mcg daily. Tab losartan 50mg daily. Tab tramadol 50mg Q6H PRN pain. Adv: DASH diet, daily BP monitoring. F/U 2 weeks with INR.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) losartan 50mg once daily [blood pressure medicine]. (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
315,"CBC: WBC 21.6 (H), Hgb 13.0 (N), Plt 489 (H).","Your blood count results: White blood cells are 21.6 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 13.0. Platelets are 489, which is high — your blood may clot too easily.",Hematology,Lab Result,high
316,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,medium
317,CXR PA: Port-a-cath in appropriate position. Bilateral hilar lymphadenopathy. Sternotomy wires intact. Pacemaker leads in appropriate position. ET tube 3cm above carina.,"Chest X-ray results: The implanted medication port is in the correct position. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The wires from prior heart surgery are intact. The pacemaker wires are in the correct position. The breathing tube is in good position.",Pulmonology,Radiology Report,high
318,"CBC: WBC 6.7 (N), Hgb 16.6 (N), Plt 117 (L).","Your blood count results: White blood cells are 6.7 (normal). Hemoglobin is normal at 16.6. Platelets are 117, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
319,"Thyroid panel: TSH 9.43 (H), Free T4 2.4.","Your thyroid test results: TSH is elevated at 9.43 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
320,"CBC: WBC 15.4 (H), Hgb 5.7 (L), Plt 473 (H).","Your blood count results: White blood cells are 15.4 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 5.7, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 473, which is high — your blood may clot too easily.",Hematology,Lab Result,high
321,HbA1c: 6.2% (H). FBS: 102 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.2%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 102, which is high (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,high
322,Procedure: ERCP with sphincterotomy. Pt 44 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 44-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
323,"31 y/o M with PMH of h/o CVA, hypothyroidism, seizure disorder on Keppra, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on Lantus 20U QHS, glipizide 5mg BID AC. F/U surgery in 10 days.","A 31-year-old man with a history of history of stroke, underactive thyroid, and seizure disorder [on Keppra] was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the surgeon in 10 days.",Gastroenterology,Discharge Summary,high
324,"Thyroid panel: TSH 6.48 (H), Free T4 0.8.","Your thyroid test results: TSH is elevated at 6.48 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
325,"US Abdomen: Pancreas unremarkable. Spleen 16cm, splenomegaly. Simple renal cysts bilaterally.",Abdominal ultrasound results: The pancreas looks normal. The spleen is enlarged [splenomegaly]. Both kidneys have harmless fluid-filled cysts.,Gastroenterology,Radiology Report,high
326,"86 y/o F with PMH of s/p CABG, DM2, DM1, gout, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on ASA 81mg daily, gabapentin 300mg TID. F/U neurology in 2 weeks.","A 86-year-old woman with a history of prior heart bypass surgery, type 2 diabetes, type 1 diabetes, and gout was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the brain/nerve doctor in 2 weeks.",Psychiatry,Discharge Summary,high
327,"BMP: Na 137 (N), K 2.9 (L), BUN 82, Cr 1.5 (H), Glucose 394.",Your blood chemistry results: Sodium is normal at 137. Potassium is low at 2.9 — may cause muscle weakness and heart rhythm issues. Creatinine is mildly elevated at 1.5. Blood sugar is 394 (high).,Nephrology,Lab Result,high
328,"89 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 89-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
329,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,low
330,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
331,"Rx: Tab metformin 500mg BID. Humalog per SSI. Tab amoxicillin 500mg TID x 10 days. Avoid grapefruit juice. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Endocrinology,Prescription,medium
332,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
333,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
334,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
335,"50 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 50-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
336,HbA1c: 6.6% (H). FBS: 291 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.6%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 291, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
337,"84 y/o F with PMH of PAD, HTN, Parkinson's disease, DVT/PE on warfarin, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Strict I&O, daily weights. D/C on montelukast 10mg QHS, methotrexate 15mg weekly, acetaminophen 650mg Q6H PRN, Augmentin 875/125 BID x 7 days. F/U INR check in 3 days.","A 84-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], high blood pressure, Parkinson's disease, and blood clots [on blood thinner warfarin] was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up for a blood thinner level check in 3 days.",Urology,Discharge Summary,high
338,"79 y/o F with PMH of ESRD on HD, gout, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Strict I&O, daily weights. D/C on rosuvastatin 10mg QHS, Lantus 20U QHS, ondansetron 4mg Q8H PRN N/V, warfarin 5mg daily. F/U surgery in 10 days.","A 79-year-old woman with a history of kidney failure requiring dialysis, and gout was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up with the surgeon in 10 days.",Gastroenterology,Discharge Summary,high
339,"23 y/o M with PMH of CKD Stage 4, s/p CABG, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on amoxicillin 500mg TID x 10 days, Spiriva 18mcg daily, rosuvastatin 10mg QHS, omeprazole 20mg AC breakfast. F/U surgery in 2 weeks for drain removal.","A 23-year-old man with a history of advanced kidney disease, and prior heart bypass surgery was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
340,Procedure: ORIF L distal radius. Pt 24 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 24-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
341,"30 y/o M with PMH of OSA on CPAP, DM1, GERD, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Compression stockings when ambulating. D/C on glipizide 5mg BID AC, amlodipine 10mg daily, lisinopril 10mg daily, prednisone taper, tramadol 50mg Q6H PRN pain. F/U hematology in 2 weeks.","A 30-year-old man with a history of sleep apnea [uses a breathing machine at night], type 1 diabetes, and acid reflux was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the blood disorder doctor in 2 weeks.",Pulmonology,Discharge Summary,high
342,"Rx: Tab ferrous sulfate 325mg BID. Tab ondansetron 4mg Q8H PRN N/V. Adv: weight bearing exercise, calcium/vit D supplementation Adv: low salt low sugar diet, regular exercise. F/U 1 week with CBC, CMP.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",General,Prescription,medium
343,"56 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 56-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
344,"54 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 54-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
345,"91 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 91-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
346,"30 y/o M with PMH of CKD Stage 3, GERD, s/p CABG, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on entresto 49/51mg BID, Augmentin 875/125 BID x 7 days, omeprazole 20mg AC breakfast, azithromycin 500mg day 1 then 250mg x 4 days. F/U nephrology in 1 week.","A 30-year-old man with a history of moderate kidney disease, acid reflux, and prior heart bypass surgery was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]; (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the kidney doctor in 1 week.",Endocrinology,Discharge Summary,high
347,HbA1c: 10.9% (H). FBS: 88 mg/dL (N).,"Your diabetes blood test results: HbA1c is 10.9%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 88, which is normal (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
348,"LFTs: AST 288 (H), ALT 441 (H), ALP 223, T.Bili 3.4 (H), Albumin 2.7.","Your liver blood test results: Liver enzymes (AST 288, ALT 441) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 3.4 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.7 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
349,"Rx: Tab glipizide 5mg BID AC. Tab ferrous sulfate 325mg BID. Tab Augmentin 875/125 BID x 7 days. Tab pregabalin 75mg BID. Adv: SMBG BID, diabetic diet Adv: weight bearing exercise, calcium/vit D supplementation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) glipizide 5mg twice daily before meals [helps release insulin]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. (4) pregabalin 75mg twice daily [nerve pain medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Neurology,Prescription,high
350,"BMP: Na 134 (L), K 3.9 (N), BUN 68, Cr 2.4 (H), Glucose 240.","Your blood chemistry results: Sodium is low at 134 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.9. Creatinine is elevated at 2.4 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 240 (high).",Nephrology,Lab Result,high
351,"Rx: Tab ferrous sulfate 325mg BID. Tab hydroxychloroquine 200mg BID. Tab Xarelto 20mg daily with dinner. Tab timolol 0.5% OU BID. Adv: fall precautions, home safety evaluation Adv: low potassium diet. F/U 1 week with wound check.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) Xarelto 20mg once daily with dinner [blood thinner]. (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week to have the wound checked.",Rheumatology,Prescription,high
352,"67 y/o F with PMH of gout, CAD, s/p TKR, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Strict I&O, daily weights. D/C on ASA 81mg daily, tramadol 50mg Q6H PRN pain, metformin 500mg BID, clopidogrel 75mg daily. F/U wound care in 3 days.","A 67-year-old woman with a history of gout, coronary artery disease [heart artery blockages], and prior knee replacement was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (3) metformin 500mg twice daily with meals [blood sugar medicine]; (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Follow-up at the wound care clinic in 3 days.",Gastroenterology,Discharge Summary,high
353,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
354,CT Head without contrast: No midline shift. No mass effect. Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage. Paranasal sinuses clear.,CT scan of the head results: The brain is centered normally. There are no tumors or masses pushing on the brain. There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain. The sinuses are clear with no infection.,Neurology,Radiology Report,high
355,"61 y/o F with PMH of s/p THR, ESRD on HD, BPH, asthma, s/p TKR, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on ondansetron 4mg Q8H PRN N/V, amlodipine 5mg daily, spironolactone 25mg daily. F/U wound care in 3 days.","A 61-year-old woman with a history of prior hip replacement, kidney failure requiring dialysis, enlarged prostate, asthma, and prior knee replacement was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) amlodipine 5mg once daily [blood pressure medicine]; (3) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
356,Procedure: PCI with DES to LAD. Pt 63 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 63-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
357,"43 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 43-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
358,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
359,MRI Lumbar Spine: Multilevel degenerative disc disease. Facet joint hypertrophy at L4-L5. Central canal stenosis at L3-L4. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: Multiple discs in the spine are showing wear and aging. The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
360,"LFTs: AST 118 (H), ALT 345 (H), ALP 145, T.Bili 4.0 (H), Albumin 4.3.","Your liver blood test results: Liver enzymes (AST 118, ALT 345) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 4.0 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.3.",Gastroenterology,Lab Result,high
361,"56 y/o M with PMH of anemia, GERD, CKD Stage 4, h/o CVA, HTN, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on sertraline 50mg daily, atorvastatin 80mg QHS, azithromycin 500mg day 1 then 250mg x 4 days, montelukast 10mg QHS, albuterol MDI 2 puffs Q4-6H PRN. F/U neurology in 2 weeks.","A 56-year-old man with a history of low blood count [anemia], acid reflux, advanced kidney disease, history of stroke, and high blood pressure was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (4) montelukast 10mg at bedtime [asthma/allergy medicine]; (5) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the brain/nerve doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
362,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,medium
363,"BMP: Na 127 (L), K 4.7 (N), BUN 73, Cr 0.7 (N), Glucose 159.","Your blood chemistry results: Sodium is low at 127 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.7. Creatinine is normal at 0.7. Blood sugar is 159 (high).",Nephrology,Lab Result,high
364,"CBC: WBC 9.0 (N), Hgb 6.6 (L), Plt 311 (N).","Your blood count results: White blood cells are 9.0 (normal). Hemoglobin is low at 6.6, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 311, which is normal.",Hematology,Lab Result,high
365,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,high
366,Procedure: Laparoscopic appendectomy. Pt 31 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 31-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
367,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
368,"CBC: WBC 11.5 (H), Hgb 15.8 (N), Plt 358 (N).","Your blood count results: White blood cells are 11.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 15.8. Platelets are 358, which is normal.",Hematology,Lab Result,high
369,"Rx: Tab carvedilol 12.5mg BID. Tab amlodipine 5mg daily. Tab metformin 1000mg BID. Tab empagliflozin 10mg daily. Adv: fall precautions, home safety evaluation. F/U 1 week with CBC, CMP.","Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
370,"80 y/o M with PMH of CKD Stage 3, DM2, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on carvedilol 12.5mg BID, potassium chloride 20mEq daily, Xarelto 20mg daily with dinner, atorvastatin 80mg QHS. F/U wound care in 3 days.","A 80-year-old man with a history of moderate kidney disease, and type 2 diabetes was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) Xarelto 20mg once daily with dinner [blood thinner]; (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up at the wound care clinic in 3 days.",Neurology,Discharge Summary,high
371,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No mass effect. Paranasal sinuses clear. No acute intracranial hemorrhage.,CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There are no tumors or masses pushing on the brain. The sinuses are clear with no infection. There is no bleeding in the brain.,Neurology,Radiology Report,high
372,"51 y/o M with PMH of SLE, PAD, HFpEF, BPH, DM2, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Strict I&O, daily weights. D/C on methotrexate 15mg weekly, metoprolol 25mg BID, ferrous sulfate 325mg BID. F/U PCP in 2 weeks.","A 51-year-old man with a history of lupus, poor blood flow in the legs [peripheral artery disease], heart failure with stiff heart muscle, enlarged prostate, and type 2 diabetes was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the primary care doctor in 2 weeks.",Neurology,Discharge Summary,high
373,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
374,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No midline shift.,CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The brain is centered normally.,Neurology,Radiology Report,high
375,"MRI Lumbar Spine: Central canal stenosis at L3-L4. Facet joint hypertrophy at L4-L5. Conus medullaris at L1, normal. L5-S1 disc desiccation with mild bulge.","MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal cord ends at a normal level. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
376,"65 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 65-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
377,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
378,CT Head without contrast: No midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Mild generalized cerebral atrophy appropriate for age. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: The brain is centered normally. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is mild brain shrinkage, which is normal for your age. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
379,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
380,HbA1c: 6.4% (H). FBS: 94 mg/dL (N).,"Your diabetes blood test results: HbA1c is 6.4%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 94, which is normal (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,medium
381,Procedure: Laparoscopic cholecystectomy. Pt 91 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 91-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
382,"33 y/o M with PMH of OSA on CPAP, ESRD on HD, HFrEF (EF 30%), OA, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on amoxicillin 500mg TID x 10 days, metoprolol 25mg BID, montelukast 10mg QHS. F/U GI in 1 week.","A 33-year-old man with a history of sleep apnea [uses a breathing machine at night], kidney failure requiring dialysis, heart failure with weak pumping (30%), and arthritis [osteoarthritis] was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
383,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,low
384,Rx: Tab pregabalin 75mg BID. Tab metformin 1000mg BID. Adv: wound care with daily dressing changes. F/U 1 week with wound check.,"Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) metformin 1000mg twice daily with meals [blood sugar medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week to have the wound checked.",Neurology,Prescription,medium
385,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,low
386,CT Head without contrast: No mass effect. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No midline shift.,CT scan of the head results: There are no tumors or masses pushing on the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The brain is centered normally.,Neurology,Radiology Report,high
387,"26 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 26-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
388,"65 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 65-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
389,"Thyroid panel: TSH 10.88 (H), Free T4 2.9.","Your thyroid test results: TSH is elevated at 10.88 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
390,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
391,"54 y/o F with PMH of s/p CABG, hypothyroidism, CAD, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on azithromycin 500mg day 1 then 250mg x 4 days, potassium chloride 20mEq daily, tramadol 50mg Q6H PRN pain, glipizide 5mg BID AC. F/U oncology in 1 week.","A 54-year-old woman with a history of prior heart bypass surgery, underactive thyroid, and coronary artery disease [heart artery blockages] was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (4) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the cancer doctor in 1 week.",Infectious Disease,Discharge Summary,high
392,"62 y/o F with PMH of HFpEF, A-fib, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on latanoprost 0.005% OU QHS, lisinopril 10mg daily, empagliflozin 10mg daily, montelukast 10mg QHS, albuterol MDI 2 puffs Q4-6H PRN. F/U hematology in 2 weeks.","A 62-year-old woman with a history of heart failure with stiff heart muscle, and irregular heartbeat [atrial fibrillation] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (4) montelukast 10mg at bedtime [asthma/allergy medicine]; (5) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the blood disorder doctor in 2 weeks.",Neurology,Discharge Summary,high
393,Procedure: PCI with DES to LAD. Pt 87 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 87-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
394,CXR PA: No cardiomegaly. Patchy bilateral infiltrates. Increased interstitial markings suggesting pulmonary edema. Left lower lobe consolidation. Compression fracture T12.,"Chest X-ray results: The heart is a normal size. There are scattered cloudy patches in both lungs suggesting infection or inflammation. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There is an area in the lower left lung that appears infected. There is a compression fracture [collapsed bone] in the lower spine at T12.",Pulmonology,Radiology Report,high
395,"78 y/o M with PMH of obesity (BMI 38), CHF, Parkinson's disease, gout, h/o CVA, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on calcium + vitamin D 600/400 daily, ASA 81mg daily. F/U endocrine in 1 week.","A 78-year-old man with a history of obesity, heart failure, Parkinson's disease, gout, and history of stroke was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) calcium plus vitamin D once daily [bone strengthening]; (2) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the hormone/diabetes doctor in 1 week.",Infectious Disease,Discharge Summary,high
396,"81 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 81-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
397,"Rx: Tab metformin 1000mg BID. Tab tramadol 50mg Q6H PRN pain. Tab timolol 0.5% OU BID. Tab sertraline 50mg daily. Adv: high fiber diet, adequate hydration Adv: fall precautions, home safety evaluation. F/U 2 weeks.","Your medicines: (1) metformin 1000mg twice daily with meals [blood sugar medicine]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (4) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back for a check-up in 2 weeks.",Endocrinology,Prescription,high
398,"55 y/o M with PMH of hypothyroidism, CHF, DM2, gout, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on metoprolol succinate 50mg daily, ciprofloxacin 500mg BID x 5 days, ferrous sulfate 325mg BID. F/U PCP in 2 weeks.","A 55-year-old man with a history of underactive thyroid, heart failure, type 2 diabetes, and gout was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
399,"26 y/o F with PMH of OA, s/p CABG, s/p THR, hypothyroidism, CHF, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on Dulcolax 10mg QHS PRN, lisinopril 20mg daily, escitalopram 10mg daily, ibuprofen 400mg Q6H PRN with food. F/U oncology in 1 week.","A 26-year-old woman with a history of arthritis [osteoarthritis], prior heart bypass surgery, prior hip replacement, underactive thyroid, and heart failure was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the cancer doctor in 1 week.",Cardiology,Discharge Summary,high
400,"48 y/o F with PMH of s/p CABG, anemia, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Strict I&O, daily weights. D/C on amlodipine 10mg daily, warfarin 5mg daily, prednisone taper, gabapentin 300mg TID, azithromycin 500mg day 1 then 250mg x 4 days. F/U endocrine in 1 week.","A 48-year-old woman with a history of prior heart bypass surgery, and low blood count [anemia] was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (4) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (5) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the hormone/diabetes doctor in 1 week.",Infectious Disease,Discharge Summary,high
401,"CBC: WBC 15.1 (H), Hgb 9.4 (L), Plt 221 (N).","Your blood count results: White blood cells are 15.1 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 9.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 221, which is normal.",Hematology,Lab Result,high
402,"47 y/o M with PMH of HLD, h/o CVA, BPH, s/p TKR, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on ferrous sulfate 325mg BID, montelukast 10mg QHS. F/U surgery in 10 days.","A 47-year-old man with a history of high cholesterol, history of stroke, enlarged prostate, and prior knee replacement was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the surgeon in 10 days.",Orthopedics,Discharge Summary,high
403,"Rx: Tab lisinopril 20mg daily. Tab hydroxychloroquine 200mg BID. Tab Dulcolax 10mg QHS PRN. Adv: DASH diet, daily BP monitoring Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks with INR.","Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
404,CT Head without contrast: No acute intracranial hemorrhage. Mild generalized cerebral atrophy appropriate for age. No mass effect. Subarachnoid hemorrhage in bilateral sylvian fissures. No midline shift.,"CT scan of the head results: There is no bleeding in the brain. There is mild brain shrinkage, which is normal for your age. There are no tumors or masses pushing on the brain. There is bleeding around the brain surface, particularly in the grooves on both sides. The brain is centered normally.",Neurology,Radiology Report,high
405,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab metoprolol 25mg BID. Adv: SMBG BID, diabetic diet. F/U PCP in 1 week for BP recheck.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
406,"CBC: WBC 24.0 (H), Hgb 15.8 (N), Plt 263 (N).","Your blood count results: White blood cells are 24.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 15.8. Platelets are 263, which is normal.",Hematology,Lab Result,high
407,"25 y/o F with PMH of anxiety, A-fib, h/o CVA, seizure disorder on Keppra, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Strict I&O, daily weights. D/C on latanoprost 0.005% OU QHS, warfarin 5mg daily. F/U nephrology in 1 week.","A 25-year-old woman with a history of anxiety, irregular heartbeat [atrial fibrillation], history of stroke, and seizure disorder [on Keppra] was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up with the kidney doctor in 1 week.",Cardiology,Discharge Summary,high
408,"24 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 24-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
409,"Rx: Tab Xarelto 20mg daily with dinner. Tab metformin 500mg BID. Tab amlodipine 10mg daily. Adv: elevate affected limb, compression stockings. F/U PCP in 1 week for BP recheck.",Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) amlodipine 10mg once daily [blood pressure medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
410,"BMP: Na 140 (N), K 3.0 (L), BUN 65, Cr 1.7 (H), Glucose 389.","Your blood chemistry results: Sodium is normal at 140. Potassium is low at 3.0 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 1.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 389 (high).",Nephrology,Lab Result,high
411,"38 y/o M with PMH of depression, asthma, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on ferrous sulfate 325mg BID, tramadol 50mg Q6H PRN pain, furosemide 40mg BID, omeprazole 20mg AC breakfast. F/U hematology in 2 weeks.","A 38-year-old man with a history of depression, and asthma was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
412,HbA1c: 5.4% (N). FBS: 206 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.4%, which is normal — you do not have diabetes. Fasting blood sugar was 206, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
413,"Rx: Tab pregabalin 75mg BID. Tab ASA 81mg daily. Adv: high fiber diet, adequate hydration Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks.","Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
414,"LFTs: AST 448 (H), ALT 531 (H), ALP 82, T.Bili 2.3 (H), Albumin 2.4.","Your liver blood test results: Liver enzymes (AST 448, ALT 531) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 2.3 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.4 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
415,"80 y/o M with PMH of PAD, CKD Stage 3, obesity (BMI 38), OSA on CPAP, BPH, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on ferrous sulfate 325mg BID, azithromycin 500mg day 1 then 250mg x 4 days, metoprolol 25mg BID, losartan 50mg daily, ASA 81mg daily. F/U neurology in 2 weeks.","A 80-year-old man with a history of poor blood flow in the legs [peripheral artery disease], moderate kidney disease, obesity, sleep apnea [uses a breathing machine at night], and enlarged prostate was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (4) losartan 50mg once daily [blood pressure medicine]; (5) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the brain/nerve doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
416,"32 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 32-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
417,"82 y/o M with PMH of HLD, seizure disorder on Keppra, s/p CABG, HTN, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on escitalopram 10mg daily, levothyroxine 75mcg daily on empty stomach, prednisone taper, calcium + vitamin D 600/400 daily, warfarin 5mg daily. F/U orthopedics in 6 weeks with X-ray.","A 82-year-old man with a history of high cholesterol, seizure disorder [on Keppra], prior heart bypass surgery, and high blood pressure was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Neurology,Discharge Summary,high
418,"54 y/o M with PMH of A-fib, DM2, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Strict I&O, daily weights. D/C on pantoprazole 40mg AC breakfast, gabapentin 300mg TID. F/U hematology in 2 weeks.","A 54-year-old man with a history of irregular heartbeat [atrial fibrillation], and type 2 diabetes was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
419,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab entresto 49/51mg BID. Tab lisinopril 10mg daily. Spiriva 18mcg daily. Tab ferrous sulfate 325mg BID. Adv: low salt diet, fluid restriction 1.5L/day. F/U INR in 3 days.",Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (4) Spiriva inhaler once daily [long-acting lung medicine]. (5) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
420,"82 y/o M with PMH of SLE, OSA on CPAP, CKD Stage 3, BPH, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Compression stockings when ambulating. D/C on gabapentin 300mg TID, ASA 81mg daily, amlodipine 5mg daily, ibuprofen 400mg Q6H PRN with food, acetaminophen 650mg Q6H PRN. F/U surgery in 2 weeks for drain removal.","A 82-year-old man with a history of lupus, sleep apnea [uses a breathing machine at night], moderate kidney disease, and enlarged prostate was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the surgeon in 2 weeks to remove the drain.",Psychiatry,Discharge Summary,high
421,"65 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 65-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
422,"23 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 23-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
423,CXR PA: Right middle lobe atelectasis. No pneumothorax. NG tube tip in stomach. Mild cardiomegaly.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is no collapsed lung. The feeding/drainage tube tip is correctly positioned in the stomach. The heart is slightly larger than normal.",Pulmonology,Radiology Report,high
424,Procedure: TURP for BPH. Pt 62 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 62-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
425,"US Abdomen: Spleen 11cm, normal. Spleen 16cm, splenomegaly. Moderate right hydronephrosis. Right kidney 10.5cm, no hydronephrosis.","Abdominal ultrasound results: The spleen is a normal size. The spleen is enlarged [splenomegaly]. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. Right kidney is normal size with no blockage.",Gastroenterology,Radiology Report,high
426,"75 y/o M with PMH of cirrhosis, s/p THR, GERD, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on sertraline 50mg daily, escitalopram 10mg daily, pregabalin 75mg BID. F/U INR check in 3 days.","A 75-year-old man with a history of liver scarring [cirrhosis], prior hip replacement, and acid reflux was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up for a blood thinner level check in 3 days.",General Surgery,Discharge Summary,high
427,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
428,"58 y/o M with PMH of OSA on CPAP, A-fib, HFpEF, CKD Stage 4, anxiety, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Strict I&O, daily weights. D/C on latanoprost 0.005% OU QHS, Eliquis 5mg BID, furosemide 40mg BID, hydroxychloroquine 200mg BID. F/U hematology in 2 weeks.","A 58-year-old man with a history of sleep apnea [uses a breathing machine at night], irregular heartbeat [atrial fibrillation], heart failure with stiff heart muscle, advanced kidney disease, and anxiety was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) Eliquis 5mg twice daily [blood thinner]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the blood disorder doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
429,CXR PA: Left lower lobe consolidation. Cardiomegaly with CTR >0.5. Small left pleural effusion. Widened mediastinum.,"Chest X-ray results: There is an area in the lower left lung that appears infected. The heart appears larger than normal. There is a small amount of fluid around the left lung. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
430,"84 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 84-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
431,Procedure: EGD with biopsy. Pt 73 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 73-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
432,"76 y/o F with PMH of CHF, cirrhosis, CKD Stage 3, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Eliquis 5mg BID, entresto 49/51mg BID, sertraline 50mg daily, omeprazole 20mg AC breakfast, levothyroxine 75mcg daily on empty stomach. F/U orthopedics in 6 weeks with X-ray.","A 76-year-old woman with a history of heart failure, liver scarring [cirrhosis], and moderate kidney disease was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Eliquis 5mg twice daily [blood thinner]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]; (5) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Infectious Disease,Discharge Summary,high
433,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,low
434,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
435,"81 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 81-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
436,"34 y/o F with PMH of DVT/PE on warfarin, DM2, DM1, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on spironolactone 25mg daily, Eliquis 5mg BID. F/U oncology in 1 week.","A 34-year-old woman with a history of blood clots [on blood thinner warfarin], type 2 diabetes, and type 1 diabetes was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) Eliquis 5mg twice daily [blood thinner]. Follow-up with the cancer doctor in 1 week.",Gastroenterology,Discharge Summary,high
437,"Thyroid panel: TSH 2.25 (N), Free T4 2.7.",Your thyroid test results: TSH is normal at 2.25. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
438,"27 y/o F with PMH of s/p TKR, hypothyroidism, HTN, GERD, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on furosemide 40mg daily, hydroxychloroquine 200mg BID, losartan 50mg daily, carvedilol 12.5mg BID. F/U endocrine in 1 week.","A 27-year-old woman with a history of prior knee replacement, underactive thyroid, high blood pressure, and acid reflux was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) losartan 50mg once daily [blood pressure medicine]; (4) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Urology,Discharge Summary,high
439,MRI Lumbar Spine: No compression fracture. Central canal stenosis at L3-L4. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: No bones are broken or collapsed. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
440,"MRI Lumbar Spine: C5-C6 disc herniation with cord compression. Facet joint hypertrophy at L4-L5. Conus medullaris at L1, normal.","MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
441,"42 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 42-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
442,"85 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 85-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
443,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,medium
444,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Acute ischemic infarct in R MCA territory. No acute intracranial hemorrhage.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is no bleeding in the brain.",Neurology,Radiology Report,high
445,"23 y/o M with PMH of RA on MTX, depression, PPM in situ, Parkinson's disease, GERD, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Compression stockings when ambulating. D/C on ibuprofen 400mg Q6H PRN with food, ondansetron 4mg Q8H PRN N/V, calcium + vitamin D 600/400 daily, methotrexate 15mg weekly. F/U surgery in 2 weeks for drain removal.","A 23-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], depression, implanted pacemaker, Parkinson's disease, and acid reflux was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (3) calcium plus vitamin D once daily [bone strengthening]; (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
446,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
447,"82 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 82-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
448,"Rx: Tab Xarelto 20mg daily with dinner. Tab lisinopril 20mg daily. Tab ondansetron 4mg Q8H PRN N/V. Humalog per SSI. Tab amlodipine 5mg daily. Adv: low salt low sugar diet, regular exercise. F/U PCP in 1 week for BP recheck.","Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) lisinopril 20mg once daily [blood pressure medicine]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) Humalog insulin before meals as directed [fast-acting insulin]. (5) amlodipine 5mg once daily [blood pressure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
449,"Rx: Tab glipizide 5mg BID AC. Tab metoprolol succinate 50mg daily. Tab sertraline 50mg daily. Tab clopidogrel 75mg daily. Adv: avoid alcohol, hepatotoxic drugs. F/U 1 month with repeat imaging.",Your medicines: (1) glipizide 5mg twice daily before meals [helps release insulin]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,low
450,"37 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 37-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
451,"87 y/o M with PMH of HLD, ESRD on HD, asthma, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on montelukast 10mg QHS, clopidogrel 75mg daily, Augmentin 875/125 BID x 7 days. F/U cardiology in 2 weeks.","A 87-year-old man with a history of high cholesterol, kidney failure requiring dialysis, and asthma was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the heart doctor in 2 weeks.",Orthopedics,Discharge Summary,high
452,"39 y/o M with PMH of HLD, depression, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on latanoprost 0.005% OU QHS, clopidogrel 75mg daily, Xarelto 20mg daily with dinner. F/U PCP in 2 weeks.","A 39-year-old man with a history of high cholesterol, and depression was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the primary care doctor in 2 weeks.",Pulmonology,Discharge Summary,high
453,"24 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 24-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
454,"Thyroid panel: TSH 1.29 (N), Free T4 1.9.",Your thyroid test results: TSH is normal at 1.29. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
455,"Lipid panel: TC 245, LDL 215, HDL 80, TG 430.","Your cholesterol results: Total cholesterol is 245. LDL (bad cholesterol) is very high at 215 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 80. Triglycerides are very high at 430 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
456,CXR PA: Increased interstitial markings suggesting pulmonary edema. Bilateral hilar lymphadenopathy. Mild cardiomegaly.,"Chest X-ray results: There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The heart is slightly larger than normal.",Pulmonology,Radiology Report,high
457,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. CBD 12mm, dilated. CBD 5mm, not dilated.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The bile duct is wider than normal [dilated], which may indicate a blockage. The bile duct is normal size [not blocked].",Gastroenterology,Radiology Report,high
458,"23 y/o M with PMH of s/p TKR, h/o TIA, obesity (BMI 38), s/p CABG, CHF, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Compression stockings when ambulating. D/C on albuterol MDI 2 puffs Q4-6H PRN, metoprolol succinate 50mg daily. F/U wound care in 3 days.","A 23-year-old man with a history of prior knee replacement, history of mini-stroke, obesity, prior heart bypass surgery, and heart failure was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up at the wound care clinic in 3 days.",General Surgery,Discharge Summary,high
459,"CBC: WBC 12.0 (H), Hgb 8.9 (L), Plt 189 (N).","Your blood count results: White blood cells are 12.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 8.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 189, which is normal.",Hematology,Lab Result,high
460,"91 y/o F with PMH of seizure disorder on Keppra, HTN, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on Dulcolax 10mg QHS PRN, calcium + vitamin D 600/400 daily, carvedilol 12.5mg BID, amlodipine 10mg daily, Lantus 20U QHS. F/U nephrology in 1 week.","A 91-year-old woman with a history of seizure disorder [on Keppra], and high blood pressure was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) amlodipine 10mg once daily [blood pressure medicine]; (5) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the kidney doctor in 1 week.",General Surgery,Discharge Summary,high
461,"LFTs: AST 380 (H), ALT 374 (H), ALP 260, T.Bili 3.8 (H), Albumin 1.5.","Your liver blood test results: Liver enzymes (AST 380, ALT 374) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 3.8 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 1.5 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
462,"66 y/o F with PMH of HFrEF (EF 30%), anxiety, s/p THR, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on latanoprost 0.005% OU QHS, amoxicillin 500mg TID x 10 days. F/U cardiology in 2 weeks.","A 66-year-old woman with a history of heart failure with weak pumping (30%), anxiety, and prior hip replacement was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
463,CXR PA: No cardiomegaly. Bilateral hilar lymphadenopathy. Pacemaker leads in appropriate position. Right lower lobe consolidation. Sternotomy wires intact.,"Chest X-ray results: The heart is a normal size. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The pacemaker wires are in the correct position. There is an area in the lower right lung that appears infected, suggesting pneumonia. The wires from prior heart surgery are intact.",Pulmonology,Radiology Report,high
464,"72 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 72-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
465,CXR PA: No pneumothorax. Right lower lobe consolidation. Mild cardiomegaly. Small left pleural effusion. Elevated left hemidiaphragm.,"Chest X-ray results: There is no collapsed lung. There is an area in the lower right lung that appears infected, suggesting pneumonia. The heart is slightly larger than normal. There is a small amount of fluid around the left lung. The left side of the breathing muscle [diaphragm] is sitting higher than normal.",Pulmonology,Radiology Report,high
466,"64 y/o M with PMH of HFrEF (EF 30%), COPD, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Low potassium diet. D/C on methotrexate 15mg weekly, Eliquis 5mg BID, calcium + vitamin D 600/400 daily. F/U surgery in 2 weeks for drain removal.","A 64-year-old man with a history of heart failure with weak pumping (30%), and chronic lung disease was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) Eliquis 5mg twice daily [blood thinner]; (3) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the surgeon in 2 weeks to remove the drain.",Pulmonology,Discharge Summary,high
467,"Rx: Tab clopidogrel 75mg daily. Tab lisinopril 10mg daily. Tab potassium chloride 20mEq daily. Tab ferrous sulfate 325mg BID. Tab furosemide 40mg daily. Adv: elevate affected limb, compression stockings Adv: low salt diet, fluid restriction 1.5L/day. F/U PCP in 1 week for BP recheck.",Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (5) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: eat less salt and limit your total fluid intake to about 6 cups per day. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,high
468,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
469,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage. No midline shift. No mass effect.,CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain. The brain is centered normally. There are no tumors or masses pushing on the brain.,Neurology,Radiology Report,high
470,"47 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 47-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
471,MRI Lumbar Spine: Multilevel degenerative disc disease. L5-S1 disc desiccation with mild bulge. No compression fracture. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: Multiple discs in the spine are showing wear and aging. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. No bones are broken or collapsed. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
472,"CBC: WBC 3.3 (L), Hgb 15.6 (N), Plt 389 (N).","Your blood count results: White blood cells are 3.3 (low, meaning your immune system may be weakened). Hemoglobin is normal at 15.6. Platelets are 389, which is normal.",Hematology,Lab Result,high
473,CXR PA: Osseous structures intact. Bilateral pleural effusions. Hyperinflated lungs consistent with COPD. Increased interstitial markings suggesting pulmonary edema. Moderate right pleural effusion.,"Chest X-ray results: The bones look normal with no fractures. There is fluid collecting around both lungs. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There is a moderate amount of fluid around the right lung.",Pulmonology,Radiology Report,high
474,"CBC: WBC 19.8 (H), Hgb 11.3 (L), Plt 213 (N).","Your blood count results: White blood cells are 19.8 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 11.3, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 213, which is normal.",Hematology,Lab Result,high
475,"CBC: WBC 21.2 (H), Hgb 17.3 (H), Plt 103 (L).","Your blood count results: White blood cells are 21.2 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is elevated at 17.3. Platelets are 103, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
476,"79 y/o F with PMH of cirrhosis, A-fib, PPM in situ, anemia, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on prednisone taper, Eliquis 5mg BID, Xarelto 20mg daily with dinner. F/U PCP in 2 weeks.","A 79-year-old woman with a history of liver scarring [cirrhosis], irregular heartbeat [atrial fibrillation], implanted pacemaker, and low blood count [anemia] was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) Eliquis 5mg twice daily [blood thinner]; (3) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the primary care doctor in 2 weeks.",Endocrinology,Discharge Summary,high
477,"53 y/o F with PMH of PAD, ICD in situ, DM2, h/o CVA, COPD, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Compression stockings when ambulating. D/C on ASA 81mg daily, azithromycin 500mg day 1 then 250mg x 4 days. F/U nephrology in 1 week.","A 53-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], implanted heart defibrillator, type 2 diabetes, history of stroke, and chronic lung disease was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
478,"CBC: WBC 23.2 (H), Hgb 7.1 (L), Plt 122 (L).","Your blood count results: White blood cells are 23.2 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 7.1, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 122, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
479,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
480,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
481,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab losartan 50mg daily. Tab methotrexate 15mg weekly. Avoid grapefruit juice Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks.",Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) losartan 50mg once daily [blood pressure medicine]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Do not drink grapefruit juice as it interferes with this medication Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
482,Procedure: PCI with DES to LAD. Pt 33 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 33-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
483,"Lipid panel: TC 313, LDL 219, HDL 38, TG 425.","Your cholesterol results: Total cholesterol is 313. LDL (bad cholesterol) is very high at 219 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is too low at 38 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 425 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
484,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
485,"79 y/o F with PMH of h/o CVA, PPM in situ, CKD Stage 3, HFrEF (EF 30%), PAD, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on acetaminophen 650mg Q6H PRN, gabapentin 300mg TID, rosuvastatin 10mg QHS, calcium + vitamin D 600/400 daily, entresto 49/51mg BID. F/U PCP in 2 weeks.","A 79-year-old woman with a history of history of stroke, implanted pacemaker, moderate kidney disease, heart failure with weak pumping (30%), and poor blood flow in the legs [peripheral artery disease] was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the primary care doctor in 2 weeks.",General Surgery,Discharge Summary,high
486,"MRI Lumbar Spine: No compression fracture. Central canal stenosis at L3-L4. Multilevel degenerative disc disease. Conus medullaris at L1, normal.","MRI of the lower back results: No bones are broken or collapsed. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. Multiple discs in the spine are showing wear and aging. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
487,"Rx: Tab rosuvastatin 10mg QHS. Tab amlodipine 10mg daily. Adv: SMBG BID, diabetic diet Do not stop abruptly, taper as directed. F/U 1 week with CBC, CMP.",Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,medium
488,"MRI Lumbar Spine: Conus medullaris at L1, normal. L4-L5 disc herniation with moderate bilateral foraminal stenosis. C5-C6 disc herniation with cord compression.","MRI of the lower back results: The spinal cord ends at a normal level. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
489,"Rx: Tab methotrexate 15mg weekly. Lantus 20U QHS. Tab calcium + vitamin D 600/400 daily. Adv: low salt diet, fluid restriction 1.5L/day Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) Lantus insulin 20 units at bedtime [long-acting insulin]. (3) calcium plus vitamin D once daily [bone strengthening]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Endocrinology,Prescription,medium
490,"US Abdomen: CBD 12mm, dilated. Right kidney 10.5cm, no hydronephrosis. GB wall thickening with stones, positive Murphy's sign. No focal hepatic lesion. Moderate right hydronephrosis. Pancreas unremarkable.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. Right kidney is normal size with no blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. No tumors or masses were found in the liver. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The pancreas looks normal.",Gastroenterology,Radiology Report,high
491,"CBC: WBC 22.1 (H), Hgb 10.7 (L), Plt 423 (H).","Your blood count results: White blood cells are 22.1 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 10.7, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 423, which is high — your blood may clot too easily.",Hematology,Lab Result,high
492,CXR PA: Osseous structures intact. Mild cardiomegaly. Elevated left hemidiaphragm. Cardiomegaly with CTR >0.5.,Chest X-ray results: The bones look normal with no fractures. The heart is slightly larger than normal. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The heart appears larger than normal.,Pulmonology,Radiology Report,high
493,"67 y/o M with PMH of seizure disorder on Keppra, SLE, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on escitalopram 10mg daily, timolol 0.5% OU BID. F/U surgery in 2 weeks for drain removal.","A 67-year-old man with a history of seizure disorder [on Keppra], and lupus was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up with the surgeon in 2 weeks to remove the drain.",Psychiatry,Discharge Summary,high
494,"43 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 43-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
495,"Thyroid panel: TSH 1.38 (N), Free T4 1.7.",Your thyroid test results: TSH is normal at 1.38. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
496,Rx: Tab montelukast 10mg QHS. Tab furosemide 40mg BID. prednisone taper. Tab ciprofloxacin 500mg BID x 5 days. Tab entresto 49/51mg BID. Adv: low potassium diet. F/U INR in 3 days.,"Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (5) Entresto 49/51mg twice daily [heart failure medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
497,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,medium
498,"Thyroid panel: TSH 4.64 (H), Free T4 2.9.","Your thyroid test results: TSH is elevated at 4.64 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
499,Procedure: EGD with biopsy. Pt 32 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 32-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
500,"Thyroid panel: TSH 13.37 (H), Free T4 2.8.","Your thyroid test results: TSH is elevated at 13.37 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
501,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,medium
502,"Rx: Humalog per SSI. Tab glipizide 5mg BID AC. Tab sertraline 50mg daily. Tab Augmentin 875/125 BID x 7 days. Adv: fall precautions, home safety evaluation Do not stop abruptly, taper as directed. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) glipizide 5mg twice daily before meals [helps release insulin]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Endocrinology,Prescription,high
503,"86 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 86-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
504,"CBC: WBC 24.4 (H), Hgb 6.0 (L), Plt 457 (H).","Your blood count results: White blood cells are 24.4 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 6.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 457, which is high — your blood may clot too easily.",Hematology,Lab Result,high
505,"63 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 63-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
506,Procedure: Laparoscopic cholecystectomy. Pt 79 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 79-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
507,CT Head without contrast: No mass effect. 4cm right subdural hematoma with 5mm midline shift. No midline shift.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. The brain is centered normally.",Neurology,Radiology Report,high
508,"34 y/o F with PMH of Parkinson's disease, asthma, ICD in situ, CHF, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on atorvastatin 40mg QHS, Dulcolax 10mg QHS PRN. F/U wound care in 3 days.","A 34-year-old woman with a history of Parkinson's disease, asthma, implanted heart defibrillator, and heart failure was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up at the wound care clinic in 3 days.",General Surgery,Discharge Summary,high
509,"MRI Lumbar Spine: C5-C6 disc herniation with cord compression. L5-S1 disc desiccation with mild bulge. Conus medullaris at L1, normal.","MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
510,"Rx: Tab metoprolol 25mg BID. Tab furosemide 40mg BID. Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks.",Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) furosemide (Lasix) 40mg twice daily [water pill]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
511,"Rx: Tab entresto 49/51mg BID. Tab atorvastatin 40mg QHS. Tab metformin 1000mg BID. prednisone taper. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with CBC, CMP.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
512,Procedure: Laparoscopic appendectomy. Pt 40 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 40-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
513,Procedure: Laparoscopic cholecystectomy. Pt 39 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 39-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
514,"CBC: WBC 22.7 (H), Hgb 11.7 (L), Plt 118 (L).","Your blood count results: White blood cells are 22.7 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 11.7, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 118, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
515,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. Multilevel degenerative disc disease. L5-S1 disc desiccation with mild bulge.,"MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. Multiple discs in the spine are showing wear and aging. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
516,"70 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 70-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
517,"US Abdomen: CBD 5mm, not dilated. Ascites moderate amount. Left kidney 8cm, cortical thinning consistent with CKD. Moderate right hydronephrosis. Spleen 11cm, normal. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The bile duct is normal size [not blocked]. There is a moderate amount of fluid in the belly [ascites]. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The spleen is a normal size. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
518,Rx: Tab latanoprost 0.005% OU QHS. Tab rosuvastatin 10mg QHS. Avoid grapefruit juice. F/U 2 weeks with INR.,Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,medium
519,"48 y/o M with PMH of GERD, SLE, OSA on CPAP, CKD Stage 4, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on furosemide 40mg daily, empagliflozin 10mg daily, ciprofloxacin 500mg BID x 5 days, gabapentin 300mg TID. F/U nephrology in 1 week.","A 48-year-old man with a history of acid reflux, lupus, sleep apnea [uses a breathing machine at night], and advanced kidney disease was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (4) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the kidney doctor in 1 week.",Cardiology,Discharge Summary,high
520,"LFTs: AST 263 (H), ALT 288 (H), ALP 81, T.Bili 4.6 (H), Albumin 2.1.","Your liver blood test results: Liver enzymes (AST 263, ALT 288) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 4.6 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.1 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
521,CXR PA: Osseous structures intact. Port-a-cath in appropriate position. Hyperinflated lungs consistent with COPD. Pacemaker leads in appropriate position.,"Chest X-ray results: The bones look normal with no fractures. The implanted medication port is in the correct position. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The pacemaker wires are in the correct position.",Pulmonology,Radiology Report,high
522,Procedure: EGD with biopsy. Pt 75 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 75-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
523,"Rx: Tab carvedilol 12.5mg BID. Tab metoprolol succinate 50mg daily. Tab timolol 0.5% OU BID. prednisone taper. Tab Xarelto 20mg daily with dinner. Adv: SMBG BID, diabetic diet. F/U 2 weeks with INR.",Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (5) Xarelto 20mg once daily with dinner [blood thinner]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
524,"86 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 86-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
525,"Thyroid panel: TSH 8.22 (H), Free T4 1.6.","Your thyroid test results: TSH is elevated at 8.22 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
526,"44 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 44-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
527,"50 y/o M with PMH of BPH, obesity (BMI 38), PAD, ICD in situ, HFrEF (EF 30%), admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on metoprolol succinate 50mg daily, levothyroxine 75mcg daily on empty stomach, amlodipine 10mg daily, spironolactone 25mg daily. F/U orthopedics in 6 weeks with X-ray.","A 50-year-old man with a history of enlarged prostate, obesity, poor blood flow in the legs [peripheral artery disease], implanted heart defibrillator, and heart failure with weak pumping (30%) was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Pulmonology,Discharge Summary,high
528,"53 y/o M with PMH of A-fib, RA on MTX, anemia, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on losartan 50mg daily, Humalog per SSI, ASA 81mg daily, pregabalin 75mg BID, acetaminophen 650mg Q6H PRN. F/U PCP in 2 weeks.","A 53-year-old man with a history of irregular heartbeat [atrial fibrillation], rheumatoid arthritis [on immune-suppressing medicine], and low blood count [anemia] was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) baby aspirin 81mg once daily [prevents blood clots]; (4) pregabalin 75mg twice daily [nerve pain medicine]; (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the primary care doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
529,"87 y/o F with PMH of seizure disorder on Keppra, PAD, PPM in situ, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on Humalog per SSI, ASA 81mg daily. F/U hematology in 2 weeks.","A 87-year-old woman with a history of seizure disorder [on Keppra], poor blood flow in the legs [peripheral artery disease], and implanted pacemaker was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) Humalog insulin before meals as directed [fast-acting insulin]; (2) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
530,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
531,"64 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 64-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
532,"BMP: Na 135 (L), K 3.2 (L), BUN 39, Cr 4.5 (H), Glucose 339.","Your blood chemistry results: Sodium is low at 135 (normal 136-145), meaning too much water in your body. Potassium is low at 3.2 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 4.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 339 (high).",Nephrology,Lab Result,high
533,"27 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 27-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
534,"26 y/o M with PMH of osteoporosis, HFrEF (EF 30%), admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on escitalopram 10mg daily, rosuvastatin 10mg QHS, glipizide 5mg BID AC, warfarin 5mg daily, levothyroxine 75mcg daily on empty stomach. F/U endocrine in 1 week.","A 26-year-old man with a history of weak bones [osteoporosis], and heart failure with weak pumping (30%) was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (5) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
535,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab ondansetron 4mg Q8H PRN N/V. Tab pregabalin 75mg BID. Tab lisinopril 10mg daily. Adv: low potassium diet Adv: low salt diet, fluid restriction 1.5L/day. F/U 6 weeks with LFTs.","Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (3) pregabalin 75mg twice daily [nerve pain medicine]. (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
536,CT Head without contrast: Acute ischemic infarct in R MCA territory. No acute intracranial hemorrhage. No midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is no bleeding in the brain. The brain is centered normally. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
537,"Lipid panel: TC 153, LDL 67, HDL 26, TG 344.","Your cholesterol results: Total cholesterol is 153. LDL (bad cholesterol) is at goal (67). HDL (good cholesterol) is too low at 26 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 344 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
538,"US Abdomen: Pancreas unremarkable. CBD 12mm, dilated. Spleen 11cm, normal.","Abdominal ultrasound results: The pancreas looks normal. The bile duct is wider than normal [dilated], which may indicate a blockage. The spleen is a normal size.",Gastroenterology,Radiology Report,high
539,"67 y/o M with PMH of PAD, HFrEF (EF 30%), admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on omeprazole 20mg AC breakfast, gabapentin 300mg TID, pregabalin 75mg BID, pantoprazole 40mg AC breakfast. F/U oncology in 1 week.","A 67-year-old man with a history of poor blood flow in the legs [peripheral artery disease], and heart failure with weak pumping (30%) was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) pregabalin 75mg twice daily [nerve pain medicine]; (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the cancer doctor in 1 week.",Cardiology,Discharge Summary,high
540,Rx: Tab methotrexate 15mg weekly. Tab warfarin 5mg daily. Tab potassium chloride 20mEq daily. Tab entresto 49/51mg BID. Adv: wound care with daily dressing changes. F/U 2 weeks.,"Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (4) Entresto 49/51mg twice daily [heart failure medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
541,"Rx: Tab amlodipine 10mg daily. Tab calcium + vitamin D 600/400 daily. Lantus 20U QHS. Adv: SMBG BID, diabetic diet Adv: avoid alcohol, hepatotoxic drugs. F/U PCP in 1 week for BP recheck.",Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) calcium plus vitamin D once daily [bone strengthening]. (3) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
542,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
543,HbA1c: 8.0% (H). FBS: 256 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.0%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 256, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
544,"47 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 47-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
545,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,high
546,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
547,"CBC: WBC 21.1 (H), Hgb 7.0 (L), Plt 363 (N).","Your blood count results: White blood cells are 21.1 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 7.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 363, which is normal.",Hematology,Lab Result,high
548,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,low
549,"LFTs: AST 38 (N), ALT 165 (H), ALP 47, T.Bili 0.4 (N), Albumin 2.7.","Your liver blood test results: Liver enzymes (AST 38, ALT 165) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is normal at 0.4. Albumin is low at 2.7 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
550,"23 y/o M with PMH of s/p CABG, Parkinson's disease, s/p TKR, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on rosuvastatin 10mg QHS, ferrous sulfate 325mg BID, timolol 0.5% OU BID, spironolactone 25mg daily. F/U nephrology in 1 week.","A 23-year-old man with a history of prior heart bypass surgery, Parkinson's disease, and prior knee replacement was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (4) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
551,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
552,"32 y/o M with PMH of anxiety, osteoporosis, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on Xarelto 20mg daily with dinner, spironolactone 25mg daily, ASA 81mg daily. F/U orthopedics in 6 weeks with X-ray.","A 32-year-old man with a history of anxiety, and weak bones [osteoporosis] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Neurology,Discharge Summary,high
553,"33 y/o M with PMH of HFrEF (EF 30%), PPM in situ, DM2, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Low potassium diet. D/C on ferrous sulfate 325mg BID, tramadol 50mg Q6H PRN pain, potassium chloride 20mEq daily. F/U orthopedics in 6 weeks with X-ray.","A 33-year-old man with a history of heart failure with weak pumping (30%), implanted pacemaker, and type 2 diabetes was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Hematology,Discharge Summary,high
554,"65 y/o F with PMH of obesity (BMI 38), DM1, HTN, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Compression stockings when ambulating. D/C on ferrous sulfate 325mg BID, atorvastatin 80mg QHS. F/U neurology in 2 weeks.","A 65-year-old woman with a history of obesity, type 1 diabetes, and high blood pressure was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
555,"88 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 88-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
556,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,low
557,"48 y/o F with PMH of HFrEF (EF 30%), seizure disorder on Keppra, ESRD on HD, DVT/PE on warfarin, BPH, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on sertraline 50mg daily, azithromycin 500mg day 1 then 250mg x 4 days, hydroxychloroquine 200mg BID. F/U PCP in 2 weeks.","A 48-year-old woman with a history of heart failure with weak pumping (30%), seizure disorder [on Keppra], kidney failure requiring dialysis, blood clots [on blood thinner warfarin], and enlarged prostate was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the primary care doctor in 2 weeks.",Endocrinology,Discharge Summary,high
558,Delivery Note: G?P? at 38+2 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
559,"43 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 43-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
560,"75 y/o F with PMH of RA on MTX, HFpEF, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on escitalopram 10mg daily, glipizide 5mg BID AC. F/U GI in 1 week.","A 75-year-old woman with a history of rheumatoid arthritis [on immune-suppressing medicine], and heart failure with stiff heart muscle was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the stomach doctor in 1 week.",Infectious Disease,Discharge Summary,high
561,"68 y/o F with PMH of CHF, SLE, HFrEF (EF 30%), osteoporosis, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on ciprofloxacin 500mg BID x 5 days, tramadol 50mg Q6H PRN pain. F/U PCP in 1 week.","A 68-year-old woman with a history of heart failure, lupus, heart failure with weak pumping (30%), and weak bones [osteoporosis] was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the primary care doctor in 1 week.",Gastroenterology,Discharge Summary,high
562,"Rx: Tab metformin 1000mg BID. Tab lisinopril 10mg daily. Tab atorvastatin 80mg QHS. Tab spironolactone 25mg daily. Tab Xarelto 20mg daily with dinner. Adv: elevate affected limb, compression stockings Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with CBC, CMP.","Your medicines: (1) metformin 1000mg twice daily with meals [blood sugar medicine]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (4) spironolactone 25mg once daily [heart-protecting water pill]. (5) Xarelto 20mg once daily with dinner [blood thinner]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
563,Procedure: R TKA. Pt 53 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 53-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
564,CXR PA: Port-a-cath in appropriate position. Right-sided pneumothorax. Widened mediastinum. Sternotomy wires intact.,"Chest X-ray results: The implanted medication port is in the correct position. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The space between the lungs appears wider than normal, which needs further evaluation. The wires from prior heart surgery are intact.",Pulmonology,Radiology Report,high
565,"Rx: Lantus 20U QHS. Tab sertraline 50mg daily. Tab calcium + vitamin D 600/400 daily. Tab ASA 81mg daily. Adv: smoking cessation, pulmonary rehab Adv: fall precautions, home safety evaluation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. (3) calcium plus vitamin D once daily [bone strengthening]. (4) baby aspirin 81mg once daily [prevents blood clots]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
566,Rx: Tab amlodipine 5mg daily. Tab carvedilol 12.5mg BID. Avoid NSAIDs. F/U 1 week with wound check.,Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) carvedilol 12.5mg twice daily [heart medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 week to have the wound checked.,Cardiology,Prescription,medium
567,"51 y/o M with PMH of gout, h/o CVA, HLD, HFrEF (EF 30%), admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on carvedilol 12.5mg BID, atorvastatin 40mg QHS. F/U pulmonology in 2 weeks.","A 51-year-old man with a history of gout, history of stroke, high cholesterol, and heart failure with weak pumping (30%) was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the lung doctor in 2 weeks.",Endocrinology,Discharge Summary,high
568,"Rx: Lantus 20U QHS. Tab metoprolol 25mg BID. Tab losartan 50mg daily. Tab metformin 500mg BID. Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks.",Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) losartan 50mg once daily [blood pressure medicine]. (4) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back for a check-up in 2 weeks.,Cardiology,Prescription,high
569,"BMP: Na 143 (N), K 3.8 (N), BUN 89, Cr 7.3 (H), Glucose 117.","Your blood chemistry results: Sodium is normal at 143. Potassium is normal at 3.8. Creatinine is elevated at 7.3 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 117 (high).",Nephrology,Lab Result,high
570,Procedure: ERCP with sphincterotomy. Pt 67 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 67-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
571,"Rx: Tab gabapentin 300mg TID. Tab Dulcolax 10mg QHS PRN. Tab rosuvastatin 10mg QHS. Tab Augmentin 875/125 BID x 7 days. Adv: elevate affected limb, compression stockings. F/U 1 month with repeat imaging.",Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,high
572,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. No compression fracture. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. No bones are broken or collapsed. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
573,HbA1c: 10.4% (H). FBS: 181 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.4%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 181, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
574,"35 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 35-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
575,"US Abdomen: Moderate right hydronephrosis. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Left kidney 8cm, cortical thinning consistent with CKD. Right kidney 10.5cm, no hydronephrosis. No focal hepatic lesion.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. Left kidney is small with thin outer layer, consistent with chronic kidney disease. Right kidney is normal size with no blockage. No tumors or masses were found in the liver.",Gastroenterology,Radiology Report,high
576,"LFTs: AST 379 (H), ALT 485 (H), ALP 36, T.Bili 6.2 (H), Albumin 3.8.","Your liver blood test results: Liver enzymes (AST 379, ALT 485) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.2 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.8.",Gastroenterology,Lab Result,high
577,"57 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 57-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
578,"Rx: Tab gabapentin 300mg TID. Tab acetaminophen 650mg Q6H PRN. albuterol MDI 2 puffs Q4-6H PRN. Adv: DASH diet, daily BP monitoring Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back for a check-up in 2 weeks.",Pulmonology,Prescription,medium
579,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
580,CT Head without contrast: Paranasal sinuses clear. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age. No acute intracranial hemorrhage.,"CT scan of the head results: The sinuses are clear with no infection. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age. There is no bleeding in the brain.",Neurology,Radiology Report,high
581,"Rx: Tab furosemide 40mg BID. Spiriva 18mcg daily. Tab Xarelto 20mg daily with dinner. Tab escitalopram 10mg daily. Adv: SMBG BID, diabetic diet Avoid grapefruit juice. F/U 2 weeks with INR.",Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) Xarelto 20mg once daily with dinner [blood thinner]. (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
582,"87 y/o M with PMH of ESRD on HD, ICD in situ, HLD, CKD Stage 4, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on potassium chloride 20mEq daily, atorvastatin 80mg QHS, Eliquis 5mg BID, metformin 500mg BID, lisinopril 20mg daily. F/U pulmonology in 2 weeks.","A 87-year-old man with a history of kidney failure requiring dialysis, implanted heart defibrillator, high cholesterol, and advanced kidney disease was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) Eliquis 5mg twice daily [blood thinner]; (4) metformin 500mg twice daily with meals [blood sugar medicine]; (5) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the lung doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
583,MRI Lumbar Spine: No compression fracture. L5-S1 disc desiccation with mild bulge. C5-C6 disc herniation with cord compression. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: No bones are broken or collapsed. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
584,MRI Lumbar Spine: Multilevel degenerative disc disease. L5-S1 disc desiccation with mild bulge.,"MRI of the lower back results: Multiple discs in the spine are showing wear and aging. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
585,"48 y/o F with PMH of DVT/PE on warfarin, cirrhosis, ESRD on HD, DM1, s/p TKR, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Low potassium diet. D/C on furosemide 40mg daily, levothyroxine 75mcg daily on empty stomach. F/U endocrine in 1 week.","A 48-year-old woman with a history of blood clots [on blood thinner warfarin], liver scarring [cirrhosis], kidney failure requiring dialysis, type 1 diabetes, and prior knee replacement was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Pulmonology,Discharge Summary,high
586,Procedure: Colonoscopy with polypectomy. Pt 44 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 44-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
587,"25 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 25-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
588,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
589,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
590,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,low
591,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab furosemide 40mg BID. Adv: avoid alcohol, hepatotoxic drugs. F/U 1 week with wound check.",Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) furosemide (Lasix) 40mg twice daily [water pill]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 week to have the wound checked.,Cardiology,Prescription,medium
592,"22 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 22-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
593,"39 y/o M with PMH of s/p THR, HFrEF (EF 30%), admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on montelukast 10mg QHS, acetaminophen 650mg Q6H PRN. F/U pulmonology in 2 weeks.","A 39-year-old man with a history of prior hip replacement, and heart failure with weak pumping (30%) was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the lung doctor in 2 weeks.",Orthopedics,Discharge Summary,high
594,"63 y/o M with PMH of PAD, A-fib, CKD Stage 4, gout, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on amlodipine 5mg daily, lisinopril 20mg daily, omeprazole 20mg AC breakfast, atorvastatin 80mg QHS, levothyroxine 75mcg daily on empty stomach. F/U nephrology in 5 days.","A 63-year-old man with a history of poor blood flow in the legs [peripheral artery disease], irregular heartbeat [atrial fibrillation], advanced kidney disease, and gout was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]; (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (5) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the kidney doctor in 5 days.",Cardiology,Discharge Summary,high
595,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
596,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
597,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
598,CXR PA: Elevated left hemidiaphragm. Small left pleural effusion. Sternotomy wires intact. Widened mediastinum. Osseous structures intact.,"Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. There is a small amount of fluid around the left lung. The wires from prior heart surgery are intact. The space between the lungs appears wider than normal, which needs further evaluation. The bones look normal with no fractures.",Pulmonology,Radiology Report,high
599,"BMP: Na 129 (L), K 5.6 (H), BUN 10, Cr 2.6 (H), Glucose 373.","Your blood chemistry results: Sodium is low at 129 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 5.6 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 2.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 373 (high).",Nephrology,Lab Result,high
600,"38 y/o F with PMH of HFrEF (EF 30%), CKD Stage 4, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on rosuvastatin 10mg QHS, ASA 81mg daily, prednisone taper. F/U pulmonology in 2 weeks.","A 38-year-old woman with a history of heart failure with weak pumping (30%), and advanced kidney disease was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the lung doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
601,"Lipid panel: TC 153, LDL 61, HDL 47, TG 203.",Your cholesterol results: Total cholesterol is 153. LDL (bad cholesterol) is at goal (61). HDL (good cholesterol) is good at 47. Triglycerides are high at 203.,Cardiology,Lab Result,high
602,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
603,"31 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 31-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
604,"US Abdomen: No focal hepatic lesion. Simple renal cysts bilaterally. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. CBD 5mm, not dilated.","Abdominal ultrasound results: No tumors or masses were found in the liver. Both kidneys have harmless fluid-filled cysts. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The bile duct is normal size [not blocked].",Gastroenterology,Radiology Report,high
605,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
606,"Rx: Tab losartan 50mg daily. Tab gabapentin 300mg TID. Tab metformin 1000mg BID. Tab furosemide 40mg daily. Adv: avoid alcohol, hepatotoxic drugs Avoid grapefruit juice. F/U 2 weeks.",Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Do not drink grapefruit juice as it interferes with this medication. Come back for a check-up in 2 weeks.,Cardiology,Prescription,high
607,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
608,"LFTs: AST 397 (H), ALT 13 (N), ALP 118, T.Bili 1.6 (H), Albumin 3.4.","Your liver blood test results: Liver enzymes (AST 397, ALT 13) are normal (normal is under 40). Bilirubin is mildly elevated at 1.6. Albumin is low at 3.4 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
609,"MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. No compression fracture. Conus medullaris at L1, normal.","MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. No bones are broken or collapsed. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
610,"22 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 22-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
611,CXR PA: No pneumothorax. ET tube 3cm above carina. Hyperinflated lungs consistent with COPD.,"Chest X-ray results: There is no collapsed lung. The breathing tube is in good position. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema].",Pulmonology,Radiology Report,high
612,"MRI Lumbar Spine: No compression fracture. Conus medullaris at L1, normal.",MRI of the lower back results: No bones are broken or collapsed. The spinal cord ends at a normal level.,Orthopedics,Radiology Report,high
613,Rx: Tab ASA 81mg daily. Tab timolol 0.5% OU BID. Adv: wound care with daily dressing changes. F/U 2 weeks with INR.,"Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
614,"CBC: WBC 5.9 (N), Hgb 7.9 (L), Plt 323 (N).","Your blood count results: White blood cells are 5.9 (normal). Hemoglobin is low at 7.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 323, which is normal.",Hematology,Lab Result,high
615,CT Head without contrast: No mass effect. Paranasal sinuses clear. No midline shift.,CT scan of the head results: There are no tumors or masses pushing on the brain. The sinuses are clear with no infection. The brain is centered normally.,Neurology,Radiology Report,high
616,CT Head without contrast: No acute intracranial hemorrhage. Chronic lacunar infarcts in bilateral basal ganglia. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is no bleeding in the brain. There are signs of small old strokes in the deep parts of the brain. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
617,"Rx: Tab warfarin 5mg daily. prednisone taper. Tab clopidogrel 75mg daily. Tab lisinopril 10mg daily. Adv: low potassium diet Adv: avoid alcohol, hepatotoxic drugs. F/U INR in 3 days.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
618,"53 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 53-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
619,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
620,"Rx: Tab timolol 0.5% OU BID. Tab empagliflozin 10mg daily. Tab hydroxychloroquine 200mg BID. Tab carvedilol 12.5mg BID. Tab acetaminophen 650mg Q6H PRN. Adv: high fiber diet, adequate hydration Do not stop abruptly, taper as directed. F/U 2 weeks.","Your medicines: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (4) carvedilol 12.5mg twice daily [heart medicine]. (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
621,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,low
622,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,medium
623,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,medium
624,"Rx: Tab lisinopril 10mg daily. Humalog per SSI. Tab latanoprost 0.005% OU QHS. Adv: high fiber diet, adequate hydration Adv: fall precautions, home safety evaluation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
625,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
626,"Rx: Tab latanoprost 0.005% OU QHS. Tab ibuprofen 400mg Q6H PRN with food. Adv: wound care with daily dressing changes Adv: DASH diet, daily BP monitoring. F/U 1 month with repeat imaging.","Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 month — a repeat scan will be ordered.",Ophthalmology,Prescription,medium
627,CT Head without contrast: No midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Paranasal sinuses clear.,CT scan of the head results: The brain is centered normally. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The sinuses are clear with no infection.,Neurology,Radiology Report,high
628,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
629,"60 y/o F with PMH of CKD Stage 4, CKD Stage 3, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on pantoprazole 40mg AC breakfast, prednisone taper, pregabalin 75mg BID, rosuvastatin 10mg QHS. F/U neurology in 2 weeks.","A 60-year-old woman with a history of advanced kidney disease, and moderate kidney disease was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) pregabalin 75mg twice daily [nerve pain medicine]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
630,"CBC: WBC 5.6 (N), Hgb 17.6 (H), Plt 477 (H).","Your blood count results: White blood cells are 5.6 (normal). Hemoglobin is elevated at 17.6. Platelets are 477, which is high — your blood may clot too easily.",Hematology,Lab Result,high
631,"38 y/o M with PMH of PPM in situ, cirrhosis, HFrEF (EF 30%), anemia, SLE, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on furosemide 40mg BID, clopidogrel 75mg daily, warfarin 5mg daily. F/U endocrine in 1 week.","A 38-year-old man with a history of implanted pacemaker, liver scarring [cirrhosis], heart failure with weak pumping (30%), low blood count [anemia], and lupus was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
632,"91 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 91-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
633,"89 y/o M with PMH of PPM in situ, RA on MTX, gout, cirrhosis, asthma, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on atorvastatin 80mg QHS, ciprofloxacin 500mg BID x 5 days, prednisone taper, sertraline 50mg daily. F/U INR check in 3 days.","A 89-year-old man with a history of implanted pacemaker, rheumatoid arthritis [on immune-suppressing medicine], gout, liver scarring [cirrhosis], and asthma was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (4) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up for a blood thinner level check in 3 days.",Pulmonology,Discharge Summary,high
634,"54 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 54-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
635,"BMP: Na 145 (N), K 3.2 (L), BUN 33, Cr 5.9 (H), Glucose 138.","Your blood chemistry results: Sodium is normal at 145. Potassium is low at 3.2 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 5.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 138 (high).",Nephrology,Lab Result,high
636,"Rx: Tab spironolactone 25mg daily. Tab acetaminophen 650mg Q6H PRN. Tab sertraline 50mg daily. Avoid NSAIDs Adv: elevate affected limb, compression stockings. F/U 6 weeks with LFTs.",Your medicines: (1) spironolactone 25mg once daily [heart-protecting water pill]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,medium
637,"Lipid panel: TC 198, LDL 102, HDL 46, TG 77.",Your cholesterol results: Total cholesterol is 198. LDL (bad cholesterol) is high at 102 (goal under 100). HDL (good cholesterol) is good at 46. Triglycerides are normal at 77.,Cardiology,Lab Result,high
638,"75 y/o F with PMH of HTN, HFpEF, A-fib, DM2, anemia, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on acetaminophen 650mg Q6H PRN, lisinopril 20mg daily. F/U nephrology in 5 days.","A 75-year-old woman with a history of high blood pressure, heart failure with stiff heart muscle, irregular heartbeat [atrial fibrillation], type 2 diabetes, and low blood count [anemia] was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the kidney doctor in 5 days.",Pulmonology,Discharge Summary,high
639,"LFTs: AST 83 (H), ALT 508 (H), ALP 244, T.Bili 1.8 (H), Albumin 2.0.","Your liver blood test results: Liver enzymes (AST 83, ALT 508) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.8. Albumin is low at 2.0 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
640,"82 y/o F with PMH of CKD Stage 3, COPD, s/p THR, h/o TIA, DM1, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on clopidogrel 75mg daily, pantoprazole 40mg AC breakfast, ciprofloxacin 500mg BID x 5 days, ibuprofen 400mg Q6H PRN with food. F/U surgery in 2 weeks for drain removal.","A 82-year-old woman with a history of moderate kidney disease, chronic lung disease, prior hip replacement, history of mini-stroke, and type 1 diabetes was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the surgeon in 2 weeks to remove the drain.",Gastroenterology,Discharge Summary,high
641,"50 y/o M with PMH of HFpEF, gout, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on escitalopram 10mg daily, Eliquis 5mg BID. F/U hematology in 2 weeks.","A 50-year-old man with a history of heart failure with stiff heart muscle, and gout was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) Eliquis 5mg twice daily [blood thinner]. Follow-up with the blood disorder doctor in 2 weeks.",Neurology,Discharge Summary,high
642,"39 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 39-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
643,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Paranasal sinuses clear. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. The sinuses are clear with no infection. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
644,"Rx: Tab empagliflozin 10mg daily. Tab carvedilol 12.5mg BID. albuterol MDI 2 puffs Q4-6H PRN. Tab latanoprost 0.005% OU QHS. Adv: avoid alcohol, hepatotoxic drugs Adv: low salt diet, fluid restriction 1.5L/day. F/U 1 week with CBC, CMP.",Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) carvedilol 12.5mg twice daily [heart medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,high
645,CXR PA: Moderate right pleural effusion. Compression fracture T12. No cardiomegaly. Pacemaker leads in appropriate position.,Chest X-ray results: There is a moderate amount of fluid around the right lung. There is a compression fracture [collapsed bone] in the lower spine at T12. The heart is a normal size. The pacemaker wires are in the correct position.,Pulmonology,Radiology Report,high
646,"28 y/o F with PMH of anxiety, anemia, CHF, BPH, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on entresto 49/51mg BID, amlodipine 10mg daily. F/U neurology in 2 weeks.","A 28-year-old woman with a history of anxiety, low blood count [anemia], heart failure, and enlarged prostate was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Nephrology,Discharge Summary,high
647,"29 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 29-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
648,CXR PA: No cardiomegaly. Osseous structures intact. Compression fracture T12. Sternotomy wires intact. ET tube 3cm above carina.,Chest X-ray results: The heart is a normal size. The bones look normal with no fractures. There is a compression fracture [collapsed bone] in the lower spine at T12. The wires from prior heart surgery are intact. The breathing tube is in good position.,Pulmonology,Radiology Report,high
649,"84 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 84-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
650,"52 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 52-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
651,"61 y/o F with PMH of HFpEF, s/p THR, DM2, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on glipizide 5mg BID AC, lisinopril 20mg daily, empagliflozin 10mg daily. F/U PCP in 1 week.","A 61-year-old woman with a history of heart failure with stiff heart muscle, prior hip replacement, and type 2 diabetes was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the primary care doctor in 1 week.",Infectious Disease,Discharge Summary,high
652,"73 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 73-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
653,"37 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 37-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
654,HbA1c: 12.8% (H). FBS: 190 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.8%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 190, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
655,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,high
656,"80 y/o M with PMH of DM2, h/o CVA, HFpEF, osteoporosis, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Low potassium diet. D/C on atorvastatin 40mg QHS, Spiriva 18mcg daily, amlodipine 5mg daily, Eliquis 5mg BID. F/U orthopedics in 6 weeks with X-ray.","A 80-year-old man with a history of type 2 diabetes, history of stroke, heart failure with stiff heart muscle, and weak bones [osteoporosis] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) Eliquis 5mg twice daily [blood thinner]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
657,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,medium
658,CXR PA: Patchy bilateral infiltrates. Hyperinflated lungs consistent with COPD. ET tube 3cm above carina. Left lower lobe consolidation. Mild cardiomegaly.,"Chest X-ray results: There are scattered cloudy patches in both lungs suggesting infection or inflammation. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The breathing tube is in good position. There is an area in the lower left lung that appears infected. The heart is slightly larger than normal.",Pulmonology,Radiology Report,high
659,"Rx: Tab gabapentin 300mg TID. Tab Augmentin 875/125 BID x 7 days. Humalog per SSI. Tab Dulcolax 10mg QHS PRN. Tab atorvastatin 80mg QHS. Adv: weight bearing exercise, calcium/vit D supplementation Avoid NSAIDs. F/U 1 month with repeat imaging.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. (3) Humalog insulin before meals as directed [fast-acting insulin]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. (5) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 month — a repeat scan will be ordered.",Pediatrics,Prescription,high
660,"47 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 47-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
661,"73 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 73-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
662,"60 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 60-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
663,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
664,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age. Chronic lacunar infarcts in bilateral basal ganglia. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age. There are signs of small old strokes in the deep parts of the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
665,"Rx: Tab timolol 0.5% OU BID. Tab Dulcolax 10mg QHS PRN. Tab ciprofloxacin 500mg BID x 5 days. Tab acetaminophen 650mg Q6H PRN. Adv: high fiber diet, adequate hydration Adv: SMBG BID, diabetic diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",General,Prescription,high
666,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,high
667,Procedure: ERCP with sphincterotomy. Pt 34 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 34-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
668,"CBC: WBC 5.6 (N), Hgb 12.8 (N), Plt 430 (H).","Your blood count results: White blood cells are 5.6 (normal). Hemoglobin is normal at 12.8. Platelets are 430, which is high — your blood may clot too easily.",Hematology,Lab Result,high
669,"67 y/o M with PMH of s/p THR, CKD Stage 4, GERD, h/o TIA, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Low potassium diet. D/C on metformin 1000mg BID, sertraline 50mg daily, lisinopril 10mg daily, amlodipine 5mg daily. F/U PCP in 1 week.","A 67-year-old man with a history of prior hip replacement, advanced kidney disease, acid reflux, and history of mini-stroke was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]; (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (4) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the primary care doctor in 1 week.",Hematology,Discharge Summary,high
670,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab ondansetron 4mg Q8H PRN N/V. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab metformin 500mg BID. Tab empagliflozin 10mg daily. Adv: smoking cessation, pulmonary rehab Avoid NSAIDs. F/U 1 week with CBC, CMP.","Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (4) metformin 500mg twice daily with meals [blood sugar medicine]. (5) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,high
671,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
672,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
673,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
674,"Rx: Tab furosemide 40mg daily. Tab amlodipine 10mg daily. Tab warfarin 5mg daily. Adv: smoking cessation, pulmonary rehab. F/U 2 weeks.",Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
675,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab ASA 81mg daily. Tab montelukast 10mg QHS. Adv: SMBG BID, diabetic diet Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
676,CT Head without contrast: Acute ischemic infarct in R MCA territory. Paranasal sinuses clear. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The sinuses are clear with no infection. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
677,Procedure: R TKA. Pt 38 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 38-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
678,"73 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 73-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
679,"Thyroid panel: TSH 2.05 (N), Free T4 1.0.",Your thyroid test results: TSH is normal at 2.05. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
680,"Rx: Tab metformin 500mg BID. Tab Dulcolax 10mg QHS PRN. Tab furosemide 40mg daily. Tab ibuprofen 400mg Q6H PRN with food. Adv: avoid alcohol, hepatotoxic drugs Adv: DASH diet, daily BP monitoring. F/U INR in 3 days.","Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 3 days for a blood thinner level check [INR].",General,Prescription,high
681,"US Abdomen: Right kidney 10.5cm, no hydronephrosis. Pancreas unremarkable. Simple renal cysts bilaterally.",Abdominal ultrasound results: Right kidney is normal size with no blockage. The pancreas looks normal. Both kidneys have harmless fluid-filled cysts.,Gastroenterology,Radiology Report,high
682,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
683,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
684,"81 y/o F with PMH of Parkinson's disease, HTN, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on warfarin 5mg daily, carvedilol 12.5mg BID, Eliquis 5mg BID, amlodipine 10mg daily, metoprolol 25mg BID. F/U oncology in 1 week.","A 81-year-old woman with a history of Parkinson's disease, and high blood pressure was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) Eliquis 5mg twice daily [blood thinner]; (4) amlodipine 10mg once daily [blood pressure medicine]; (5) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the cancer doctor in 1 week.",Cardiology,Discharge Summary,high
685,"41 y/o M with PMH of cirrhosis, PPM in situ, HLD, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Strict I&O, daily weights. D/C on sertraline 50mg daily, hydroxychloroquine 200mg BID, prednisone taper, Spiriva 18mcg daily. F/U oncology in 1 week.","A 41-year-old man with a history of liver scarring [cirrhosis], implanted pacemaker, and high cholesterol was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (4) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the cancer doctor in 1 week.",General Surgery,Discharge Summary,high
686,CXR PA: ET tube 3cm above carina. Increased interstitial markings suggesting pulmonary edema. Pacemaker leads in appropriate position. Left lower lobe consolidation. No pneumothorax.,"Chest X-ray results: The breathing tube is in good position. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. The pacemaker wires are in the correct position. There is an area in the lower left lung that appears infected. There is no collapsed lung.",Pulmonology,Radiology Report,high
687,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
688,Procedure: TURP for BPH. Pt 89 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 89-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
689,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
690,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Spiriva 18mcg daily. Tab hydroxychloroquine 200mg BID. Adv: DASH diet, daily BP monitoring Adv: smoking cessation, pulmonary rehab. F/U 1 week with wound check.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week to have the wound checked.",Pulmonology,Prescription,medium
691,"Rx: Tab timolol 0.5% OU BID. Tab atorvastatin 80mg QHS. Tab entresto 49/51mg BID. Tab empagliflozin 10mg daily. Avoid NSAIDs Adv: high fiber diet, adequate hydration. F/U 2 weeks with INR.","Your medicines: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (3) Entresto 49/51mg twice daily [heart failure medicine]. (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
692,"84 y/o F with PMH of HFrEF (EF 30%), ICD in situ, h/o TIA, depression, HLD, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on omeprazole 20mg AC breakfast, prednisone taper. F/U neurology in 2 weeks.","A 84-year-old woman with a history of heart failure with weak pumping (30%), implanted heart defibrillator, history of mini-stroke, depression, and high cholesterol was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the brain/nerve doctor in 2 weeks.",Pulmonology,Discharge Summary,high
693,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
694,Procedure: Laparoscopic cholecystectomy. Pt 42 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 42-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
695,"BMP: Na 128 (L), K 4.6 (N), BUN 26, Cr 0.6 (N), Glucose 251.","Your blood chemistry results: Sodium is low at 128 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.6. Creatinine is normal at 0.6. Blood sugar is 251 (high).",Nephrology,Lab Result,high
696,"CBC: WBC 10.2 (N), Hgb 12.4 (N), Plt 214 (N).","Your blood count results: White blood cells are 10.2 (normal). Hemoglobin is normal at 12.4. Platelets are 214, which is normal.",Hematology,Lab Result,medium
697,"Rx: Tab atorvastatin 40mg QHS. Tab glipizide 5mg BID AC. Do not stop abruptly, taper as directed Adv: DASH diet, daily BP monitoring. F/U 1 month with repeat imaging.","Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) glipizide 5mg twice daily before meals [helps release insulin]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
698,"BMP: Na 139 (N), K 2.9 (L), BUN 13, Cr 0.9 (N), Glucose 86.",Your blood chemistry results: Sodium is normal at 139. Potassium is low at 2.9 — may cause muscle weakness and heart rhythm issues. Creatinine is normal at 0.9. Blood sugar is 86 (normal).,Nephrology,Lab Result,high
699,"Rx: Tab hydroxychloroquine 200mg BID. Tab furosemide 40mg BID. Tab entresto 49/51mg BID. Adv: low potassium diet Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 month with repeat imaging.","Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) Entresto 49/51mg twice daily [heart failure medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
700,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
701,CXR PA: Moderate right pleural effusion. Small left pleural effusion. Right middle lobe atelectasis. Patchy bilateral infiltrates. Port-a-cath in appropriate position.,"Chest X-ray results: There is a moderate amount of fluid around the right lung. There is a small amount of fluid around the left lung. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The implanted medication port is in the correct position.",Pulmonology,Radiology Report,high
702,"25 y/o F with PMH of ICD in situ, s/p THR, depression, HLD, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on metformin 500mg BID, montelukast 10mg QHS, azithromycin 500mg day 1 then 250mg x 4 days, calcium + vitamin D 600/400 daily, ciprofloxacin 500mg BID x 5 days. F/U hematology in 2 weeks.","A 25-year-old woman with a history of implanted heart defibrillator, prior hip replacement, depression, and high cholesterol was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
703,Delivery Note: G?P? at 38+2 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
704,"Lipid panel: TC 241, LDL 41, HDL 49, TG 181.",Your cholesterol results: Total cholesterol is 241. LDL (bad cholesterol) is at goal (41). HDL (good cholesterol) is good at 49. Triglycerides are high at 181.,Cardiology,Lab Result,high
705,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. No mass effect. No acute intracranial hemorrhage. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No midline shift.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There are no tumors or masses pushing on the brain. There is no bleeding in the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The brain is centered normally.",Neurology,Radiology Report,high
706,"63 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 63-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
707,"Lipid panel: TC 306, LDL 44, HDL 57, TG 189.",Your cholesterol results: Total cholesterol is 306. LDL (bad cholesterol) is at goal (44). HDL (good cholesterol) is good at 57. Triglycerides are high at 189.,Cardiology,Lab Result,high
708,"LFTs: AST 441 (H), ALT 62 (H), ALP 121, T.Bili 1.3 (H), Albumin 3.0.","Your liver blood test results: Liver enzymes (AST 441, ALT 62) are mildly elevated (normal is under 40). Bilirubin is mildly elevated at 1.3. Albumin is low at 3.0 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
709,"Rx: Tab calcium + vitamin D 600/400 daily. Tab furosemide 40mg BID. Tab furosemide 40mg daily. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: fall precautions, home safety evaluation Adv: elevate affected limb, compression stockings. F/U INR in 3 days.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
710,"22 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 22-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
711,"27 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 27-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
712,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. Multilevel degenerative disc disease.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
713,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
714,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab atorvastatin 40mg QHS. Tab potassium chloride 20mEq daily. Tab montelukast 10mg QHS. Adv: SMBG BID, diabetic diet Adv: smoking cessation, pulmonary rehab. F/U INR in 3 days.",Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (4) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
715,"91 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 91-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
716,"34 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 34-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
717,"69 y/o M with PMH of ICD in situ, s/p TKR, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on acetaminophen 650mg Q6H PRN, atorvastatin 40mg QHS, pantoprazole 40mg AC breakfast, Eliquis 5mg BID. F/U orthopedics in 6 weeks with X-ray.","A 69-year-old man with a history of implanted heart defibrillator, and prior knee replacement was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]; (4) Eliquis 5mg twice daily [blood thinner]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Hematology,Discharge Summary,high
718,"80 y/o F with PMH of CHF, CAD, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on hydroxychloroquine 200mg BID, furosemide 40mg daily, Spiriva 18mcg daily. F/U PCP in 2 weeks.","A 80-year-old woman with a history of heart failure, and coronary artery disease [heart artery blockages] was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
719,"40 y/o F with PMH of CKD Stage 3, CAD, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Compression stockings when ambulating. D/C on Xarelto 20mg daily with dinner, ASA 81mg daily, prednisone taper, lisinopril 10mg daily. F/U surgery in 2 weeks for drain removal.","A 40-year-old woman with a history of moderate kidney disease, and coronary artery disease [heart artery blockages] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the surgeon in 2 weeks to remove the drain.",Nephrology,Discharge Summary,high
720,CXR PA: Patchy bilateral infiltrates. Small left pleural effusion. Osseous structures intact.,Chest X-ray results: There are scattered cloudy patches in both lungs suggesting infection or inflammation. There is a small amount of fluid around the left lung. The bones look normal with no fractures.,Pulmonology,Radiology Report,high
721,CT Head without contrast: Paranasal sinuses clear. No acute intracranial hemorrhage. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: The sinuses are clear with no infection. There is no bleeding in the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
722,"69 y/o M with PMH of ESRD on HD, DVT/PE on warfarin, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on carvedilol 12.5mg BID, prednisone taper. F/U hematology in 2 weeks.","A 69-year-old man with a history of kidney failure requiring dialysis, and blood clots [on blood thinner warfarin] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the blood disorder doctor in 2 weeks.",Pulmonology,Discharge Summary,high
723,"23 y/o M with PMH of CHF, GERD, CKD Stage 3, h/o CVA, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Low potassium diet. D/C on latanoprost 0.005% OU QHS, metformin 500mg BID, carvedilol 12.5mg BID, warfarin 5mg daily, levothyroxine 75mcg daily on empty stomach. F/U surgery in 2 weeks for drain removal.","A 23-year-old man with a history of heart failure, acid reflux, moderate kidney disease, and history of stroke was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) metformin 500mg twice daily with meals [blood sugar medicine]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (5) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",General Surgery,Discharge Summary,high
724,HbA1c: 12.2% (H). FBS: 109 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.2%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 109, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
725,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
726,CXR PA: Sternotomy wires intact. Mild cardiomegaly. No cardiomegaly. Patchy bilateral infiltrates.,Chest X-ray results: The wires from prior heart surgery are intact. The heart is slightly larger than normal. The heart is a normal size. There are scattered cloudy patches in both lungs suggesting infection or inflammation.,Pulmonology,Radiology Report,high
727,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
728,CXR PA: Right-sided pneumothorax. ET tube 3cm above carina. Osseous structures intact.,Chest X-ray results: The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The breathing tube is in good position. The bones look normal with no fractures.,Pulmonology,Radiology Report,high
729,CXR PA: Left lower lobe consolidation. No pneumothorax. Right lower lobe consolidation. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: There is an area in the lower left lung that appears infected. There is no collapsed lung. There is an area in the lower right lung that appears infected, suggesting pneumonia. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
730,"Rx: Tab pregabalin 75mg BID. Spiriva 18mcg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab hydroxychloroquine 200mg BID. Adv: low potassium diet Adv: elevate affected limb, compression stockings. F/U INR in 3 days.","Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 3 days for a blood thinner level check [INR].",Pulmonology,Prescription,high
731,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
732,"Rx: Tab gabapentin 300mg TID. Tab ondansetron 4mg Q8H PRN N/V. Adv: fall precautions, home safety evaluation Avoid NSAIDs. F/U 1 month with repeat imaging.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 month — a repeat scan will be ordered.",Neurology,Prescription,medium
733,Procedure: EGD with biopsy. Pt 32 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 32-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
734,"Rx: Tab atorvastatin 40mg QHS. prednisone taper. Tab spironolactone 25mg daily. Avoid grapefruit juice. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) spironolactone 25mg once daily [heart-protecting water pill]. Do not drink grapefruit juice as it interferes with this medication. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
735,"49 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 49-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
736,"75 y/o F with PMH of DM2, RA on MTX, PAD, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on metoprolol 25mg BID, amoxicillin 500mg TID x 10 days, carvedilol 12.5mg BID, lisinopril 10mg daily, tramadol 50mg Q6H PRN pain. F/U wound care in 3 days.","A 75-year-old woman with a history of type 2 diabetes, rheumatoid arthritis [on immune-suppressing medicine], and poor blood flow in the legs [peripheral artery disease] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up at the wound care clinic in 3 days.",Pulmonology,Discharge Summary,high
737,"80 y/o M with PMH of h/o CVA, CKD Stage 3, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on potassium chloride 20mEq daily, clopidogrel 75mg daily, ibuprofen 400mg Q6H PRN with food, Lantus 20U QHS. F/U hematology in 2 weeks.","A 80-year-old man with a history of history of stroke, and moderate kidney disease was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
738,"47 y/o F with PMH of OA, s/p THR, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Strict I&O, daily weights. D/C on metformin 500mg BID, Spiriva 18mcg daily, glipizide 5mg BID AC, acetaminophen 650mg Q6H PRN, Dulcolax 10mg QHS PRN. F/U GI in 1 week.","A 47-year-old woman with a history of arthritis [osteoarthritis], and prior hip replacement was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (5) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the stomach doctor in 1 week.",Pulmonology,Discharge Summary,high
739,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. L5-S1 disc desiccation with mild bulge. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
740,"CBC: WBC 8.1 (N), Hgb 7.7 (L), Plt 75 (L).","Your blood count results: White blood cells are 8.1 (normal). Hemoglobin is low at 7.7, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 75, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
741,Procedure: ERCP with sphincterotomy. Pt 44 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 44-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
742,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
743,Procedure: ORIF L distal radius. Pt 71 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 71-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
744,HbA1c: 10.1% (H). FBS: 307 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.1%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 307, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
745,Procedure: Laparoscopic cholecystectomy. Pt 83 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 83-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
746,"43 y/o F with PMH of SLE, A-fib, asthma, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on glipizide 5mg BID AC, atorvastatin 40mg QHS, clopidogrel 75mg daily. F/U nephrology in 5 days.","A 43-year-old woman with a history of lupus, irregular heartbeat [atrial fibrillation], and asthma was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. Follow-up with the kidney doctor in 5 days.",Cardiology,Discharge Summary,high
747,"63 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 63-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
748,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab entresto 49/51mg BID. Tab metoprolol succinate 50mg daily. Tab hydroxychloroquine 200mg BID. Adv: low potassium diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
749,"Rx: Tab amlodipine 10mg daily. Tab entresto 49/51mg BID. Spiriva 18mcg daily. Tab levothyroxine 75mcg daily on empty stomach. Tab ciprofloxacin 500mg BID x 5 days. Adv: avoid alcohol, hepatotoxic drugs Adv: smoking cessation, pulmonary rehab. F/U INR in 3 days.",Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) Spiriva inhaler once daily [long-acting lung medicine]. (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (5) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
750,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab atorvastatin 40mg QHS. Tab Eliquis 5mg BID. Tab potassium chloride 20mEq daily. Adv: wound care with daily dressing changes Adv: SMBG BID, diabetic diet. F/U 2 weeks.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) Eliquis 5mg twice daily [blood thinner]. (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back for a check-up in 2 weeks.",General,Prescription,high
751,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,medium
752,"Rx: Tab furosemide 40mg daily. Tab azithromycin 500mg day 1 then 250mg x 4 days. Do not stop abruptly, taper as directed Adv: avoid alcohol, hepatotoxic drugs. F/U INR in 3 days.","Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
753,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
754,"84 y/o M with PMH of anxiety, CKD Stage 4, HFrEF (EF 30%), OSA on CPAP, OA, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Compression stockings when ambulating. D/C on furosemide 40mg daily, potassium chloride 20mEq daily. F/U nephrology in 1 week.","A 84-year-old man with a history of anxiety, advanced kidney disease, heart failure with weak pumping (30%), sleep apnea [uses a breathing machine at night], and arthritis [osteoarthritis] was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the kidney doctor in 1 week.",General Surgery,Discharge Summary,high
755,"77 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 77-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
756,Rx: Tab calcium + vitamin D 600/400 daily. Tab tramadol 50mg Q6H PRN pain. Tab entresto 49/51mg BID. Tab lisinopril 10mg daily. Avoid grapefruit juice. F/U 2 weeks with INR.,Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) Entresto 49/51mg twice daily [heart failure medicine]. (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
757,"BMP: Na 131 (L), K 5.1 (H), BUN 25, Cr 1.6 (H), Glucose 206.","Your blood chemistry results: Sodium is low at 131 (normal 136-145), meaning too much water in your body. Potassium is high at 5.1 — needs monitoring. Creatinine is elevated at 1.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 206 (high).",Nephrology,Lab Result,high
758,"Rx: Spiriva 18mcg daily. Tab potassium chloride 20mEq daily. Tab metformin 500mg BID. Tab metoprolol succinate 50mg daily. Tab Dulcolax 10mg QHS PRN. Adv: elevate affected limb, compression stockings. F/U PCP in 1 week for BP recheck.",Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (5) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: keep the affected leg elevated when resting and wear compression stockings. See your primary care doctor in 1 week to recheck blood pressure.,General,Prescription,high
759,"CBC: WBC 5.3 (N), Hgb 14.6 (N), Plt 202 (N).","Your blood count results: White blood cells are 5.3 (normal). Hemoglobin is normal at 14.6. Platelets are 202, which is normal.",Hematology,Lab Result,medium
760,Rx: Tab lisinopril 20mg daily. Tab warfarin 5mg daily. Adv: low potassium diet. F/U 1 week with wound check.,"Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
761,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
762,"Rx: Tab rosuvastatin 10mg QHS. Tab furosemide 40mg daily. Adv: wound care with daily dressing changes. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
763,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
764,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,high
765,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,medium
766,"BMP: Na 125 (L), K 6.8 (H), BUN 13, Cr 7.5 (H), Glucose 301.","Your blood chemistry results: Sodium is low at 125 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.8 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 7.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 301 (high).",Nephrology,Lab Result,high
767,HbA1c: 8.7% (H). FBS: 312 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.7%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 312, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
768,CXR PA: Right-sided pneumothorax. Hyperinflated lungs consistent with COPD. Cardiomegaly with CTR >0.5. Compression fracture T12. Right lower lobe consolidation.,"Chest X-ray results: The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The heart appears larger than normal. There is a compression fracture [collapsed bone] in the lower spine at T12. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
769,"64 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 64-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
770,"33 y/o M with PMH of cirrhosis, seizure disorder on Keppra, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Strict I&O, daily weights. D/C on timolol 0.5% OU BID, Dulcolax 10mg QHS PRN, empagliflozin 10mg daily, omeprazole 20mg AC breakfast, Lantus 20U QHS. F/U surgery in 2 weeks for drain removal.","A 33-year-old man with a history of liver scarring [cirrhosis], and seizure disorder [on Keppra] was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]; (5) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
771,CXR PA: Hyperinflated lungs consistent with COPD. Left lower lobe consolidation. Right lower lobe consolidation.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There is an area in the lower left lung that appears infected. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
772,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Humalog per SSI. Tab timolol 0.5% OU BID. Adv: high fiber diet, adequate hydration. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Pulmonology,Prescription,medium
773,Procedure: EGD with biopsy. Pt 56 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 56-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
774,"Thyroid panel: TSH 12.72 (H), Free T4 0.4.","Your thyroid test results: TSH is elevated at 12.72 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is low — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
775,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab lisinopril 10mg daily. Adv: DASH diet, daily BP monitoring Adv: wound care with daily dressing changes. F/U 2 weeks.","Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
776,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,high
777,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
778,"US Abdomen: Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Spleen 11cm, normal. Left kidney 8cm, cortical thinning consistent with CKD.","Abdominal ultrasound results: The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The spleen is a normal size. Left kidney is small with thin outer layer, consistent with chronic kidney disease.",Gastroenterology,Radiology Report,high
779,"63 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 63-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
780,"90 y/o M with PMH of h/o TIA, RA on MTX, CKD Stage 3, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on gabapentin 300mg TID, ciprofloxacin 500mg BID x 5 days, lisinopril 20mg daily, Eliquis 5mg BID. F/U cardiology in 2 weeks.","A 90-year-old man with a history of history of mini-stroke, rheumatoid arthritis [on immune-suppressing medicine], and moderate kidney disease was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) lisinopril 20mg once daily [blood pressure medicine]; (4) Eliquis 5mg twice daily [blood thinner]. Follow-up with the heart doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
781,"44 y/o M with PMH of DM1, gout, OA, s/p TKR, asthma, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on amoxicillin 500mg TID x 10 days, furosemide 40mg daily, metoprolol 25mg BID. F/U neurology in 2 weeks.","A 44-year-old man with a history of type 1 diabetes, gout, arthritis [osteoarthritis], prior knee replacement, and asthma was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the brain/nerve doctor in 2 weeks.",Pulmonology,Discharge Summary,high
782,"Rx: Lantus 20U QHS. Tab metformin 500mg BID. Tab glipizide 5mg BID AC. Tab ciprofloxacin 500mg BID x 5 days. Tab azithromycin 500mg day 1 then 250mg x 4 days. Avoid NSAIDs Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with CBC, CMP.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) glipizide 5mg twice daily before meals [helps release insulin]. (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (5) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,high
783,Procedure: Colonoscopy with polypectomy. Pt 62 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 62-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
784,"55 y/o F with PMH of hypothyroidism, OSA on CPAP, CHF, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on ibuprofen 400mg Q6H PRN with food, amlodipine 10mg daily, omeprazole 20mg AC breakfast, albuterol MDI 2 puffs Q4-6H PRN. F/U cardiology in 2 weeks.","A 55-year-old woman with a history of underactive thyroid, sleep apnea [uses a breathing machine at night], and heart failure was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]; (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the heart doctor in 2 weeks.",General Surgery,Discharge Summary,high
785,"53 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 53-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
786,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
787,"Rx: Tab calcium + vitamin D 600/400 daily. Tab metformin 1000mg BID. Tab rosuvastatin 10mg QHS. albuterol MDI 2 puffs Q4-6H PRN. Adv: high fiber diet, adequate hydration. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) metformin 1000mg twice daily with meals [blood sugar medicine]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Pediatrics,Prescription,high
788,"33 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 33-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
789,Procedure: TURP for BPH. Pt 76 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 76-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
790,"MRI Lumbar Spine: Central canal stenosis at L3-L4. Conus medullaris at L1, normal. L5-S1 disc desiccation with mild bulge.","MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. The spinal cord ends at a normal level. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
791,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
792,"US Abdomen: CBD 12mm, dilated. Ascites moderate amount. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. CBD 5mm, not dilated. Right kidney 10.5cm, no hydronephrosis. Left kidney 8cm, cortical thinning consistent with CKD.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. There is a moderate amount of fluid in the belly [ascites]. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The bile duct is normal size [not blocked]. Right kidney is normal size with no blockage. Left kidney is small with thin outer layer, consistent with chronic kidney disease.",Gastroenterology,Radiology Report,high
793,"76 y/o F with PMH of A-fib, s/p TKR, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on warfarin 5mg daily, empagliflozin 10mg daily. F/U INR check in 3 days.","A 76-year-old woman with a history of irregular heartbeat [atrial fibrillation], and prior knee replacement was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
794,"BMP: Na 125 (L), K 3.2 (L), BUN 51, Cr 6.9 (H), Glucose 136.","Your blood chemistry results: Sodium is low at 125 (normal 136-145), meaning too much water in your body. Potassium is low at 3.2 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 6.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 136 (high).",Nephrology,Lab Result,high
795,CXR PA: Osseous structures intact. Elevated left hemidiaphragm. Clear lung fields bilaterally. ET tube 3cm above carina.,Chest X-ray results: The bones look normal with no fractures. The left side of the breathing muscle [diaphragm] is sitting higher than normal. Both lungs look clear with no problems. The breathing tube is in good position.,Pulmonology,Radiology Report,high
796,"85 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 85-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
797,"40 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 40-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
798,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
799,"48 y/o M with PMH of CHF, ESRD on HD, anxiety, OSA on CPAP, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on metformin 500mg BID, metoprolol 25mg BID. F/U orthopedics in 6 weeks with X-ray.","A 48-year-old man with a history of heart failure, kidney failure requiring dialysis, anxiety, and sleep apnea [uses a breathing machine at night] was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Hematology,Discharge Summary,high
800,"Rx: Tab methotrexate 15mg weekly. Tab amlodipine 5mg daily. Tab losartan 50mg daily. Adv: wound care with daily dressing changes. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) losartan 50mg once daily [blood pressure medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
801,"LFTs: AST 242 (H), ALT 282 (H), ALP 130, T.Bili 0.4 (N), Albumin 4.9.","Your liver blood test results: Liver enzymes (AST 242, ALT 282) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is normal at 0.4. Albumin is normal at 4.9.",Gastroenterology,Lab Result,high
802,CXR PA: Left lower lobe consolidation. No cardiomegaly. Bilateral pleural effusions. No pneumothorax.,Chest X-ray results: There is an area in the lower left lung that appears infected. The heart is a normal size. There is fluid collecting around both lungs. There is no collapsed lung.,Pulmonology,Radiology Report,high
803,Delivery Note: G?P? at 39+1 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
804,"49 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 49-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
805,"56 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 56-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
806,CXR PA: Clear lung fields bilaterally. Pacemaker leads in appropriate position. Widened mediastinum.,"Chest X-ray results: Both lungs look clear with no problems. The pacemaker wires are in the correct position. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
807,"Lipid panel: TC 198, LDL 154, HDL 71, TG 481.",Your cholesterol results: Total cholesterol is 198. LDL (bad cholesterol) is high at 154 (goal under 100). HDL (good cholesterol) is good at 71. Triglycerides are very high at 481 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
808,"73 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 73-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
809,"55 y/o M with PMH of CAD, GERD, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on timolol 0.5% OU BID, atorvastatin 80mg QHS, amlodipine 5mg daily, warfarin 5mg daily, atorvastatin 40mg QHS. F/U PCP in 1 week.","A 55-year-old man with a history of coronary artery disease [heart artery blockages], and acid reflux was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (5) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the primary care doctor in 1 week.",Psychiatry,Discharge Summary,high
810,"Lipid panel: TC 297, LDL 131, HDL 57, TG 326.",Your cholesterol results: Total cholesterol is 297. LDL (bad cholesterol) is high at 131 (goal under 100). HDL (good cholesterol) is good at 57. Triglycerides are very high at 326 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
811,CXR PA: Osseous structures intact. Elevated left hemidiaphragm. Bilateral hilar lymphadenopathy. Patchy bilateral infiltrates. Cardiomegaly with CTR >0.5.,"Chest X-ray results: The bones look normal with no fractures. The left side of the breathing muscle [diaphragm] is sitting higher than normal. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The heart appears larger than normal.",Pulmonology,Radiology Report,high
812,CT Head without contrast: No midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. 4cm right subdural hematoma with 5mm midline shift. Mild generalized cerebral atrophy appropriate for age. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: The brain is centered normally. There is bleeding around the brain surface, particularly in the grooves on both sides. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is mild brain shrinkage, which is normal for your age. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
813,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
814,Rx: Tab amlodipine 5mg daily. Tab acetaminophen 650mg Q6H PRN. Avoid NSAIDs Adv: low potassium diet. F/U PCP in 1 week for BP recheck.,"Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
815,"US Abdomen: Moderate right hydronephrosis. GB wall thickening with stones, positive Murphy's sign. Ascites moderate amount. Spleen 16cm, splenomegaly.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. There is a moderate amount of fluid in the belly [ascites]. The spleen is enlarged [splenomegaly].",Gastroenterology,Radiology Report,high
816,"Rx: Tab potassium chloride 20mEq daily. Tab omeprazole 20mg AC breakfast. Tab Eliquis 5mg BID. Adv: high fiber diet, adequate hydration Adv: low potassium diet. F/U 1 month with repeat imaging.","Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) Eliquis 5mg twice daily [blood thinner]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 month — a repeat scan will be ordered.",Gastroenterology,Prescription,medium
817,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. Multilevel degenerative disc disease. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. Multiple discs in the spine are showing wear and aging. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
818,"81 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 81-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
819,"Thyroid panel: TSH 0.81 (N), Free T4 0.6.",Your thyroid test results: TSH is normal at 0.81. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
820,"60 y/o F with PMH of asthma, hypothyroidism, HTN, s/p THR, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on carvedilol 12.5mg BID, tramadol 50mg Q6H PRN pain, escitalopram 10mg daily. F/U PCP in 1 week.","A 60-year-old woman with a history of asthma, underactive thyroid, high blood pressure, and prior hip replacement was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Follow-up with the primary care doctor in 1 week.",Endocrinology,Discharge Summary,high
821,CXR PA: Patchy bilateral infiltrates. Right middle lobe atelectasis. Clear lung fields bilaterally. Bilateral pleural effusions. Elevated left hemidiaphragm.,"Chest X-ray results: There are scattered cloudy patches in both lungs suggesting infection or inflammation. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. Both lungs look clear with no problems. There is fluid collecting around both lungs. The left side of the breathing muscle [diaphragm] is sitting higher than normal.",Pulmonology,Radiology Report,high
822,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
823,CXR PA: ET tube 3cm above carina. Elevated left hemidiaphragm. Right-sided pneumothorax. Bilateral hilar lymphadenopathy. Osseous structures intact.,"Chest X-ray results: The breathing tube is in good position. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The bones look normal with no fractures.",Pulmonology,Radiology Report,high
824,Procedure: Laparoscopic appendectomy. Pt 60 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 60-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
825,"61 y/o F with PMH of CHF, obesity (BMI 38), admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on empagliflozin 10mg daily, Lantus 20U QHS, amoxicillin 500mg TID x 10 days, Eliquis 5mg BID, lisinopril 20mg daily. F/U PCP in 1 week.","A 61-year-old woman with a history of heart failure, and obesity was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (4) Eliquis 5mg twice daily [blood thinner]; (5) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the primary care doctor in 1 week.",Pulmonology,Discharge Summary,high
826,"LFTs: AST 83 (H), ALT 293 (H), ALP 268, T.Bili 0.4 (N), Albumin 4.1.","Your liver blood test results: Liver enzymes (AST 83, ALT 293) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is normal at 0.4. Albumin is normal at 4.1.",Gastroenterology,Lab Result,high
827,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Paranasal sinuses clear. Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The sinuses are clear with no infection. There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain.",Neurology,Radiology Report,high
828,"83 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 83-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
829,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab metoprolol succinate 50mg daily. Tab pantoprazole 40mg AC breakfast. Tab losartan 50mg daily. Spiriva 18mcg daily. Adv: wound care with daily dressing changes. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. (4) losartan 50mg once daily [blood pressure medicine]. (5) Spiriva inhaler once daily [long-acting lung medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
830,"LFTs: AST 484 (H), ALT 346 (H), ALP 300, T.Bili 2.5 (H), Albumin 4.9.","Your liver blood test results: Liver enzymes (AST 484, ALT 346) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 2.5 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.9.",Gastroenterology,Lab Result,high
831,"Rx: Tab furosemide 40mg BID. Tab Eliquis 5mg BID. Tab pregabalin 75mg BID. Tab potassium chloride 20mEq daily. Tab ciprofloxacin 500mg BID x 5 days. Do not stop abruptly, taper as directed. F/U 1 month with repeat imaging.",Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) Eliquis 5mg twice daily [blood thinner]. (3) pregabalin 75mg twice daily [nerve pain medicine]. (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (5) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,high
832,Procedure: Laparoscopic cholecystectomy. Pt 74 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 74-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
833,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,low
834,Rx: Tab furosemide 40mg daily. Spiriva 18mcg daily. Adv: wound care with daily dressing changes. F/U 2 weeks with INR.,"Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) Spiriva inhaler once daily [long-acting lung medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
835,"57 y/o F with PMH of cirrhosis, HTN, obesity (BMI 38), GERD, seizure disorder on Keppra, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Strict I&O, daily weights. D/C on Dulcolax 10mg QHS PRN, Humalog per SSI. F/U orthopedics in 6 weeks with X-ray.","A 57-year-old woman with a history of liver scarring [cirrhosis], high blood pressure, obesity, acid reflux, and seizure disorder [on Keppra] was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
836,"23 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 23-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
837,"89 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 89-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
838,"65 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 65-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
839,"38 y/o F with PMH of h/o CVA, SLE, GERD, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on acetaminophen 650mg Q6H PRN, omeprazole 20mg AC breakfast. F/U oncology in 1 week.","A 38-year-old woman with a history of history of stroke, lupus, and acid reflux was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the cancer doctor in 1 week.",Pulmonology,Discharge Summary,high
840,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. 4cm right subdural hematoma with 5mm midline shift. No acute intracranial hemorrhage.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is no bleeding in the brain.",Neurology,Radiology Report,high
841,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab potassium chloride 20mEq daily. Tab montelukast 10mg QHS. Tab glipizide 5mg BID AC. Adv: SMBG BID, diabetic diet. F/U 1 week with wound check.",Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) montelukast 10mg at bedtime [asthma/allergy medicine]. (4) glipizide 5mg twice daily before meals [helps release insulin]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week to have the wound checked.,Pulmonology,Prescription,high
842,"81 y/o M with PMH of PPM in situ, CKD Stage 4, cirrhosis, Parkinson's disease, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on ondansetron 4mg Q8H PRN N/V, Xarelto 20mg daily with dinner, escitalopram 10mg daily. F/U surgery in 10 days.","A 81-year-old man with a history of implanted pacemaker, advanced kidney disease, liver scarring [cirrhosis], and Parkinson's disease was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Follow-up with the surgeon in 10 days.",Endocrinology,Discharge Summary,high
843,"86 y/o F with PMH of BPH, s/p CABG, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Compression stockings when ambulating. D/C on amlodipine 10mg daily, methotrexate 15mg weekly. F/U nephrology in 1 week.","A 86-year-old woman with a history of enlarged prostate, and prior heart bypass surgery was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the kidney doctor in 1 week.",Cardiology,Discharge Summary,high
844,"81 y/o F with PMH of osteoporosis, BPH, HTN, COPD, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on atorvastatin 40mg QHS, sertraline 50mg daily. F/U nephrology in 1 week.","A 81-year-old woman with a history of weak bones [osteoporosis], enlarged prostate, high blood pressure, and chronic lung disease was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the kidney doctor in 1 week.",Pulmonology,Discharge Summary,high
845,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. Multilevel degenerative disc disease.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
846,CT Head without contrast: No acute intracranial hemorrhage. Acute ischemic infarct in R MCA territory. No mass effect. Chronic lacunar infarcts in bilateral basal ganglia. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is no bleeding in the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are no tumors or masses pushing on the brain. There are signs of small old strokes in the deep parts of the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
847,"42 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 42-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
848,"Lipid panel: TC 199, LDL 156, HDL 36, TG 62.","Your cholesterol results: Total cholesterol is 199. LDL (bad cholesterol) is high at 156 (goal under 100). HDL (good cholesterol) is too low at 36 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are normal at 62.",Cardiology,Lab Result,high
849,Delivery Note: G?P? at 39+1 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
850,Procedure: ORIF L distal radius. Pt 48 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 48-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
851,"44 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 44-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
852,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,medium
853,CXR PA: Left lower lobe consolidation. Bilateral pleural effusions. Patchy bilateral infiltrates. Right middle lobe atelectasis. Clear lung fields bilaterally.,"Chest X-ray results: There is an area in the lower left lung that appears infected. There is fluid collecting around both lungs. There are scattered cloudy patches in both lungs suggesting infection or inflammation. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. Both lungs look clear with no problems.",Pulmonology,Radiology Report,high
854,"78 y/o F with PMH of CKD Stage 3, Parkinson's disease, gout, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on ferrous sulfate 325mg BID, glipizide 5mg BID AC, atorvastatin 40mg QHS, spironolactone 25mg daily. F/U PCP in 1 week.","A 78-year-old woman with a history of moderate kidney disease, Parkinson's disease, and gout was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]; (4) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up with the primary care doctor in 1 week.",Cardiology,Discharge Summary,high
855,"52 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 52-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
856,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
857,"Rx: Tab lisinopril 10mg daily. Tab rosuvastatin 10mg QHS. Tab amlodipine 10mg daily. Tab ibuprofen 400mg Q6H PRN with food. Adv: low salt diet, fluid restriction 1.5L/day. F/U 6 weeks with LFTs.",Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) amlodipine 10mg once daily [blood pressure medicine]. (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,high
858,"Rx: Tab methotrexate 15mg weekly. Tab entresto 49/51mg BID. Tab spironolactone 25mg daily. Tab latanoprost 0.005% OU QHS. Tab ibuprofen 400mg Q6H PRN with food. Adv: weight bearing exercise, calcium/vit D supplementation Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) spironolactone 25mg once daily [heart-protecting water pill]. (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (5) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
859,"59 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 59-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
860,HbA1c: 8.4% (H). FBS: 79 mg/dL (N).,"Your diabetes blood test results: HbA1c is 8.4%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 79, which is normal (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
861,CXR PA: Clear lung fields bilaterally. Small left pleural effusion. Sternotomy wires intact. Widened mediastinum.,"Chest X-ray results: Both lungs look clear with no problems. There is a small amount of fluid around the left lung. The wires from prior heart surgery are intact. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
862,"CBC: WBC 15.5 (H), Hgb 13.1 (N), Plt 148 (L).","Your blood count results: White blood cells are 15.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 13.1. Platelets are 148, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
863,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
864,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
865,"81 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 81-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
866,"Rx: Tab ferrous sulfate 325mg BID. Lantus 20U QHS. Adv: high fiber diet, adequate hydration Adv: weight bearing exercise, calcium/vit D supplementation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. See your primary care doctor in 1 week to recheck blood pressure.",Endocrinology,Prescription,medium
867,Procedure: Port-a-cath placement. Pt 67 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 67-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
868,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
869,"US Abdomen: Spleen 11cm, normal. CBD 12mm, dilated. Right kidney 10.5cm, no hydronephrosis. Simple renal cysts bilaterally.","Abdominal ultrasound results: The spleen is a normal size. The bile duct is wider than normal [dilated], which may indicate a blockage. Right kidney is normal size with no blockage. Both kidneys have harmless fluid-filled cysts.",Gastroenterology,Radiology Report,high
870,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
871,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,low
872,CXR PA: Patchy bilateral infiltrates. Bilateral pleural effusions. Right middle lobe atelectasis.,"Chest X-ray results: There are scattered cloudy patches in both lungs suggesting infection or inflammation. There is fluid collecting around both lungs. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
873,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. No compression fracture.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
874,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. L5-S1 disc desiccation with mild bulge. Central canal stenosis at L3-L4. No compression fracture.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
875,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
876,"79 y/o M with PMH of BPH, CKD Stage 4, h/o CVA, CHF, h/o TIA, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Compression stockings when ambulating. D/C on metformin 1000mg BID, latanoprost 0.005% OU QHS, glipizide 5mg BID AC, prednisone taper, sertraline 50mg daily. F/U GI in 1 week.","A 79-year-old man with a history of enlarged prostate, advanced kidney disease, history of stroke, heart failure, and history of mini-stroke was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the stomach doctor in 1 week.",Infectious Disease,Discharge Summary,high
877,"46 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 46-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
878,"LFTs: AST 415 (H), ALT 252 (H), ALP 230, T.Bili 7.2 (H), Albumin 2.9.","Your liver blood test results: Liver enzymes (AST 415, ALT 252) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 7.2 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.9 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
879,Rx: Tab empagliflozin 10mg daily. Tab furosemide 40mg BID. Tab gabapentin 300mg TID. Tab hydroxychloroquine 200mg BID. Adv: low potassium diet. F/U 2 weeks.,"Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
880,"62 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 62-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
881,"32 y/o M with PMH of obesity (BMI 38), CAD, ICD in situ, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Low potassium diet. D/C on omeprazole 20mg AC breakfast, acetaminophen 650mg Q6H PRN. F/U surgery in 2 weeks for drain removal.","A 32-year-old man with a history of obesity, coronary artery disease [heart artery blockages], and implanted heart defibrillator was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
882,CXR PA: Bilateral pleural effusions. Elevated left hemidiaphragm. Small left pleural effusion.,Chest X-ray results: There is fluid collecting around both lungs. The left side of the breathing muscle [diaphragm] is sitting higher than normal. There is a small amount of fluid around the left lung.,Pulmonology,Radiology Report,high
883,"BMP: Na 137 (N), K 4.9 (N), BUN 54, Cr 2.8 (H), Glucose 216.","Your blood chemistry results: Sodium is normal at 137. Potassium is normal at 4.9. Creatinine is elevated at 2.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 216 (high).",Nephrology,Lab Result,high
884,"55 y/o M with PMH of gout, COPD, h/o TIA, DM1, osteoporosis, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on pregabalin 75mg BID, sertraline 50mg daily, atorvastatin 40mg QHS, calcium + vitamin D 600/400 daily, rosuvastatin 10mg QHS. F/U surgery in 10 days.","A 55-year-old man with a history of gout, chronic lung disease, history of mini-stroke, type 1 diabetes, and weak bones [osteoporosis] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the surgeon in 10 days.",Gastroenterology,Discharge Summary,high
885,CT Head without contrast: Paranasal sinuses clear. Subarachnoid hemorrhage in bilateral sylvian fissures. No mass effect. Mild generalized cerebral atrophy appropriate for age. No midline shift.,"CT scan of the head results: The sinuses are clear with no infection. There is bleeding around the brain surface, particularly in the grooves on both sides. There are no tumors or masses pushing on the brain. There is mild brain shrinkage, which is normal for your age. The brain is centered normally.",Neurology,Radiology Report,high
886,"MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. No compression fracture. Conus medullaris at L1, normal. C5-C6 disc herniation with cord compression.","MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. No bones are broken or collapsed. The spinal cord ends at a normal level. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
887,Procedure: ORIF L distal radius. Pt 84 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 84-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
888,"23 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 23-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
889,CT Head without contrast: Acute ischemic infarct in R MCA territory. 4cm right subdural hematoma with 5mm midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No midline shift. No acute intracranial hemorrhage.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The brain is centered normally. There is no bleeding in the brain.",Neurology,Radiology Report,high
890,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab omeprazole 20mg AC breakfast. Tab clopidogrel 75mg daily. Tab ASA 81mg daily. Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. (4) baby aspirin 81mg once daily [prevents blood clots]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
891,"60 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 60-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
892,"BMP: Na 124 (L), K 3.0 (L), BUN 27, Cr 3.3 (H), Glucose 224.","Your blood chemistry results: Sodium is low at 124 (normal 136-145), meaning too much water in your body. Potassium is low at 3.0 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 3.3 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 224 (high).",Nephrology,Lab Result,high
893,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
894,Procedure: EGD with biopsy. Pt 25 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 25-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
895,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. Left kidney 8cm, cortical thinning consistent with CKD. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Pancreas unremarkable.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The pancreas looks normal.",Gastroenterology,Radiology Report,high
896,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. Multilevel degenerative disc disease. No compression fracture. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. Multiple discs in the spine are showing wear and aging. No bones are broken or collapsed. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
897,CXR PA: Right lower lobe consolidation. NG tube tip in stomach. Right middle lobe atelectasis.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. The feeding/drainage tube tip is correctly positioned in the stomach. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
898,"Rx: Tab montelukast 10mg QHS. Tab lisinopril 10mg daily. Adv: low salt low sugar diet, regular exercise. F/U INR in 3 days.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
899,"BMP: Na 135 (L), K 4.8 (N), BUN 79, Cr 7.4 (H), Glucose 66.","Your blood chemistry results: Sodium is low at 135 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.8. Creatinine is elevated at 7.4 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 66 (low).",Nephrology,Lab Result,high
900,HbA1c: 13.8% (H). FBS: 72 mg/dL (N).,"Your diabetes blood test results: HbA1c is 13.8%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 72, which is normal (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
901,Procedure: R TKA. Pt 80 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 80-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
902,"42 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 42-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
903,CXR PA: Port-a-cath in appropriate position. Bilateral hilar lymphadenopathy. Mild cardiomegaly. Pacemaker leads in appropriate position.,"Chest X-ray results: The implanted medication port is in the correct position. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The heart is slightly larger than normal. The pacemaker wires are in the correct position.",Pulmonology,Radiology Report,high
904,"35 y/o F with PMH of CKD Stage 4, BPH, ESRD on HD, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Augmentin 875/125 BID x 7 days, entresto 49/51mg BID. F/U INR check in 3 days.","A 35-year-old woman with a history of advanced kidney disease, enlarged prostate, and kidney failure requiring dialysis was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up for a blood thinner level check in 3 days.",Hematology,Discharge Summary,high
905,"BMP: Na 130 (L), K 5.8 (H), BUN 32, Cr 1.3 (H), Glucose 365.","Your blood chemistry results: Sodium is low at 130 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 5.8 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is mildly elevated at 1.3. Blood sugar is 365 (high).",Nephrology,Lab Result,high
906,"BMP: Na 122 (L), K 4.6 (N), BUN 83, Cr 3.8 (H), Glucose 268.","Your blood chemistry results: Sodium is low at 122 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.6. Creatinine is elevated at 3.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 268 (high).",Nephrology,Lab Result,high
907,Procedure: R TKA. Pt 30 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 30-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
908,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab sertraline 50mg daily. Tab montelukast 10mg QHS. Adv: SMBG BID, diabetic diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Pulmonology,Prescription,medium
909,"32 y/o F with PMH of HFrEF (EF 30%), PPM in situ, h/o CVA, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on metformin 1000mg BID, ASA 81mg daily, sertraline 50mg daily, levothyroxine 75mcg daily on empty stomach. F/U surgery in 2 weeks for drain removal.","A 32-year-old woman with a history of heart failure with weak pumping (30%), implanted pacemaker, and history of stroke was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Urology,Discharge Summary,high
910,"MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. No compression fracture. Conus medullaris at L1, normal. Multilevel degenerative disc disease.","MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. No bones are broken or collapsed. The spinal cord ends at a normal level. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
911,"Rx: Tab clopidogrel 75mg daily. Tab metoprolol 25mg BID. Tab spironolactone 25mg daily. Tab atorvastatin 40mg QHS. Tab omeprazole 20mg AC breakfast. Adv: wound care with daily dressing changes Adv: elevate affected limb, compression stockings. F/U INR in 3 days.","Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) spironolactone 25mg once daily [heart-protecting water pill]. (4) atorvastatin 40mg at bedtime [cholesterol medicine]. (5) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
912,"91 y/o M with PMH of hypothyroidism, OA, HLD, GERD, COPD, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on ibuprofen 400mg Q6H PRN with food, levothyroxine 75mcg daily on empty stomach, sertraline 50mg daily. F/U GI in 1 week.","A 91-year-old man with a history of underactive thyroid, arthritis [osteoarthritis], high cholesterol, acid reflux, and chronic lung disease was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the stomach doctor in 1 week.",General Surgery,Discharge Summary,high
913,"Rx: Tab calcium + vitamin D 600/400 daily. Tab ferrous sulfate 325mg BID. Tab Augmentin 875/125 BID x 7 days. Tab latanoprost 0.005% OU QHS. Adv: weight bearing exercise, calcium/vit D supplementation Adv: fall precautions, home safety evaluation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. See your primary care doctor in 1 week to recheck blood pressure.",General,Prescription,high
914,"Rx: Tab pantoprazole 40mg AC breakfast. Tab potassium chloride 20mEq daily. Adv: weight bearing exercise, calcium/vit D supplementation Adv: fall precautions, home safety evaluation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. See your primary care doctor in 1 week to recheck blood pressure.",Gastroenterology,Prescription,medium
915,"53 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 53-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
916,CT Head without contrast: No midline shift. Paranasal sinuses clear. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: The brain is centered normally. The sinuses are clear with no infection. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
917,"56 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 56-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
918,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
919,"44 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 44-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
920,"23 y/o M with PMH of CKD Stage 4, h/o TIA, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on atorvastatin 80mg QHS, amlodipine 5mg daily, tramadol 50mg Q6H PRN pain, timolol 0.5% OU BID, pantoprazole 40mg AC breakfast. F/U wound care in 3 days.","A 23-year-old man with a history of advanced kidney disease, and history of mini-stroke was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) amlodipine 5mg once daily [blood pressure medicine]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (5) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up at the wound care clinic in 3 days.",Infectious Disease,Discharge Summary,high
921,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
922,"50 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 50-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
923,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,high
924,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,high
925,"84 y/o M with PMH of OA, CHF, DM1, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on montelukast 10mg QHS, pantoprazole 40mg AC breakfast, potassium chloride 20mEq daily. F/U oncology in 1 week.","A 84-year-old man with a history of arthritis [osteoarthritis], heart failure, and type 1 diabetes was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the cancer doctor in 1 week.",Orthopedics,Discharge Summary,high
926,"38 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 38-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
927,Procedure: TURP for BPH. Pt 23 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 23-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
928,"LFTs: AST 479 (H), ALT 596 (H), ALP 115, T.Bili 6.7 (H), Albumin 3.1.","Your liver blood test results: Liver enzymes (AST 479, ALT 596) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.7 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 3.1 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
929,"23 y/o F with PMH of HTN, anemia, hypothyroidism, PAD, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Compression stockings when ambulating. D/C on acetaminophen 650mg Q6H PRN, latanoprost 0.005% OU QHS. F/U pulmonology in 2 weeks.","A 23-year-old woman with a history of high blood pressure, low blood count [anemia], underactive thyroid, and poor blood flow in the legs [peripheral artery disease] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Follow-up with the lung doctor in 2 weeks.",Nephrology,Discharge Summary,high
930,"LFTs: AST 398 (H), ALT 296 (H), ALP 63, T.Bili 0.4 (N), Albumin 4.0.","Your liver blood test results: Liver enzymes (AST 398, ALT 296) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is normal at 0.4. Albumin is normal at 4.0.",Gastroenterology,Lab Result,high
931,"28 y/o M with PMH of s/p THR, DVT/PE on warfarin, CHF, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Spiriva 18mcg daily, ondansetron 4mg Q8H PRN N/V. F/U orthopedics in 6 weeks with X-ray.","A 28-year-old man with a history of prior hip replacement, blood clots [on blood thinner warfarin], and heart failure was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Nephrology,Discharge Summary,high
932,"27 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 27-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
933,"Rx: Tab furosemide 40mg daily. Tab levothyroxine 75mcg daily on empty stomach. Tab carvedilol 12.5mg BID. Adv: SMBG BID, diabetic diet Adv: avoid alcohol, hepatotoxic drugs. F/U 1 week with wound check.",Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) carvedilol 12.5mg twice daily [heart medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 week to have the wound checked.,Cardiology,Prescription,medium
934,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
935,"75 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 75-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
936,"Rx: prednisone taper. Tab montelukast 10mg QHS. Tab lisinopril 10mg daily. Tab clopidogrel 75mg daily. Tab latanoprost 0.005% OU QHS. Adv: elevate affected limb, compression stockings Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks with INR.",Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. (5) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
937,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab clopidogrel 75mg daily. Tab acetaminophen 650mg Q6H PRN. Adv: low salt low sugar diet, regular exercise Adv: fall precautions, home safety evaluation. F/U 2 weeks.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
938,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
939,"LFTs: AST 430 (H), ALT 394 (H), ALP 152, T.Bili 4.8 (H), Albumin 3.5.","Your liver blood test results: Liver enzymes (AST 430, ALT 394) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 4.8 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.5.",Gastroenterology,Lab Result,high
940,"29 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 29-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
941,CXR PA: No pneumothorax. Right lower lobe consolidation. Right middle lobe atelectasis. Compression fracture T12.,"Chest X-ray results: There is no collapsed lung. There is an area in the lower right lung that appears infected, suggesting pneumonia. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is a compression fracture [collapsed bone] in the lower spine at T12.",Pulmonology,Radiology Report,high
942,"62 y/o F with PMH of ESRD on HD, HLD, BPH, gout, GERD, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on amlodipine 10mg daily, losartan 50mg daily. F/U oncology in 1 week.","A 62-year-old woman with a history of kidney failure requiring dialysis, high cholesterol, enlarged prostate, gout, and acid reflux was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) losartan 50mg once daily [blood pressure medicine]. Follow-up with the cancer doctor in 1 week.",Gastroenterology,Discharge Summary,high
943,CXR PA: Right middle lobe atelectasis. Compression fracture T12. Osseous structures intact. No cardiomegaly.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is a compression fracture [collapsed bone] in the lower spine at T12. The bones look normal with no fractures. The heart is a normal size.",Pulmonology,Radiology Report,high
944,"63 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 63-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
945,"53 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 53-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
946,Rx: Tab glipizide 5mg BID AC. Tab latanoprost 0.005% OU QHS. Adv: wound care with daily dressing changes. F/U INR in 3 days.,"Your medicines: (1) glipizide 5mg twice daily before meals [helps release insulin]. (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 3 days for a blood thinner level check [INR].",Endocrinology,Prescription,medium
947,"82 y/o M with PMH of HFpEF, hypothyroidism, s/p TKR, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on montelukast 10mg QHS, ASA 81mg daily, entresto 49/51mg BID, metformin 1000mg BID, pregabalin 75mg BID. F/U neurology in 2 weeks.","A 82-year-old man with a history of heart failure with stiff heart muscle, underactive thyroid, and prior knee replacement was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) Entresto 49/51mg twice daily [heart failure medicine]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]; (5) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
948,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. 4cm right subdural hematoma with 5mm midline shift. No acute intracranial hemorrhage. Chronic lacunar infarcts in bilateral basal ganglia. No mass effect.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is no bleeding in the brain. There are signs of small old strokes in the deep parts of the brain. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
949,"69 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 69-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
950,"73 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 73-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
951,"US Abdomen: Spleen 11cm, normal. CBD 5mm, not dilated. Pancreas unremarkable.",Abdominal ultrasound results: The spleen is a normal size. The bile duct is normal size [not blocked]. The pancreas looks normal.,Gastroenterology,Radiology Report,high
952,"Rx: Tab ferrous sulfate 325mg BID. Tab lisinopril 10mg daily. Humalog per SSI. Adv: wound care with daily dressing changes. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) Humalog insulin before meals as directed [fast-acting insulin]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
953,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab lisinopril 20mg daily. Tab Eliquis 5mg BID. Tab amlodipine 10mg daily. Tab losartan 50mg daily. Adv: wound care with daily dressing changes Adv: smoking cessation, pulmonary rehab. F/U PCP in 1 week for BP recheck.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) lisinopril 20mg once daily [blood pressure medicine]. (3) Eliquis 5mg twice daily [blood thinner]. (4) amlodipine 10mg once daily [blood pressure medicine]. (5) losartan 50mg once daily [blood pressure medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
954,HbA1c: 13.6% (H). FBS: 110 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.6%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 110, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
955,CXR PA: Increased interstitial markings suggesting pulmonary edema. Bilateral hilar lymphadenopathy. Clear lung fields bilaterally. Pacemaker leads in appropriate position. Widened mediastinum.,"Chest X-ray results: There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. Both lungs look clear with no problems. The pacemaker wires are in the correct position. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
956,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
957,"Rx: Tab lisinopril 10mg daily. Tab Xarelto 20mg daily with dinner. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) Xarelto 20mg once daily with dinner [blood thinner]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
958,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab methotrexate 15mg weekly. Tab clopidogrel 75mg daily. Tab furosemide 40mg daily. Adv: low salt low sugar diet, regular exercise. F/U PCP in 1 week for BP recheck.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
959,"53 y/o M with PMH of HFpEF, BPH, CAD, s/p THR, COPD, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on prednisone taper, albuterol MDI 2 puffs Q4-6H PRN, rosuvastatin 10mg QHS. F/U GI in 1 week.","A 53-year-old man with a history of heart failure with stiff heart muscle, enlarged prostate, coronary artery disease [heart artery blockages], prior hip replacement, and chronic lung disease was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
960,"72 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 72-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
961,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
962,"45 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 45-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
963,"88 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 88-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
964,"Rx: prednisone taper. Tab pregabalin 75mg BID. albuterol MDI 2 puffs Q4-6H PRN. Tab warfarin 5mg daily. Adv: avoid alcohol, hepatotoxic drugs. F/U PCP in 1 week for BP recheck.",Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). See your primary care doctor in 1 week to recheck blood pressure.,Pulmonology,Prescription,high
965,"71 y/o F with PMH of cirrhosis, CKD Stage 3, anxiety, OA, CHF, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Low potassium diet. D/C on methotrexate 15mg weekly, potassium chloride 20mEq daily, metoprolol succinate 50mg daily, acetaminophen 650mg Q6H PRN. F/U endocrine in 1 week.","A 71-year-old woman with a history of liver scarring [cirrhosis], moderate kidney disease, anxiety, arthritis [osteoarthritis], and heart failure was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the hormone/diabetes doctor in 1 week.",Nephrology,Discharge Summary,high
966,"52 y/o F with PMH of CAD, s/p CABG, DVT/PE on warfarin, h/o TIA, osteoporosis, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on warfarin 5mg daily, lisinopril 20mg daily. F/U neurology in 2 weeks.","A 52-year-old woman with a history of coronary artery disease [heart artery blockages], prior heart bypass surgery, blood clots [on blood thinner warfarin], history of mini-stroke, and weak bones [osteoporosis] was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
967,"LFTs: AST 457 (H), ALT 450 (H), ALP 76, T.Bili 3.1 (H), Albumin 4.8.","Your liver blood test results: Liver enzymes (AST 457, ALT 450) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 3.1 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.8.",Gastroenterology,Lab Result,high
968,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
969,"Thyroid panel: TSH 3.94 (N), Free T4 1.2.",Your thyroid test results: TSH is normal at 3.94. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
970,"US Abdomen: Moderate right hydronephrosis. Right kidney 10.5cm, no hydronephrosis. No focal hepatic lesion. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. Right kidney is normal size with no blockage. No tumors or masses were found in the liver. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
971,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
972,"23 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 23-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
973,Procedure: ERCP with sphincterotomy. Pt 47 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 47-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
974,"37 y/o M with PMH of PAD, h/o TIA, COPD, depression, hypothyroidism, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on spironolactone 25mg daily, Dulcolax 10mg QHS PRN, sertraline 50mg daily, ASA 81mg daily. F/U surgery in 2 weeks for drain removal.","A 37-year-old man with a history of poor blood flow in the legs [peripheral artery disease], history of mini-stroke, chronic lung disease, depression, and underactive thyroid was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the surgeon in 2 weeks to remove the drain.",Infectious Disease,Discharge Summary,high
975,"Rx: Tab gabapentin 300mg TID. Tab pantoprazole 40mg AC breakfast. Humalog per SSI. prednisone taper. Adv: DASH diet, daily BP monitoring. F/U 2 weeks with INR.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) Humalog insulin before meals as directed [fast-acting insulin]. (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 2 weeks for a blood thinner level check [INR].",Neurology,Prescription,high
976,"73 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 73-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
977,"BMP: Na 135 (L), K 3.9 (N), BUN 74, Cr 4.6 (H), Glucose 376.","Your blood chemistry results: Sodium is low at 135 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.9. Creatinine is elevated at 4.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 376 (high).",Nephrology,Lab Result,high
978,Procedure: Laparoscopic cholecystectomy. Pt 67 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 67-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
979,Procedure: Port-a-cath placement. Pt 30 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 30-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
980,"CBC: WBC 8.3 (N), Hgb 8.7 (L), Plt 347 (N).","Your blood count results: White blood cells are 8.3 (normal). Hemoglobin is low at 8.7, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 347, which is normal.",Hematology,Lab Result,high
981,"30 y/o M with PMH of Parkinson's disease, s/p THR, seizure disorder on Keppra, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on furosemide 40mg BID, hydroxychloroquine 200mg BID, ondansetron 4mg Q8H PRN N/V. F/U endocrine in 1 week.","A 30-year-old man with a history of Parkinson's disease, prior hip replacement, and seizure disorder [on Keppra] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Neurology,Discharge Summary,high
982,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,high
983,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
984,CXR PA: ET tube 3cm above carina. Osseous structures intact. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: The breathing tube is in good position. The bones look normal with no fractures. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
985,Procedure: Laparoscopic cholecystectomy. Pt 72 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 72-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
986,"63 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 63-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
987,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
988,"CBC: WBC 7.1 (N), Hgb 5.7 (L), Plt 34 (L).","Your blood count results: White blood cells are 7.1 (normal). Hemoglobin is low at 5.7, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 34, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
989,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
990,"CBC: WBC 17.5 (H), Hgb 13.5 (N), Plt 307 (N).","Your blood count results: White blood cells are 17.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 13.5. Platelets are 307, which is normal.",Hematology,Lab Result,high
991,"Rx: Tab calcium + vitamin D 600/400 daily. Tab methotrexate 15mg weekly. Tab amoxicillin 500mg TID x 10 days. Adv: SMBG BID, diabetic diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Infectious Disease,Prescription,medium
992,"32 y/o F with PMH of HFrEF (EF 30%), s/p THR, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on atorvastatin 40mg QHS, ondansetron 4mg Q8H PRN N/V, gabapentin 300mg TID. F/U GI in 1 week.","A 32-year-old woman with a history of heart failure with weak pumping (30%), and prior hip replacement was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the stomach doctor in 1 week.",Psychiatry,Discharge Summary,high
993,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,low
994,"80 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 80-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
995,"58 y/o M with PMH of ESRD on HD, OSA on CPAP, obesity (BMI 38), PPM in situ, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Low potassium diet. D/C on rosuvastatin 10mg QHS, losartan 50mg daily. F/U orthopedics in 6 weeks with X-ray.","A 58-year-old man with a history of kidney failure requiring dialysis, sleep apnea [uses a breathing machine at night], obesity, and implanted pacemaker was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) losartan 50mg once daily [blood pressure medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Infectious Disease,Discharge Summary,high
996,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,medium
997,"67 y/o M with PMH of asthma, HFrEF (EF 30%), admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on carvedilol 12.5mg BID, clopidogrel 75mg daily, acetaminophen 650mg Q6H PRN, Xarelto 20mg daily with dinner, atorvastatin 80mg QHS. F/U PCP in 1 week.","A 67-year-old man with a history of asthma, and heart failure with weak pumping (30%) was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (4) Xarelto 20mg once daily with dinner [blood thinner]; (5) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the primary care doctor in 1 week.",Cardiology,Discharge Summary,high
998,"Rx: Tab empagliflozin 10mg daily. Tab warfarin 5mg daily. Tab timolol 0.5% OU BID. Tab methotrexate 15mg weekly. Adv: high fiber diet, adequate hydration Adv: smoking cessation, pulmonary rehab. F/U 1 week with wound check.","Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week to have the wound checked.",Endocrinology,Prescription,high
999,HbA1c: 5.0% (N). FBS: 111 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.0%, which is normal — you do not have diabetes. Fasting blood sugar was 111, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
1000,"Rx: Tab carvedilol 12.5mg BID. Tab levothyroxine 75mcg daily on empty stomach. Do not stop abruptly, taper as directed Adv: avoid alcohol, hepatotoxic drugs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
1001,"29 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 29-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
1002,"22 y/o F with PMH of anemia, SLE, s/p CABG, PPM in situ, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on sertraline 50mg daily, Humalog per SSI, furosemide 40mg BID. F/U orthopedics in 6 weeks with X-ray.","A 22-year-old woman with a history of low blood count [anemia], lupus, prior heart bypass surgery, and implanted pacemaker was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) furosemide (Lasix) 40mg twice daily [water pill]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Psychiatry,Discharge Summary,high
1003,"Rx: Tab gabapentin 300mg TID. Tab clopidogrel 75mg daily. Tab glipizide 5mg BID AC. Lantus 20U QHS. Tab methotrexate 15mg weekly. Adv: weight bearing exercise, calcium/vit D supplementation Avoid grapefruit juice. F/U 1 week with CBC, CMP.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) glipizide 5mg twice daily before meals [helps release insulin]. (4) Lantus insulin 20 units at bedtime [long-acting insulin]. (5) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Do not drink grapefruit juice as it interferes with this medication. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,high
1004,"Rx: Tab rosuvastatin 10mg QHS. Tab pantoprazole 40mg AC breakfast. Tab levothyroxine 75mcg daily on empty stomach. Tab metoprolol succinate 50mg daily. Tab warfarin 5mg daily. Adv: low salt low sugar diet, regular exercise Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks with INR.","Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (5) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
1005,"Rx: Tab methotrexate 15mg weekly. Tab ASA 81mg daily. Tab ferrous sulfate 325mg BID. Tab levothyroxine 75mcg daily on empty stomach. Tab Eliquis 5mg BID. Avoid grapefruit juice Adv: DASH diet, daily BP monitoring. F/U 1 week with wound check.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (5) Eliquis 5mg twice daily [blood thinner]. Do not drink grapefruit juice as it interferes with this medication Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
1006,Rx: Tab acetaminophen 650mg Q6H PRN. Tab glipizide 5mg BID AC. Tab methotrexate 15mg weekly. Tab ciprofloxacin 500mg BID x 5 days. Tab hydroxychloroquine 200mg BID. Avoid NSAIDs. F/U INR in 3 days.,Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) glipizide 5mg twice daily before meals [helps release insulin]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (5) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 3 days for a blood thinner level check [INR].,Rheumatology,Prescription,high
1007,"CBC: WBC 10.5 (N), Hgb 11.1 (L), Plt 319 (N).","Your blood count results: White blood cells are 10.5 (normal). Hemoglobin is low at 11.1, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 319, which is normal.",Hematology,Lab Result,high
1008,"38 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 38-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1009,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
1010,"56 y/o M with PMH of gout, ICD in situ, CHF, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on lisinopril 10mg daily, levothyroxine 75mcg daily on empty stomach, Eliquis 5mg BID. F/U nephrology in 1 week.","A 56-year-old man with a history of gout, implanted heart defibrillator, and heart failure was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) Eliquis 5mg twice daily [blood thinner]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
1011,"Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab furosemide 40mg BID. Tab ondansetron 4mg Q8H PRN N/V. Adv: low salt diet, fluid restriction 1.5L/day Adv: elevate affected limb, compression stockings. F/U 1 week with CBC, CMP.",Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,General,Prescription,medium
1012,"US Abdomen: Left kidney 8cm, cortical thinning consistent with CKD. Right kidney 10.5cm, no hydronephrosis. CBD 12mm, dilated. GB wall thickening with stones, positive Murphy's sign. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: Left kidney is small with thin outer layer, consistent with chronic kidney disease. Right kidney is normal size with no blockage. The bile duct is wider than normal [dilated], which may indicate a blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
1013,"48 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 48-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1014,"Rx: prednisone taper. Tab Eliquis 5mg BID. Tab Xarelto 20mg daily with dinner. Tab ASA 81mg daily. Tab metoprolol succinate 50mg daily. Adv: fall precautions, home safety evaluation Adv: wound care with daily dressing changes. F/U 2 weeks.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) Eliquis 5mg twice daily [blood thinner]. (3) Xarelto 20mg once daily with dinner [blood thinner]. (4) baby aspirin 81mg once daily [prevents blood clots]. (5) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
1015,"Thyroid panel: TSH 11.31 (H), Free T4 1.2.","Your thyroid test results: TSH is elevated at 11.31 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
1016,"Thyroid panel: TSH 14.14 (H), Free T4 2.7.","Your thyroid test results: TSH is elevated at 14.14 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
1017,"Rx: Tab metoprolol 25mg BID. Tab metformin 500mg BID. Tab pantoprazole 40mg AC breakfast. Tab levothyroxine 75mcg daily on empty stomach. Adv: low potassium diet Adv: elevate affected limb, compression stockings. F/U 1 week with CBC, CMP.","Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,high
1018,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Acute ischemic infarct in R MCA territory. Mild generalized cerebral atrophy appropriate for age. Paranasal sinuses clear. No acute intracranial hemorrhage.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is mild brain shrinkage, which is normal for your age. The sinuses are clear with no infection. There is no bleeding in the brain.",Neurology,Radiology Report,high
1019,"88 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 88-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1020,MRI Lumbar Spine: No compression fracture. C5-C6 disc herniation with cord compression.,"MRI of the lower back results: No bones are broken or collapsed. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
1021,"83 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 83-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1022,"30 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 30-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1023,"Rx: Tab escitalopram 10mg daily. Tab timolol 0.5% OU BID. Avoid NSAIDs Adv: DASH diet, daily BP monitoring. F/U 2 weeks.","Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back for a check-up in 2 weeks.",Psychiatry,Prescription,medium
1024,"Rx: Tab atorvastatin 80mg QHS. Tab timolol 0.5% OU BID. Adv: low potassium diet Adv: weight bearing exercise, calcium/vit D supplementation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
1025,Procedure: PCI with DES to LAD. Pt 63 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 63-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
1026,"Rx: Tab carvedilol 12.5mg BID. Tab metoprolol 25mg BID. Adv: high fiber diet, adequate hydration. F/U 6 weeks with LFTs.","Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
1027,Procedure: TURP for BPH. Pt 63 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 63-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
1028,CT Head without contrast: No acute intracranial hemorrhage. Chronic lacunar infarcts in bilateral basal ganglia. Acute ischemic infarct in R MCA territory. 4cm right subdural hematoma with 5mm midline shift. No mass effect.,"CT scan of the head results: There is no bleeding in the brain. There are signs of small old strokes in the deep parts of the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
1029,Procedure: PCI with DES to LAD. Pt 23 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 23-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
1030,"BMP: Na 127 (L), K 3.7 (N), BUN 62, Cr 7.4 (H), Glucose 302.","Your blood chemistry results: Sodium is low at 127 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.7. Creatinine is elevated at 7.4 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 302 (high).",Nephrology,Lab Result,high
1031,"30 y/o F with PMH of h/o CVA, COPD, h/o TIA, Parkinson's disease, osteoporosis, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on metoprolol succinate 50mg daily, metformin 500mg BID, spironolactone 25mg daily, calcium + vitamin D 600/400 daily, glipizide 5mg BID AC. F/U INR check in 3 days.","A 30-year-old woman with a history of history of stroke, chronic lung disease, history of mini-stroke, Parkinson's disease, and weak bones [osteoporosis] was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) metformin 500mg twice daily with meals [blood sugar medicine]; (3) spironolactone 25mg once daily [heart-protecting water pill]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up for a blood thinner level check in 3 days.",Urology,Discharge Summary,high
1032,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1033,"Rx: Tab calcium + vitamin D 600/400 daily. Tab metoprolol succinate 50mg daily. Tab ciprofloxacin 500mg BID x 5 days. Tab timolol 0.5% OU BID. Adv: low salt low sugar diet, regular exercise. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
1034,"53 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 53-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1035,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. Multilevel degenerative disc disease.,MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. Multiple discs in the spine are showing wear and aging.,Orthopedics,Radiology Report,high
1036,"54 y/o F with PMH of RA on MTX, depression, GERD, ESRD on HD, gout, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Low potassium diet. D/C on amlodipine 5mg daily, amoxicillin 500mg TID x 10 days, metoprolol succinate 50mg daily. F/U surgery in 10 days.","A 54-year-old woman with a history of rheumatoid arthritis [on immune-suppressing medicine], depression, acid reflux, kidney failure requiring dialysis, and gout was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
1037,"US Abdomen: No focal hepatic lesion. Left kidney 8cm, cortical thinning consistent with CKD. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: No tumors or masses were found in the liver. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
1038,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1039,"Rx: Tab calcium + vitamin D 600/400 daily. Tab losartan 50mg daily. Tab entresto 49/51mg BID. Adv: DASH diet, daily BP monitoring. F/U 1 week with wound check.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) losartan 50mg once daily [blood pressure medicine]. (3) Entresto 49/51mg twice daily [heart failure medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
1040,Procedure: Laparoscopic appendectomy. Pt 52 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 52-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1041,HbA1c: 13.6% (H). FBS: 307 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.6%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 307, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1042,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,low
1043,"38 y/o F with PMH of COPD, OSA on CPAP, asthma, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on acetaminophen 650mg Q6H PRN, losartan 50mg daily, azithromycin 500mg day 1 then 250mg x 4 days, pregabalin 75mg BID, furosemide 40mg BID. F/U orthopedics in 6 weeks with X-ray.","A 38-year-old woman with a history of chronic lung disease, sleep apnea [uses a breathing machine at night], and asthma was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) losartan 50mg once daily [blood pressure medicine]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (4) pregabalin 75mg twice daily [nerve pain medicine]; (5) furosemide (Lasix) 40mg twice daily [water pill]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
1044,"Rx: Humalog per SSI. Tab ferrous sulfate 325mg BID. Tab gabapentin 300mg TID. Tab timolol 0.5% OU BID. Tab potassium chloride 20mEq daily. Adv: low salt low sugar diet, regular exercise. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (5) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",General,Prescription,high
1045,"CBC: WBC 10.3 (N), Hgb 12.0 (N), Plt 294 (N).","Your blood count results: White blood cells are 10.3 (normal). Hemoglobin is normal at 12.0. Platelets are 294, which is normal.",Hematology,Lab Result,medium
1046,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. GB sludge, no stones. Pancreas unremarkable.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The gallbladder contains thickened bile [sludge] but no stones. The pancreas looks normal.",Gastroenterology,Radiology Report,high
1047,"55 y/o M with PMH of CKD Stage 4, cirrhosis, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Strict I&O, daily weights. D/C on gabapentin 300mg TID, calcium + vitamin D 600/400 daily, hydroxychloroquine 200mg BID, levothyroxine 75mcg daily on empty stomach, latanoprost 0.005% OU QHS. F/U PCP in 2 weeks.","A 55-year-old man with a history of advanced kidney disease, and liver scarring [cirrhosis] was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (5) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Follow-up with the primary care doctor in 2 weeks.",Pulmonology,Discharge Summary,high
1048,"42 y/o F with PMH of CKD Stage 4, HLD, RA on MTX, hypothyroidism, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Strict I&O, daily weights. D/C on Eliquis 5mg BID, latanoprost 0.005% OU QHS. F/U wound care in 3 days.","A 42-year-old woman with a history of advanced kidney disease, high cholesterol, rheumatoid arthritis [on immune-suppressing medicine], and underactive thyroid was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Eliquis 5mg twice daily [blood thinner]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Follow-up at the wound care clinic in 3 days.",General Surgery,Discharge Summary,high
1049,"70 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 70-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1050,Procedure: R TKA. Pt 50 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 50-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1051,"38 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 38-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1052,"BMP: Na 130 (L), K 3.6 (N), BUN 86, Cr 5.4 (H), Glucose 210.","Your blood chemistry results: Sodium is low at 130 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.6. Creatinine is elevated at 5.4 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 210 (high).",Nephrology,Lab Result,high
1053,"CBC: WBC 12.5 (H), Hgb 17.1 (H), Plt 25 (L).","Your blood count results: White blood cells are 12.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is elevated at 17.1. Platelets are 25, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
1054,HbA1c: 5.4% (N). FBS: 396 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.4%, which is normal — you do not have diabetes. Fasting blood sugar was 396, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
1055,"76 y/o M with PMH of OA, cirrhosis, RA on MTX, seizure disorder on Keppra, s/p TKR, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on prednisone taper, sertraline 50mg daily, hydroxychloroquine 200mg BID. F/U neurology in 2 weeks.","A 76-year-old man with a history of arthritis [osteoarthritis], liver scarring [cirrhosis], rheumatoid arthritis [on immune-suppressing medicine], seizure disorder [on Keppra], and prior knee replacement was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
1056,"Rx: Humalog per SSI. Tab gabapentin 300mg TID. Tab tramadol 50mg Q6H PRN pain. Adv: SMBG BID, diabetic diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Neurology,Prescription,medium
1057,Procedure: ERCP with sphincterotomy. Pt 78 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 78-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1058,"47 y/o M with PMH of osteoporosis, CAD, obesity (BMI 38), admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on montelukast 10mg QHS, warfarin 5mg daily, prednisone taper. F/U INR check in 3 days.","A 47-year-old man with a history of weak bones [osteoporosis], coronary artery disease [heart artery blockages], and obesity was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
1059,"Rx: Tab methotrexate 15mg weekly. Tab clopidogrel 75mg daily. Tab hydroxychloroquine 200mg BID. Avoid grapefruit juice. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Do not drink grapefruit juice as it interferes with this medication. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Rheumatology,Prescription,medium
1060,"Rx: Tab metformin 500mg BID. Tab escitalopram 10mg daily. Tab sertraline 50mg daily. Tab atorvastatin 80mg QHS. Tab timolol 0.5% OU BID. Adv: high fiber diet, adequate hydration. F/U 1 week with CBC, CMP.","Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (5) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Psychiatry,Prescription,high
1061,"47 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 47-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1062,"Lipid panel: TC 287, LDL 139, HDL 51, TG 122.",Your cholesterol results: Total cholesterol is 287. LDL (bad cholesterol) is high at 139 (goal under 100). HDL (good cholesterol) is good at 51. Triglycerides are normal at 122.,Cardiology,Lab Result,high
1063,"LFTs: AST 200 (H), ALT 255 (H), ALP 68, T.Bili 0.7 (N), Albumin 3.2.","Your liver blood test results: Liver enzymes (AST 200, ALT 255) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is normal at 0.7. Albumin is low at 3.2 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
1064,"52 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 52-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1065,"46 y/o M with PMH of SLE, HTN, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on pantoprazole 40mg AC breakfast, Humalog per SSI, Dulcolax 10mg QHS PRN, acetaminophen 650mg Q6H PRN. F/U nephrology in 5 days.","A 46-year-old man with a history of lupus, and high blood pressure was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) Dulcolax 10mg at bedtime as needed [for constipation]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the kidney doctor in 5 days.",Orthopedics,Discharge Summary,high
1066,"BMP: Na 149 (H), K 3.8 (N), BUN 37, Cr 1.5 (H), Glucose 364.","Your blood chemistry results: Sodium is high at 149, meaning you may be dehydrated. Potassium is normal at 3.8. Creatinine is mildly elevated at 1.5. Blood sugar is 364 (high).",Nephrology,Lab Result,high
1067,"67 y/o F with PMH of GERD, anxiety, OA, s/p TKR, DVT/PE on warfarin, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on methotrexate 15mg weekly, spironolactone 25mg daily, ferrous sulfate 325mg BID, Lantus 20U QHS. F/U INR check in 3 days.","A 67-year-old woman with a history of acid reflux, anxiety, arthritis [osteoarthritis], prior knee replacement, and blood clots [on blood thinner warfarin] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up for a blood thinner level check in 3 days.",Nephrology,Discharge Summary,high
1068,"28 y/o M with PMH of obesity (BMI 38), h/o TIA, DM2, anemia, gout, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Lantus 20U QHS, metformin 1000mg BID, furosemide 40mg BID, gabapentin 300mg TID. F/U surgery in 2 weeks for drain removal.","A 28-year-old man with a history of obesity, history of mini-stroke, type 2 diabetes, low blood count [anemia], and gout was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the surgeon in 2 weeks to remove the drain.",Infectious Disease,Discharge Summary,high
1069,"CBC: WBC 8.7 (N), Hgb 7.9 (L), Plt 383 (N).","Your blood count results: White blood cells are 8.7 (normal). Hemoglobin is low at 7.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 383, which is normal.",Hematology,Lab Result,high
1070,"BMP: Na 138 (N), K 6.4 (H), BUN 7, Cr 3.8 (H), Glucose 381.","Your blood chemistry results: Sodium is normal at 138. Potassium is dangerously high at 6.4 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 3.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 381 (high).",Nephrology,Lab Result,high
1071,CXR PA: Small left pleural effusion. Hyperinflated lungs consistent with COPD. No pneumothorax. Bilateral hilar lymphadenopathy. ET tube 3cm above carina.,"Chest X-ray results: There is a small amount of fluid around the left lung. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There is no collapsed lung. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The breathing tube is in good position.",Pulmonology,Radiology Report,high
1072,"Lipid panel: TC 278, LDL 51, HDL 44, TG 54.",Your cholesterol results: Total cholesterol is 278. LDL (bad cholesterol) is at goal (51). HDL (good cholesterol) is good at 44. Triglycerides are normal at 54.,Cardiology,Lab Result,medium
1073,"26 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 26-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1074,"CBC: WBC 21.7 (H), Hgb 8.5 (L), Plt 147 (L).","Your blood count results: White blood cells are 21.7 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 8.5, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 147, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
1075,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,low
1076,HbA1c: 13.3% (H). FBS: 325 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.3%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 325, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1077,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,medium
1078,"73 y/o M with PMH of CAD, BPH, GERD, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on Augmentin 875/125 BID x 7 days, clopidogrel 75mg daily, atorvastatin 40mg QHS. F/U nephrology in 1 week.","A 73-year-old man with a history of coronary artery disease [heart artery blockages], enlarged prostate, and acid reflux was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
1079,"Rx: Tab lisinopril 10mg daily. Tab levothyroxine 75mcg daily on empty stomach. Tab losartan 50mg daily. Tab Eliquis 5mg BID. Tab warfarin 5mg daily. Adv: avoid alcohol, hepatotoxic drugs. F/U 1 month with repeat imaging.",Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) losartan 50mg once daily [blood pressure medicine]. (4) Eliquis 5mg twice daily [blood thinner]. (5) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,high
1080,"70 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 70-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1081,"47 y/o F with PMH of Parkinson's disease, SLE, RA on MTX, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on Spiriva 18mcg daily, sertraline 50mg daily. F/U nephrology in 5 days.","A 47-year-old woman with a history of Parkinson's disease, lupus, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the kidney doctor in 5 days.",Infectious Disease,Discharge Summary,high
1082,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. Multilevel degenerative disc disease. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. Multiple discs in the spine are showing wear and aging. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
1083,MRI Lumbar Spine: No compression fracture. Multilevel degenerative disc disease. Central canal stenosis at L3-L4.,"MRI of the lower back results: No bones are broken or collapsed. Multiple discs in the spine are showing wear and aging. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
1084,"CBC: WBC 18.4 (H), Hgb 16.9 (N), Plt 391 (N).","Your blood count results: White blood cells are 18.4 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 16.9. Platelets are 391, which is normal.",Hematology,Lab Result,high
1085,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. No midline shift. No acute intracranial hemorrhage. Chronic lacunar infarcts in bilateral basal ganglia. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. The brain is centered normally. There is no bleeding in the brain. There are signs of small old strokes in the deep parts of the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
1086,"82 y/o F with PMH of COPD, A-fib, depression, HTN, seizure disorder on Keppra, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Spiriva 18mcg daily, montelukast 10mg QHS, Xarelto 20mg daily with dinner, potassium chloride 20mEq daily. F/U surgery in 10 days.","A 82-year-old woman with a history of chronic lung disease, irregular heartbeat [atrial fibrillation], depression, high blood pressure, and seizure disorder [on Keppra] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]; (3) Xarelto 20mg once daily with dinner [blood thinner]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the surgeon in 10 days.",Gastroenterology,Discharge Summary,high
1087,"30 y/o F with PMH of DVT/PE on warfarin, cirrhosis, CHF, s/p TKR, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Xarelto 20mg daily with dinner, glipizide 5mg BID AC. F/U endocrine in 1 week.","A 30-year-old woman with a history of blood clots [on blood thinner warfarin], liver scarring [cirrhosis], heart failure, and prior knee replacement was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the hormone/diabetes doctor in 1 week.",Neurology,Discharge Summary,high
1088,CXR PA: Bilateral pleural effusions. Small left pleural effusion. Compression fracture T12. Mild cardiomegaly. Port-a-cath in appropriate position.,Chest X-ray results: There is fluid collecting around both lungs. There is a small amount of fluid around the left lung. There is a compression fracture [collapsed bone] in the lower spine at T12. The heart is slightly larger than normal. The implanted medication port is in the correct position.,Pulmonology,Radiology Report,high
1089,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,high
1090,"28 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 28-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1091,"34 y/o M with PMH of OA, HTN, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on amlodipine 10mg daily, Lantus 20U QHS. F/U cardiology in 2 weeks.","A 34-year-old man with a history of arthritis [osteoarthritis], and high blood pressure was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the heart doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
1092,"MRI Lumbar Spine: Conus medullaris at L1, normal. Multilevel degenerative disc disease. Central canal stenosis at L3-L4.","MRI of the lower back results: The spinal cord ends at a normal level. Multiple discs in the spine are showing wear and aging. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
1093,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. No acute intracranial hemorrhage. No midline shift.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is no bleeding in the brain. The brain is centered normally.",Neurology,Radiology Report,high
1094,"Rx: Tab potassium chloride 20mEq daily. Tab metoprolol 25mg BID. Tab pantoprazole 40mg AC breakfast. Tab latanoprost 0.005% OU QHS. Tab ASA 81mg daily. Avoid grapefruit juice Adv: high fiber diet, adequate hydration. F/U 2 weeks.","Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (5) baby aspirin 81mg once daily [prevents blood clots]. Do not drink grapefruit juice as it interferes with this medication Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
1095,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,high
1096,"Rx: Lantus 20U QHS. Tab amlodipine 5mg daily. Tab timolol 0.5% OU BID. Adv: SMBG BID, diabetic diet. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
1097,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1098,"91 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 91-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
1099,"80 y/o M with PMH of PPM in situ, DM2, HLD, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Strict I&O, daily weights. D/C on empagliflozin 10mg daily, atorvastatin 80mg QHS, hydroxychloroquine 200mg BID, prednisone taper. F/U nephrology in 5 days.","A 80-year-old man with a history of implanted pacemaker, type 2 diabetes, and high cholesterol was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the kidney doctor in 5 days.",General Surgery,Discharge Summary,high
1100,"60 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 60-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1101,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain.",Neurology,Radiology Report,high
1102,Procedure: EGD with biopsy. Pt 40 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 40-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1103,"81 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 81-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1104,CT Head without contrast: No mass effect. Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage.,CT scan of the head results: There are no tumors or masses pushing on the brain. There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain.,Neurology,Radiology Report,high
1105,"77 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 77-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1106,"64 y/o M with PMH of cirrhosis, DM1, HFpEF, SLE, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on ondansetron 4mg Q8H PRN N/V, metoprolol succinate 50mg daily, Humalog per SSI, calcium + vitamin D 600/400 daily. F/U neurology in 2 weeks.","A 64-year-old man with a history of liver scarring [cirrhosis], type 1 diabetes, heart failure with stiff heart muscle, and lupus was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) Humalog insulin before meals as directed [fast-acting insulin]; (4) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the brain/nerve doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
1107,"Rx: Tab warfarin 5mg daily. Tab gabapentin 300mg TID. Adv: DASH diet, daily BP monitoring. F/U INR in 3 days.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 3 days for a blood thinner level check [INR].",Neurology,Prescription,medium
1108,"US Abdomen: GB sludge, no stones. Left kidney 8cm, cortical thinning consistent with CKD. CBD 5mm, not dilated. Right kidney 10.5cm, no hydronephrosis. Ascites moderate amount. Simple renal cysts bilaterally.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The bile duct is normal size [not blocked]. Right kidney is normal size with no blockage. There is a moderate amount of fluid in the belly [ascites]. Both kidneys have harmless fluid-filled cysts.",Gastroenterology,Radiology Report,high
1109,"51 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 51-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
1110,"Rx: Tab Xarelto 20mg daily with dinner. Tab levothyroxine 75mcg daily on empty stomach. prednisone taper. Tab amlodipine 10mg daily. Tab tramadol 50mg Q6H PRN pain. Adv: low potassium diet Adv: SMBG BID, diabetic diet. F/U 1 week with CBC, CMP.","Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (4) amlodipine 10mg once daily [blood pressure medicine]. (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
1111,"Rx: Tab atorvastatin 40mg QHS. Tab Xarelto 20mg daily with dinner. Tab ondansetron 4mg Q8H PRN N/V. Adv: low salt diet, fluid restriction 1.5L/day. F/U 1 week with CBC, CMP.",Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,medium
1112,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,high
1113,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1114,CXR PA: Osseous structures intact. Pacemaker leads in appropriate position. Compression fracture T12. Moderate right pleural effusion. Right middle lobe atelectasis.,"Chest X-ray results: The bones look normal with no fractures. The pacemaker wires are in the correct position. There is a compression fracture [collapsed bone] in the lower spine at T12. There is a moderate amount of fluid around the right lung. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
1115,"Rx: Tab gabapentin 300mg TID. Tab lisinopril 10mg daily. Humalog per SSI. Lantus 20U QHS. Tab ASA 81mg daily. Adv: elevate affected limb, compression stockings. F/U 6 weeks with LFTs.",Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) Humalog insulin before meals as directed [fast-acting insulin]. (4) Lantus insulin 20 units at bedtime [long-acting insulin]. (5) baby aspirin 81mg once daily [prevents blood clots]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,high
1116,"26 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 26-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1117,"89 y/o F with PMH of ICD in situ, anemia, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on pantoprazole 40mg AC breakfast, azithromycin 500mg day 1 then 250mg x 4 days. F/U pulmonology in 2 weeks.","A 89-year-old woman with a history of implanted heart defibrillator, and low blood count [anemia] was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the lung doctor in 2 weeks.",Cardiology,Discharge Summary,high
1118,"63 y/o M with PMH of CKD Stage 4, HFpEF, depression, SLE, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Compression stockings when ambulating. D/C on lisinopril 20mg daily, Spiriva 18mcg daily, amoxicillin 500mg TID x 10 days, Dulcolax 10mg QHS PRN. F/U GI in 1 week.","A 63-year-old man with a history of advanced kidney disease, heart failure with stiff heart muscle, depression, and lupus was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (4) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the stomach doctor in 1 week.",Gastroenterology,Discharge Summary,high
1119,"69 y/o M with PMH of s/p THR, depression, gout, s/p TKR, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Augmentin 875/125 BID x 7 days, acetaminophen 650mg Q6H PRN. F/U pulmonology in 2 weeks.","A 69-year-old man with a history of prior hip replacement, depression, gout, and prior knee replacement was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the lung doctor in 2 weeks.",General Surgery,Discharge Summary,high
1120,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
1121,Rx: Tab hydroxychloroquine 200mg BID. Tab azithromycin 500mg day 1 then 250mg x 4 days. prednisone taper. Humalog per SSI. Avoid grapefruit juice. F/U 2 weeks with INR.,"Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (4) Humalog insulin before meals as directed [fast-acting insulin]. Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks for a blood thinner level check [INR].",Rheumatology,Prescription,high
1122,"29 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 29-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1123,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
1124,"48 y/o M with PMH of CKD Stage 4, HLD, Parkinson's disease, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on lisinopril 10mg daily, acetaminophen 650mg Q6H PRN, prednisone taper. F/U endocrine in 1 week.","A 48-year-old man with a history of advanced kidney disease, high cholesterol, and Parkinson's disease was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
1125,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1126,"52 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 52-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1127,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab metformin 500mg BID. Tab losartan 50mg daily. Tab Eliquis 5mg BID. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: low potassium diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) losartan 50mg once daily [blood pressure medicine]. (4) Eliquis 5mg twice daily [blood thinner]. (5) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Infectious Disease,Prescription,high
1128,Procedure: Colonoscopy with polypectomy. Pt 33 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 33-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1129,CXR PA: Pacemaker leads in appropriate position. Right middle lobe atelectasis. Sternotomy wires intact.,"Chest X-ray results: The pacemaker wires are in the correct position. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The wires from prior heart surgery are intact.",Pulmonology,Radiology Report,high
1130,"57 y/o M with PMH of seizure disorder on Keppra, CKD Stage 3, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on metformin 500mg BID, Dulcolax 10mg QHS PRN, gabapentin 300mg TID, Spiriva 18mcg daily. F/U orthopedics in 6 weeks with X-ray.","A 57-year-old man with a history of seizure disorder [on Keppra], and moderate kidney disease was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (4) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Infectious Disease,Discharge Summary,high
1131,"78 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 78-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1132,Procedure: Laparoscopic cholecystectomy. Pt 87 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 87-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1133,"LFTs: AST 79 (H), ALT 81 (H), ALP 214, T.Bili 1.7 (H), Albumin 4.9.","Your liver blood test results: Liver enzymes (AST 79, ALT 81) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is mildly elevated at 1.7. Albumin is normal at 4.9.",Gastroenterology,Lab Result,high
1134,HbA1c: 9.4% (H). FBS: 134 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.4%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 134, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
1135,CXR PA: Left lower lobe consolidation. Pacemaker leads in appropriate position. Bilateral pleural effusions. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: There is an area in the lower left lung that appears infected. The pacemaker wires are in the correct position. There is fluid collecting around both lungs. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
1136,"MRI Lumbar Spine: C5-C6 disc herniation with cord compression. L5-S1 disc desiccation with mild bulge. No compression fracture. Conus medullaris at L1, normal.","MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. No bones are broken or collapsed. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
1137,Procedure: PCI with DES to LAD. Pt 86 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 86-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
1138,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
1139,"Rx: Spiriva 18mcg daily. Tab metformin 500mg BID. Tab rosuvastatin 10mg QHS. Tab entresto 49/51mg BID. Adv: low salt low sugar diet, regular exercise. F/U 1 week with CBC, CMP.","Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) Entresto 49/51mg twice daily [heart failure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
1140,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab calcium + vitamin D 600/400 daily. Tab gabapentin 300mg TID. Tab metoprolol succinate 50mg daily. Adv: low salt low sugar diet, regular exercise Avoid grapefruit juice. F/U 2 weeks with INR.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) calcium plus vitamin D once daily [bone strengthening]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks for a blood thinner level check [INR].",General,Prescription,high
1141,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1142,"70 y/o F with PMH of HFpEF, asthma, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on montelukast 10mg QHS, clopidogrel 75mg daily, Eliquis 5mg BID. F/U oncology in 1 week.","A 70-year-old woman with a history of heart failure with stiff heart muscle, and asthma was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) Eliquis 5mg twice daily [blood thinner]. Follow-up with the cancer doctor in 1 week.",Endocrinology,Discharge Summary,high
1143,Procedure: Laparoscopic appendectomy. Pt 87 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 87-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1144,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
1145,"Rx: Spiriva 18mcg daily. Tab ASA 81mg daily. Avoid grapefruit juice Adv: DASH diet, daily BP monitoring. F/U 2 weeks.","Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. Do not drink grapefruit juice as it interferes with this medication Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
1146,"70 y/o F with PMH of OA, CHF, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Strict I&O, daily weights. D/C on azithromycin 500mg day 1 then 250mg x 4 days, metoprolol succinate 50mg daily, amoxicillin 500mg TID x 10 days. F/U surgery in 10 days.","A 70-year-old woman with a history of arthritis [osteoarthritis], and heart failure was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the surgeon in 10 days.",Orthopedics,Discharge Summary,high
1147,"MRI Lumbar Spine: No compression fracture. Conus medullaris at L1, normal. Central canal stenosis at L3-L4. Multilevel degenerative disc disease.","MRI of the lower back results: No bones are broken or collapsed. The spinal cord ends at a normal level. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
1148,"US Abdomen: CBD 12mm, dilated. GB wall thickening with stones, positive Murphy's sign. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. GB sludge, no stones. Pancreas unremarkable.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The gallbladder contains thickened bile [sludge] but no stones. The pancreas looks normal.",Gastroenterology,Radiology Report,high
1149,CT Head without contrast: No acute intracranial hemorrhage. Mild generalized cerebral atrophy appropriate for age. Paranasal sinuses clear. No midline shift. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There is no bleeding in the brain. There is mild brain shrinkage, which is normal for your age. The sinuses are clear with no infection. The brain is centered normally. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
1150,"44 y/o F with PMH of s/p TKR, HTN, DVT/PE on warfarin, RA on MTX, hypothyroidism, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on pregabalin 75mg BID, gabapentin 300mg TID, ibuprofen 400mg Q6H PRN with food, Lantus 20U QHS. F/U INR check in 3 days.","A 44-year-old woman with a history of prior knee replacement, high blood pressure, blood clots [on blood thinner warfarin], rheumatoid arthritis [on immune-suppressing medicine], and underactive thyroid was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up for a blood thinner level check in 3 days.",Endocrinology,Discharge Summary,high
1151,"78 y/o M with PMH of ICD in situ, COPD, CHF, HLD, DM1, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on potassium chloride 20mEq daily, losartan 50mg daily, hydroxychloroquine 200mg BID, atorvastatin 80mg QHS. F/U PCP in 1 week.","A 78-year-old man with a history of implanted heart defibrillator, chronic lung disease, heart failure, high cholesterol, and type 1 diabetes was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) losartan 50mg once daily [blood pressure medicine]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the primary care doctor in 1 week.",Endocrinology,Discharge Summary,high
1152,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
1153,Procedure: TURP for BPH. Pt 62 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 62-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
1154,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,low
1155,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1156,HbA1c: 13.1% (H). FBS: 78 mg/dL (N).,"Your diabetes blood test results: HbA1c is 13.1%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 78, which is normal (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1157,"27 y/o F with PMH of cirrhosis, PPM in situ, h/o CVA, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on lisinopril 20mg daily, gabapentin 300mg TID, amlodipine 10mg daily. F/U neurology in 2 weeks.","A 27-year-old woman with a history of liver scarring [cirrhosis], implanted pacemaker, and history of stroke was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Pulmonology,Discharge Summary,high
1158,CXR PA: Sternotomy wires intact. No cardiomegaly. NG tube tip in stomach. Port-a-cath in appropriate position.,Chest X-ray results: The wires from prior heart surgery are intact. The heart is a normal size. The feeding/drainage tube tip is correctly positioned in the stomach. The implanted medication port is in the correct position.,Pulmonology,Radiology Report,high
1159,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,high
1160,"69 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 69-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
1161,"Lipid panel: TC 143, LDL 138, HDL 56, TG 435.",Your cholesterol results: Total cholesterol is 143. LDL (bad cholesterol) is high at 138 (goal under 100). HDL (good cholesterol) is good at 56. Triglycerides are very high at 435 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
1162,"69 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 69-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1163,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1164,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. Subarachnoid hemorrhage in bilateral sylvian fissures. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There is bleeding around the brain surface, particularly in the grooves on both sides. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
1165,"Lipid panel: TC 240, LDL 144, HDL 25, TG 383.","Your cholesterol results: Total cholesterol is 240. LDL (bad cholesterol) is high at 144 (goal under 100). HDL (good cholesterol) is too low at 25 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 383 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
1166,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
1167,"Rx: Tab Dulcolax 10mg QHS PRN. Tab ondansetron 4mg Q8H PRN N/V. Adv: smoking cessation, pulmonary rehab Adv: SMBG BID, diabetic diet. F/U INR in 3 days.",Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 3 days for a blood thinner level check [INR].,General,Prescription,medium
1168,"BMP: Na 129 (L), K 2.8 (L), BUN 61, Cr 4.8 (H), Glucose 262.","Your blood chemistry results: Sodium is low at 129 (normal 136-145), meaning too much water in your body. Potassium is low at 2.8 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 4.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 262 (high).",Nephrology,Lab Result,high
1169,CXR PA: Moderate right pleural effusion. Clear lung fields bilaterally. Right middle lobe atelectasis. Right-sided pneumothorax. Osseous structures intact.,"Chest X-ray results: There is a moderate amount of fluid around the right lung. Both lungs look clear with no problems. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The bones look normal with no fractures.",Pulmonology,Radiology Report,high
1170,"LFTs: AST 308 (H), ALT 483 (H), ALP 67, T.Bili 6.6 (H), Albumin 2.5.","Your liver blood test results: Liver enzymes (AST 308, ALT 483) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.6 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.5 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
1171,"Rx: Tab escitalopram 10mg daily. Tab atorvastatin 40mg QHS. Tab levothyroxine 75mcg daily on empty stomach. Tab acetaminophen 650mg Q6H PRN. Tab ciprofloxacin 500mg BID x 5 days. Avoid NSAIDs Adv: low salt low sugar diet, regular exercise. F/U 1 week with wound check.","Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (5) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
1172,"CBC: WBC 19.5 (H), Hgb 10.8 (L), Plt 51 (L).","Your blood count results: White blood cells are 19.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 10.8, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 51, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
1173,CXR PA: Moderate right pleural effusion. Compression fracture T12. Left lower lobe consolidation. Right middle lobe atelectasis.,"Chest X-ray results: There is a moderate amount of fluid around the right lung. There is a compression fracture [collapsed bone] in the lower spine at T12. There is an area in the lower left lung that appears infected. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
1174,"64 y/o F with PMH of HLD, hypothyroidism, SLE, anemia, ICD in situ, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on ondansetron 4mg Q8H PRN N/V, prednisone taper. F/U hematology in 2 weeks.","A 64-year-old woman with a history of high cholesterol, underactive thyroid, lupus, low blood count [anemia], and implanted heart defibrillator was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the blood disorder doctor in 2 weeks.",Urology,Discharge Summary,high
1175,"54 y/o M with PMH of RA on MTX, asthma, PAD, HLD, A-fib, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on lisinopril 10mg daily, spironolactone 25mg daily, Xarelto 20mg daily with dinner. F/U neurology in 2 weeks.","A 54-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], asthma, poor blood flow in the legs [peripheral artery disease], high cholesterol, and irregular heartbeat [atrial fibrillation] was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
1176,Delivery Note: G?P? at 37+3 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1177,"25 y/o M with PMH of GERD, CAD, depression, A-fib, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on calcium + vitamin D 600/400 daily, metformin 500mg BID, lisinopril 10mg daily. F/U orthopedics in 6 weeks with X-ray.","A 25-year-old man with a history of acid reflux, coronary artery disease [heart artery blockages], depression, and irregular heartbeat [atrial fibrillation] was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) calcium plus vitamin D once daily [bone strengthening]; (2) metformin 500mg twice daily with meals [blood sugar medicine]; (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",General Surgery,Discharge Summary,high
1178,"51 y/o M with PMH of s/p TKR, ICD in situ, A-fib, anxiety, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Strict I&O, daily weights. D/C on carvedilol 12.5mg BID, prednisone taper, pantoprazole 40mg AC breakfast. F/U wound care in 3 days.","A 51-year-old man with a history of prior knee replacement, implanted heart defibrillator, irregular heartbeat [atrial fibrillation], and anxiety was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up at the wound care clinic in 3 days.",General Surgery,Discharge Summary,high
1179,"Rx: Tab lisinopril 10mg daily. Tab entresto 49/51mg BID. Tab potassium chloride 20mEq daily. Avoid grapefruit juice Adv: low salt diet, fluid restriction 1.5L/day. F/U INR in 3 days.",Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Do not drink grapefruit juice as it interferes with this medication Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,medium
1180,CT Head without contrast: No midline shift. Chronic lacunar infarcts in bilateral basal ganglia. 4cm right subdural hematoma with 5mm midline shift. Acute ischemic infarct in R MCA territory. No mass effect.,"CT scan of the head results: The brain is centered normally. There are signs of small old strokes in the deep parts of the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
1181,"33 y/o F with PMH of Parkinson's disease, OA, depression, PPM in situ, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on clopidogrel 75mg daily, prednisone taper, metoprolol 25mg BID, furosemide 40mg daily, metformin 1000mg BID. F/U orthopedics in 6 weeks with X-ray.","A 33-year-old woman with a history of Parkinson's disease, arthritis [osteoarthritis], depression, and implanted pacemaker was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (5) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Infectious Disease,Discharge Summary,high
1182,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
1183,"58 y/o M with PMH of osteoporosis, asthma, h/o CVA, hypothyroidism, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Spiriva 18mcg daily, potassium chloride 20mEq daily, furosemide 40mg BID, atorvastatin 80mg QHS. F/U surgery in 10 days.","A 58-year-old man with a history of weak bones [osteoporosis], asthma, history of stroke, and underactive thyroid was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the surgeon in 10 days.",Infectious Disease,Discharge Summary,high
1184,CXR PA: Right-sided pneumothorax. NG tube tip in stomach. Small left pleural effusion.,Chest X-ray results: The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The feeding/drainage tube tip is correctly positioned in the stomach. There is a small amount of fluid around the left lung.,Pulmonology,Radiology Report,high
1185,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1186,"Rx: Tab metformin 1000mg BID. Humalog per SSI. Tab furosemide 40mg BID. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks with INR.",Your medicines: (1) metformin 1000mg twice daily with meals [blood sugar medicine]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) furosemide (Lasix) 40mg twice daily [water pill]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 2 weeks for a blood thinner level check [INR].,Endocrinology,Prescription,medium
1187,CXR PA: Widened mediastinum. No pneumothorax. Right-sided pneumothorax. NG tube tip in stomach. Right lower lobe consolidation.,"Chest X-ray results: The space between the lungs appears wider than normal, which needs further evaluation. There is no collapsed lung. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The feeding/drainage tube tip is correctly positioned in the stomach. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
1188,"76 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 76-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1189,CXR PA: Right lower lobe consolidation. Increased interstitial markings suggesting pulmonary edema. Bilateral hilar lymphadenopathy. Hyperinflated lungs consistent with COPD. Pacemaker leads in appropriate position.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The pacemaker wires are in the correct position.",Pulmonology,Radiology Report,high
1190,"US Abdomen: Left kidney 8cm, cortical thinning consistent with CKD. CBD 12mm, dilated. Spleen 11cm, normal. Simple renal cysts bilaterally. Right kidney 10.5cm, no hydronephrosis.","Abdominal ultrasound results: Left kidney is small with thin outer layer, consistent with chronic kidney disease. The bile duct is wider than normal [dilated], which may indicate a blockage. The spleen is a normal size. Both kidneys have harmless fluid-filled cysts. Right kidney is normal size with no blockage.",Gastroenterology,Radiology Report,high
1191,"LFTs: AST 115 (H), ALT 445 (H), ALP 284, T.Bili 6.1 (H), Albumin 2.1.","Your liver blood test results: Liver enzymes (AST 115, ALT 445) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.1 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.1 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
1192,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
1193,"42 y/o F with PMH of seizure disorder on Keppra, HLD, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on tramadol 50mg Q6H PRN pain, rosuvastatin 10mg QHS, potassium chloride 20mEq daily, albuterol MDI 2 puffs Q4-6H PRN. F/U surgery in 10 days.","A 42-year-old woman with a history of seizure disorder [on Keppra], and high cholesterol was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
1194,"74 y/o F with PMH of osteoporosis, ESRD on HD, hypothyroidism, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on lisinopril 20mg daily, tramadol 50mg Q6H PRN pain, furosemide 40mg daily, ondansetron 4mg Q8H PRN N/V. F/U surgery in 10 days.","A 74-year-old woman with a history of weak bones [osteoporosis], kidney failure requiring dialysis, and underactive thyroid was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
1195,"74 y/o F with PMH of A-fib, HLD, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on timolol 0.5% OU BID, amlodipine 10mg daily, empagliflozin 10mg daily, glipizide 5mg BID AC. F/U nephrology in 5 days.","A 74-year-old woman with a history of irregular heartbeat [atrial fibrillation], and high cholesterol was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (4) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the kidney doctor in 5 days.",Endocrinology,Discharge Summary,high
1196,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Mild generalized cerebral atrophy appropriate for age. Paranasal sinuses clear.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is mild brain shrinkage, which is normal for your age. The sinuses are clear with no infection.",Neurology,Radiology Report,high
1197,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1198,"LFTs: AST 44 (H), ALT 184 (H), ALP 149, T.Bili 7.2 (H), Albumin 3.6.","Your liver blood test results: Liver enzymes (AST 44, ALT 184) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is high at 7.2 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.6.",Gastroenterology,Lab Result,high
1199,Rx: Tab atorvastatin 40mg QHS. Tab ondansetron 4mg Q8H PRN N/V. Adv: low potassium diet. F/U PCP in 1 week for BP recheck.,"Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
1200,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1201,"Rx: Tab gabapentin 300mg TID. Tab Dulcolax 10mg QHS PRN. Adv: fall precautions, home safety evaluation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Neurology,Prescription,medium
1202,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1203,Procedure: Colonoscopy with polypectomy. Pt 68 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 68-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1204,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
1205,"Thyroid panel: TSH 5.45 (H), Free T4 1.2.","Your thyroid test results: TSH is elevated at 5.45 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
1206,"69 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 69-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1207,"Rx: Tab calcium + vitamin D 600/400 daily. Tab furosemide 40mg BID. Do not stop abruptly, taper as directed Adv: wound care with daily dressing changes. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) furosemide (Lasix) 40mg twice daily [water pill]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
1208,"64 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 64-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1209,"MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. Facet joint hypertrophy at L4-L5. C5-C6 disc herniation with cord compression. Conus medullaris at L1, normal.","MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The small joints in the spine at L4-L5 are enlarged from arthritis. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
1210,"LFTs: AST 272 (H), ALT 61 (H), ALP 81, T.Bili 4.2 (H), Albumin 4.5.","Your liver blood test results: Liver enzymes (AST 272, ALT 61) are mildly elevated (normal is under 40). Bilirubin is high at 4.2 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.5.",Gastroenterology,Lab Result,high
1211,"Thyroid panel: TSH 2.84 (N), Free T4 1.1.",Your thyroid test results: TSH is normal at 2.84. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
1212,CXR PA: Mild cardiomegaly. ET tube 3cm above carina. Bilateral pleural effusions.,Chest X-ray results: The heart is slightly larger than normal. The breathing tube is in good position. There is fluid collecting around both lungs.,Pulmonology,Radiology Report,high
1213,"61 y/o M with PMH of s/p CABG, s/p THR, CKD Stage 4, cirrhosis, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on rosuvastatin 10mg QHS, lisinopril 20mg daily, ibuprofen 400mg Q6H PRN with food. F/U hematology in 2 weeks.","A 61-year-old man with a history of prior heart bypass surgery, prior hip replacement, advanced kidney disease, and liver scarring [cirrhosis] was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the blood disorder doctor in 2 weeks.",Pulmonology,Discharge Summary,high
1214,"US Abdomen: CBD 5mm, not dilated. GB wall thickening with stones, positive Murphy's sign. Pancreas unremarkable.","Abdominal ultrasound results: The bile duct is normal size [not blocked]. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The pancreas looks normal.",Gastroenterology,Radiology Report,high
1215,"BMP: Na 150 (H), K 2.7 (L), BUN 66, Cr 2.6 (H), Glucose 235.","Your blood chemistry results: Sodium is high at 150, meaning you may be dehydrated. Potassium is low at 2.7 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 2.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 235 (high).",Nephrology,Lab Result,high
1216,"US Abdomen: Spleen 11cm, normal. Spleen 16cm, splenomegaly. CBD 12mm, dilated.","Abdominal ultrasound results: The spleen is a normal size. The spleen is enlarged [splenomegaly]. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
1217,"Rx: Tab warfarin 5mg daily. Tab glipizide 5mg BID AC. Tab entresto 49/51mg BID. Tab furosemide 40mg daily. Adv: low salt low sugar diet, regular exercise Adv: elevate affected limb, compression stockings. F/U INR in 3 days.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) glipizide 5mg twice daily before meals [helps release insulin]. (3) Entresto 49/51mg twice daily [heart failure medicine]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
1218,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1219,Procedure: ORIF L distal radius. Pt 40 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 40-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1220,"Rx: Humalog per SSI. Tab ibuprofen 400mg Q6H PRN with food. Tab glipizide 5mg BID AC. Tab furosemide 40mg daily. Tab levothyroxine 75mcg daily on empty stomach. Adv: smoking cessation, pulmonary rehab. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (3) glipizide 5mg twice daily before meals [helps release insulin]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (5) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Endocrinology,Prescription,high
1221,"Rx: Tab empagliflozin 10mg daily. Lantus 20U QHS. Tab ferrous sulfate 325mg BID. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks with INR.","Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) Lantus insulin 20 units at bedtime [long-acting insulin]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 2 weeks for a blood thinner level check [INR].",Endocrinology,Prescription,medium
1222,"31 y/o M with PMH of PPM in situ, h/o CVA, DM2, gout, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Strict I&O, daily weights. D/C on Augmentin 875/125 BID x 7 days, omeprazole 20mg AC breakfast, metformin 500mg BID. F/U PCP in 1 week.","A 31-year-old man with a history of implanted pacemaker, history of stroke, type 2 diabetes, and gout was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the primary care doctor in 1 week.",Infectious Disease,Discharge Summary,high
1223,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. Central canal stenosis at L3-L4.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
1224,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab warfarin 5mg daily. Adv: low salt low sugar diet, regular exercise Avoid NSAIDs. F/U 1 week with wound check.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 week to have the wound checked.",Hematology,Prescription,medium
1225,"BMP: Na 137 (N), K 4.0 (N), BUN 28, Cr 4.9 (H), Glucose 216.","Your blood chemistry results: Sodium is normal at 137. Potassium is normal at 4.0. Creatinine is elevated at 4.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 216 (high).",Nephrology,Lab Result,high
1226,"US Abdomen: Ascites moderate amount. CBD 5mm, not dilated. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. The bile duct is normal size [not blocked]. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
1227,"BMP: Na 137 (N), K 5.5 (H), BUN 42, Cr 3.7 (H), Glucose 351.","Your blood chemistry results: Sodium is normal at 137. Potassium is high at 5.5 — needs monitoring. Creatinine is elevated at 3.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 351 (high).",Nephrology,Lab Result,high
1228,"34 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 34-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1229,"27 y/o M with PMH of CKD Stage 4, cirrhosis, anxiety, HLD, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on atorvastatin 80mg QHS, escitalopram 10mg daily, amoxicillin 500mg TID x 10 days, sertraline 50mg daily. F/U nephrology in 5 days.","A 27-year-old man with a history of advanced kidney disease, liver scarring [cirrhosis], anxiety, and high cholesterol was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (4) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the kidney doctor in 5 days.",Infectious Disease,Discharge Summary,high
1230,"Rx: Tab metformin 500mg BID. Tab amlodipine 5mg daily. Avoid NSAIDs Adv: smoking cessation, pulmonary rehab. F/U 1 week with CBC, CMP.",Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,medium
1231,HbA1c: 11.0% (H). FBS: 361 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.0%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 361, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1232,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1233,"80 y/o M with PMH of cirrhosis, ESRD on HD, obesity (BMI 38), admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on amoxicillin 500mg TID x 10 days, warfarin 5mg daily, escitalopram 10mg daily, albuterol MDI 2 puffs Q4-6H PRN. F/U INR check in 3 days.","A 80-year-old man with a history of liver scarring [cirrhosis], kidney failure requiring dialysis, and obesity was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
1234,"84 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 84-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1235,"BMP: Na 123 (L), K 5.2 (H), BUN 81, Cr 3.2 (H), Glucose 164.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is high at 5.2 — needs monitoring. Creatinine is elevated at 3.2 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 164 (high).",Nephrology,Lab Result,high
1236,"49 y/o M with PMH of s/p CABG, h/o CVA, CKD Stage 4, BPH, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on methotrexate 15mg weekly, amoxicillin 500mg TID x 10 days, calcium + vitamin D 600/400 daily. F/U endocrine in 1 week.","A 49-year-old man with a history of prior heart bypass surgery, history of stroke, advanced kidney disease, and enlarged prostate was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the hormone/diabetes doctor in 1 week.",Endocrinology,Discharge Summary,high
1237,MRI Lumbar Spine: Multilevel degenerative disc disease. L5-S1 disc desiccation with mild bulge. L4-L5 disc herniation with moderate bilateral foraminal stenosis. No compression fracture.,"MRI of the lower back results: Multiple discs in the spine are showing wear and aging. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
1238,"Rx: Tab omeprazole 20mg AC breakfast. Tab hydroxychloroquine 200mg BID. Adv: SMBG BID, diabetic diet. F/U PCP in 1 week for BP recheck.",Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. See your primary care doctor in 1 week to recheck blood pressure.,Gastroenterology,Prescription,medium
1239,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1240,"70 y/o F with PMH of depression, h/o CVA, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on ciprofloxacin 500mg BID x 5 days, Humalog per SSI, tramadol 50mg Q6H PRN pain, losartan 50mg daily. F/U wound care in 3 days.","A 70-year-old woman with a history of depression, and history of stroke was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (4) losartan 50mg once daily [blood pressure medicine]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
1241,"67 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 67-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1242,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1243,"81 y/o F with PMH of A-fib, CHF, OSA on CPAP, obesity (BMI 38), gout, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on warfarin 5mg daily, losartan 50mg daily, entresto 49/51mg BID, Augmentin 875/125 BID x 7 days, sertraline 50mg daily. F/U nephrology in 5 days.","A 81-year-old woman with a history of irregular heartbeat [atrial fibrillation], heart failure, sleep apnea [uses a breathing machine at night], obesity, and gout was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) losartan 50mg once daily [blood pressure medicine]; (3) Entresto 49/51mg twice daily [heart failure medicine]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]; (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the kidney doctor in 5 days.",Infectious Disease,Discharge Summary,high
1244,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Mild generalized cerebral atrophy appropriate for age. Paranasal sinuses clear. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is mild brain shrinkage, which is normal for your age. The sinuses are clear with no infection. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
1245,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Acute ischemic infarct in R MCA territory. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
1246,"Lipid panel: TC 162, LDL 180, HDL 71, TG 85.","Your cholesterol results: Total cholesterol is 162. LDL (bad cholesterol) is very high at 180 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 71. Triglycerides are normal at 85.",Cardiology,Lab Result,high
1247,"Rx: Tab lisinopril 20mg daily. Tab losartan 50mg daily. Tab timolol 0.5% OU BID. Tab furosemide 40mg BID. albuterol MDI 2 puffs Q4-6H PRN. Adv: low salt diet, fluid restriction 1.5L/day Adv: DASH diet, daily BP monitoring. F/U INR in 3 days.","Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) losartan 50mg once daily [blood pressure medicine]. (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
1248,"77 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 77-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1249,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab methotrexate 15mg weekly. Tab sertraline 50mg daily. Adv: fall precautions, home safety evaluation Adv: low potassium diet. F/U 1 week with wound check.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week to have the wound checked.",Psychiatry,Prescription,medium
1250,HbA1c: 12.4% (H). FBS: 167 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.4%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 167, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1251,"50 y/o F with PMH of osteoporosis, DVT/PE on warfarin, ICD in situ, gout, s/p THR, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on ciprofloxacin 500mg BID x 5 days, Dulcolax 10mg QHS PRN. F/U surgery in 10 days.","A 50-year-old woman with a history of weak bones [osteoporosis], blood clots [on blood thinner warfarin], implanted heart defibrillator, gout, and prior hip replacement was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
1252,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1253,CXR PA: Mild cardiomegaly. ET tube 3cm above carina. Hyperinflated lungs consistent with COPD. Left lower lobe consolidation.,"Chest X-ray results: The heart is slightly larger than normal. The breathing tube is in good position. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There is an area in the lower left lung that appears infected.",Pulmonology,Radiology Report,high
1254,"LFTs: AST 295 (H), ALT 496 (H), ALP 107, T.Bili 6.0 (H), Albumin 4.9.","Your liver blood test results: Liver enzymes (AST 295, ALT 496) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.0 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.9.",Gastroenterology,Lab Result,high
1255,"73 y/o F with PMH of Parkinson's disease, HTN, OA, HFpEF, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on potassium chloride 20mEq daily, clopidogrel 75mg daily, gabapentin 300mg TID. F/U nephrology in 5 days.","A 73-year-old woman with a history of Parkinson's disease, high blood pressure, arthritis [osteoarthritis], and heart failure with stiff heart muscle was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the kidney doctor in 5 days.",Cardiology,Discharge Summary,high
1256,"45 y/o F with PMH of CAD, hypothyroidism, BPH, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on methotrexate 15mg weekly, entresto 49/51mg BID, atorvastatin 40mg QHS. F/U cardiology in 2 weeks.","A 45-year-old woman with a history of coronary artery disease [heart artery blockages], underactive thyroid, and enlarged prostate was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the heart doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
1257,"80 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 80-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1258,"84 y/o M with PMH of CKD Stage 4, hypothyroidism, PAD, OSA on CPAP, anemia, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on pregabalin 75mg BID, calcium + vitamin D 600/400 daily, glipizide 5mg BID AC. F/U oncology in 1 week.","A 84-year-old man with a history of advanced kidney disease, underactive thyroid, poor blood flow in the legs [peripheral artery disease], sleep apnea [uses a breathing machine at night], and low blood count [anemia] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the cancer doctor in 1 week.",Gastroenterology,Discharge Summary,high
1259,Procedure: Laparoscopic appendectomy. Pt 35 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 35-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1260,"82 y/o M with PMH of HFpEF, PPM in situ, gout, hypothyroidism, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on ferrous sulfate 325mg BID, carvedilol 12.5mg BID, clopidogrel 75mg daily. F/U oncology in 1 week.","A 82-year-old man with a history of heart failure with stiff heart muscle, implanted pacemaker, gout, and underactive thyroid was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. Follow-up with the cancer doctor in 1 week.",Orthopedics,Discharge Summary,high
1261,Rx: Tab Dulcolax 10mg QHS PRN. Tab furosemide 40mg daily. Tab calcium + vitamin D 600/400 daily. Avoid grapefruit juice. F/U 6 weeks with LFTs.,Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) calcium plus vitamin D once daily [bone strengthening]. Do not drink grapefruit juice as it interferes with this medication. Come back in 6 weeks for liver function blood tests.,General,Prescription,medium
1262,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,high
1263,CT Head without contrast: No midline shift. Mild generalized cerebral atrophy appropriate for age. Paranasal sinuses clear. Acute ischemic infarct in R MCA territory. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: The brain is centered normally. There is mild brain shrinkage, which is normal for your age. The sinuses are clear with no infection. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
1264,"32 y/o F with PMH of OA, CAD, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on amoxicillin 500mg TID x 10 days, empagliflozin 10mg daily. F/U INR check in 3 days.","A 32-year-old woman with a history of arthritis [osteoarthritis], and coronary artery disease [heart artery blockages] was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up for a blood thinner level check in 3 days.",Gastroenterology,Discharge Summary,high
1265,"Rx: Humalog per SSI. Tab ondansetron 4mg Q8H PRN N/V. Adv: SMBG BID, diabetic diet. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Endocrinology,Prescription,medium
1266,"CBC: WBC 13.6 (H), Hgb 17.1 (H), Plt 112 (L).","Your blood count results: White blood cells are 13.6 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is elevated at 17.1. Platelets are 112, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
1267,"US Abdomen: Spleen 16cm, splenomegaly. Moderate right hydronephrosis. Spleen 11cm, normal.","Abdominal ultrasound results: The spleen is enlarged [splenomegaly]. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The spleen is a normal size.",Gastroenterology,Radiology Report,high
1268,"MRI Lumbar Spine: Conus medullaris at L1, normal. Central canal stenosis at L3-L4. No compression fracture.","MRI of the lower back results: The spinal cord ends at a normal level. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
1269,CXR PA: Elevated left hemidiaphragm. Right middle lobe atelectasis. Bilateral hilar lymphadenopathy.,"Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
1270,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1271,CXR PA: No pneumothorax. Port-a-cath in appropriate position. Sternotomy wires intact.,Chest X-ray results: There is no collapsed lung. The implanted medication port is in the correct position. The wires from prior heart surgery are intact.,Pulmonology,Radiology Report,high
1272,"68 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 68-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1273,"33 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 33-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
1274,"42 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 42-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1275,"51 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 51-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1276,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
1277,"BMP: Na 128 (L), K 4.9 (N), BUN 37, Cr 3.2 (H), Glucose 113.","Your blood chemistry results: Sodium is low at 128 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.9. Creatinine is elevated at 3.2 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 113 (high).",Nephrology,Lab Result,high
1278,MRI Lumbar Spine: No compression fracture. Facet joint hypertrophy at L4-L5. Multilevel degenerative disc disease.,MRI of the lower back results: No bones are broken or collapsed. The small joints in the spine at L4-L5 are enlarged from arthritis. Multiple discs in the spine are showing wear and aging.,Orthopedics,Radiology Report,high
1279,"Rx: Tab montelukast 10mg QHS. Tab carvedilol 12.5mg BID. Tab lisinopril 20mg daily. Adv: high fiber diet, adequate hydration. F/U 2 weeks with INR.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) carvedilol 12.5mg twice daily [heart medicine]. (3) lisinopril 20mg once daily [blood pressure medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
1280,"Rx: Tab furosemide 40mg BID. Tab Dulcolax 10mg QHS PRN. Tab potassium chloride 20mEq daily. Tab methotrexate 15mg weekly. Tab metformin 1000mg BID. Adv: DASH diet, daily BP monitoring Adv: elevate affected limb, compression stockings. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (5) metformin 1000mg twice daily with meals [blood sugar medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",General,Prescription,high
1281,"Rx: Tab metoprolol succinate 50mg daily. albuterol MDI 2 puffs Q4-6H PRN. Tab ondansetron 4mg Q8H PRN N/V. Tab furosemide 40mg BID. Lantus 20U QHS. Adv: fall precautions, home safety evaluation Avoid NSAIDs. F/U 1 month with repeat imaging.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
1282,"BMP: Na 127 (L), K 5.4 (H), BUN 10, Cr 0.8 (N), Glucose 353.","Your blood chemistry results: Sodium is low at 127 (normal 136-145), meaning too much water in your body. Potassium is high at 5.4 — needs monitoring. Creatinine is normal at 0.8. Blood sugar is 353 (high).",Nephrology,Lab Result,high
1283,HbA1c: 7.0% (H). FBS: 390 mg/dL (H).,"Your diabetes blood test results: HbA1c is 7.0%, which is above the target of 7.0%. Your blood sugar has been somewhat poorly controlled over the past 3 months. Fasting blood sugar was 390, which is high (normal is 70-100). Your diabetes medicines may need adjustment. Discuss with your doctor.",Endocrinology,Lab Result,high
1284,"89 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 89-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1285,"28 y/o F with PMH of Parkinson's disease, A-fib, s/p THR, HFrEF (EF 30%), admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on acetaminophen 650mg Q6H PRN, levothyroxine 75mcg daily on empty stomach, Humalog per SSI. F/U surgery in 10 days.","A 28-year-old woman with a history of Parkinson's disease, irregular heartbeat [atrial fibrillation], prior hip replacement, and heart failure with weak pumping (30%) was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the surgeon in 10 days.",Infectious Disease,Discharge Summary,high
1286,"BMP: Na 148 (H), K 6.4 (H), BUN 83, Cr 7.2 (H), Glucose 164.","Your blood chemistry results: Sodium is high at 148, meaning you may be dehydrated. Potassium is dangerously high at 6.4 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 7.2 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 164 (high).",Nephrology,Lab Result,high
1287,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
1288,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,high
1289,"Rx: Tab metformin 1000mg BID. Tab gabapentin 300mg TID. Adv: avoid alcohol, hepatotoxic drugs. F/U PCP in 1 week for BP recheck.",Your medicines: (1) metformin 1000mg twice daily with meals [blood sugar medicine]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). See your primary care doctor in 1 week to recheck blood pressure.,Pediatrics,Prescription,medium
1290,"75 y/o M with PMH of s/p THR, ICD in situ, A-fib, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on prednisone taper, methotrexate 15mg weekly. F/U surgery in 10 days.","A 75-year-old man with a history of prior hip replacement, implanted heart defibrillator, and irregular heartbeat [atrial fibrillation] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the surgeon in 10 days.",Orthopedics,Discharge Summary,high
1291,"34 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 34-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1292,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
1293,"Rx: Tab calcium + vitamin D 600/400 daily. Tab Dulcolax 10mg QHS PRN. Adv: high fiber diet, adequate hydration. F/U 2 weeks.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back for a check-up in 2 weeks.",General,Prescription,medium
1294,"Lipid panel: TC 120, LDL 172, HDL 53, TG 342.","Your cholesterol results: Total cholesterol is 120. LDL (bad cholesterol) is very high at 172 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 53. Triglycerides are very high at 342 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
1295,"52 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 52-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1296,"Thyroid panel: TSH 4.43 (N), Free T4 0.8.",Your thyroid test results: TSH is normal at 4.43. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
1297,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
1298,"Rx: Tab montelukast 10mg QHS. Tab rosuvastatin 10mg QHS. Adv: low salt low sugar diet, regular exercise Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
1299,HbA1c: 13.4% (H). FBS: 99 mg/dL (N).,"Your diabetes blood test results: HbA1c is 13.4%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 99, which is normal (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1300,Procedure: EGD with biopsy. Pt 63 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 63-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1301,"Rx: Tab glipizide 5mg BID AC. Tab potassium chloride 20mEq daily. Tab furosemide 40mg BID. Tab levothyroxine 75mcg daily on empty stomach. Tab ASA 81mg daily. Adv: SMBG BID, diabetic diet Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with INR.",Your medicines: (1) glipizide 5mg twice daily before meals [helps release insulin]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) furosemide (Lasix) 40mg twice daily [water pill]. (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (5) baby aspirin 81mg once daily [prevents blood clots]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
1302,Procedure: EGD with biopsy. Pt 73 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 73-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1303,Procedure: R TKA. Pt 52 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 52-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1304,Procedure: TURP for BPH. Pt 69 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 69-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
1305,"68 y/o M with PMH of DM1, depression, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on amlodipine 5mg daily, Humalog per SSI, amlodipine 10mg daily, ASA 81mg daily. F/U pulmonology in 2 weeks.","A 68-year-old man with a history of type 1 diabetes, and depression was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the lung doctor in 2 weeks.",General Surgery,Discharge Summary,high
1306,"BMP: Na 124 (L), K 2.6 (L), BUN 15, Cr 7.1 (H), Glucose 238.","Your blood chemistry results: Sodium is low at 124 (normal 136-145), meaning too much water in your body. Potassium is low at 2.6 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 7.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 238 (high).",Nephrology,Lab Result,high
1307,"76 y/o F with PMH of BPH, HTN, RA on MTX, Parkinson's disease, DVT/PE on warfarin, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on Lantus 20U QHS, calcium + vitamin D 600/400 daily. F/U wound care in 3 days.","A 76-year-old woman with a history of enlarged prostate, high blood pressure, rheumatoid arthritis [on immune-suppressing medicine], Parkinson's disease, and blood clots [on blood thinner warfarin] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) calcium plus vitamin D once daily [bone strengthening]. Follow-up at the wound care clinic in 3 days.",Neurology,Discharge Summary,high
1308,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,high
1309,CXR PA: ET tube 3cm above carina. Right lower lobe consolidation. Bilateral hilar lymphadenopathy. Patchy bilateral infiltrates.,"Chest X-ray results: The breathing tube is in good position. There is an area in the lower right lung that appears infected, suggesting pneumonia. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There are scattered cloudy patches in both lungs suggesting infection or inflammation.",Pulmonology,Radiology Report,high
1310,"89 y/o F with PMH of s/p TKR, seizure disorder on Keppra, Parkinson's disease, PAD, OA, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Strict I&O, daily weights. D/C on Humalog per SSI, atorvastatin 40mg QHS, calcium + vitamin D 600/400 daily, glipizide 5mg BID AC. F/U neurology in 2 weeks.","A 89-year-old woman with a history of prior knee replacement, seizure disorder [on Keppra], Parkinson's disease, poor blood flow in the legs [peripheral artery disease], and arthritis [osteoarthritis] was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Humalog insulin before meals as directed [fast-acting insulin]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) calcium plus vitamin D once daily [bone strengthening]; (4) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the brain/nerve doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
1311,"Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab pantoprazole 40mg AC breakfast. Tab amlodipine 10mg daily. Avoid NSAIDs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) amlodipine 10mg once daily [blood pressure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
1312,"76 y/o M with PMH of OSA on CPAP, HLD, asthma, anemia, cirrhosis, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on entresto 49/51mg BID, warfarin 5mg daily, ondansetron 4mg Q8H PRN N/V, ASA 81mg daily, furosemide 40mg BID. F/U orthopedics in 6 weeks with X-ray.","A 76-year-old man with a history of sleep apnea [uses a breathing machine at night], high cholesterol, asthma, low blood count [anemia], and liver scarring [cirrhosis] was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) baby aspirin 81mg once daily [prevents blood clots]; (5) furosemide (Lasix) 40mg twice daily [water pill]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Infectious Disease,Discharge Summary,high
1313,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
1314,"45 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 45-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
1315,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
1316,"29 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 29-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1317,"Rx: Tab hydroxychloroquine 200mg BID. Tab glipizide 5mg BID AC. Adv: low salt diet, fluid restriction 1.5L/day. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) glipizide 5mg twice daily before meals [helps release insulin]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Endocrinology,Prescription,medium
1318,"23 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 23-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1319,"85 y/o M with PMH of ICD in situ, h/o CVA, PAD, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on amlodipine 5mg daily, Augmentin 875/125 BID x 7 days, metoprolol 25mg BID, empagliflozin 10mg daily, Spiriva 18mcg daily. F/U pulmonology in 2 weeks.","A 85-year-old man with a history of implanted heart defibrillator, history of stroke, and poor blood flow in the legs [peripheral artery disease] was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (5) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the lung doctor in 2 weeks.",Endocrinology,Discharge Summary,high
1320,"73 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 73-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1321,"38 y/o F with PMH of HFrEF (EF 30%), s/p TKR, Parkinson's disease, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on Dulcolax 10mg QHS PRN, lisinopril 10mg daily, omeprazole 20mg AC breakfast, metoprolol succinate 50mg daily, pregabalin 75mg BID. F/U PCP in 2 weeks.","A 38-year-old woman with a history of heart failure with weak pumping (30%), prior knee replacement, and Parkinson's disease was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (5) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
1322,"86 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 86-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1323,"70 y/o M with PMH of anxiety, anemia, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on empagliflozin 10mg daily, Dulcolax 10mg QHS PRN, lisinopril 10mg daily, glipizide 5mg BID AC, pregabalin 75mg BID. F/U surgery in 10 days.","A 70-year-old man with a history of anxiety, and low blood count [anemia] was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (4) glipizide 5mg twice daily before meals [helps release insulin]; (5) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the surgeon in 10 days.",General Surgery,Discharge Summary,high
1324,Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab omeprazole 20mg AC breakfast. Adv: low potassium diet. F/U 2 weeks with INR.,"Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks for a blood thinner level check [INR].",Gastroenterology,Prescription,medium
1325,"73 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 73-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1326,"84 y/o M with PMH of DM1, s/p THR, anemia, CHF, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on methotrexate 15mg weekly, warfarin 5mg daily. F/U oncology in 1 week.","A 84-year-old man with a history of type 1 diabetes, prior hip replacement, low blood count [anemia], and heart failure was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up with the cancer doctor in 1 week.",General Surgery,Discharge Summary,high
1327,"62 y/o F with PMH of cirrhosis, h/o TIA, CKD Stage 4, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on lisinopril 20mg daily, glipizide 5mg BID AC, rosuvastatin 10mg QHS, Humalog per SSI, metformin 1000mg BID. F/U PCP in 1 week.","A 62-year-old woman with a history of liver scarring [cirrhosis], history of mini-stroke, and advanced kidney disease was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) Humalog insulin before meals as directed [fast-acting insulin]; (5) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the primary care doctor in 1 week.",Hematology,Discharge Summary,high
1328,"CBC: WBC 11.1 (H), Hgb 9.6 (L), Plt 381 (N).","Your blood count results: White blood cells are 11.1 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 9.6, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 381, which is normal.",Hematology,Lab Result,high
1329,CT Head without contrast: Acute ischemic infarct in R MCA territory. 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Paranasal sinuses clear.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The sinuses are clear with no infection.",Neurology,Radiology Report,high
1330,"BMP: Na 139 (N), K 5.9 (H), BUN 45, Cr 1.9 (H), Glucose 289.","Your blood chemistry results: Sodium is normal at 139. Potassium is dangerously high at 5.9 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 1.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 289 (high).",Nephrology,Lab Result,high
1331,Procedure: ERCP with sphincterotomy. Pt 65 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 65-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1332,"54 y/o M with PMH of ESRD on HD, obesity (BMI 38), A-fib, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on levothyroxine 75mcg daily on empty stomach, Spiriva 18mcg daily. F/U PCP in 1 week.","A 54-year-old man with a history of kidney failure requiring dialysis, obesity, and irregular heartbeat [atrial fibrillation] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the primary care doctor in 1 week.",Pulmonology,Discharge Summary,high
1333,HbA1c: 10.2% (H). FBS: 295 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.2%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 295, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1334,"73 y/o F with PMH of A-fib, depression, OA, h/o TIA, hypothyroidism, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on Eliquis 5mg BID, azithromycin 500mg day 1 then 250mg x 4 days, spironolactone 25mg daily. F/U endocrine in 1 week.","A 73-year-old woman with a history of irregular heartbeat [atrial fibrillation], depression, arthritis [osteoarthritis], history of mini-stroke, and underactive thyroid was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Eliquis 5mg twice daily [blood thinner]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up with the hormone/diabetes doctor in 1 week.",Infectious Disease,Discharge Summary,high
1335,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1336,"US Abdomen: No focal hepatic lesion. Spleen 16cm, splenomegaly. CBD 5mm, not dilated. CBD 12mm, dilated. GB wall thickening with stones, positive Murphy's sign. GB sludge, no stones.","Abdominal ultrasound results: No tumors or masses were found in the liver. The spleen is enlarged [splenomegaly]. The bile duct is normal size [not blocked]. The bile duct is wider than normal [dilated], which may indicate a blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The gallbladder contains thickened bile [sludge] but no stones.",Gastroenterology,Radiology Report,high
1337,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1338,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1339,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,low
1340,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
1341,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1342,"Lipid panel: TC 122, LDL 168, HDL 53, TG 187.","Your cholesterol results: Total cholesterol is 122. LDL (bad cholesterol) is very high at 168 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 53. Triglycerides are high at 187.",Cardiology,Lab Result,high
1343,CXR PA: Compression fracture T12. Sternotomy wires intact. Patchy bilateral infiltrates. Osseous structures intact.,Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. The wires from prior heart surgery are intact. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The bones look normal with no fractures.,Pulmonology,Radiology Report,high
1344,"38 y/o F with PMH of COPD, HFpEF, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on metformin 500mg BID, entresto 49/51mg BID, ferrous sulfate 325mg BID, Humalog per SSI. F/U oncology in 1 week.","A 38-year-old woman with a history of chronic lung disease, and heart failure with stiff heart muscle was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the cancer doctor in 1 week.",Pulmonology,Discharge Summary,high
1345,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1346,"75 y/o F with PMH of obesity (BMI 38), OA, osteoporosis, OSA on CPAP, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on prednisone taper, ibuprofen 400mg Q6H PRN with food, Humalog per SSI. F/U surgery in 10 days.","A 75-year-old woman with a history of obesity, arthritis [osteoarthritis], weak bones [osteoporosis], and sleep apnea [uses a breathing machine at night] was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
1347,Rx: Tab Xarelto 20mg daily with dinner. Tab acetaminophen 650mg Q6H PRN. Tab rosuvastatin 10mg QHS. Tab amoxicillin 500mg TID x 10 days. Tab Dulcolax 10mg QHS PRN. Adv: wound care with daily dressing changes. F/U 6 weeks with LFTs.,"Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (5) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 6 weeks for liver function blood tests.",General,Prescription,high
1348,"US Abdomen: Ascites moderate amount. Spleen 11cm, normal. Simple renal cysts bilaterally. Moderate right hydronephrosis.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. The spleen is a normal size. Both kidneys have harmless fluid-filled cysts. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage.",Gastroenterology,Radiology Report,high
1349,CXR PA: Port-a-cath in appropriate position. Right lower lobe consolidation. Bilateral hilar lymphadenopathy. Bilateral pleural effusions. No pneumothorax.,"Chest X-ray results: The implanted medication port is in the correct position. There is an area in the lower right lung that appears infected, suggesting pneumonia. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There is fluid collecting around both lungs. There is no collapsed lung.",Pulmonology,Radiology Report,high
1350,"61 y/o M with PMH of seizure disorder on Keppra, PAD, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on amlodipine 10mg daily, montelukast 10mg QHS. F/U endocrine in 1 week.","A 61-year-old man with a history of seizure disorder [on Keppra], and poor blood flow in the legs [peripheral artery disease] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Psychiatry,Discharge Summary,high
1351,"55 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 55-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
1352,CXR PA: Right-sided pneumothorax. Right middle lobe atelectasis. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
1353,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1354,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Mild generalized cerebral atrophy appropriate for age. No acute intracranial hemorrhage. Subarachnoid hemorrhage in bilateral sylvian fissures. No midline shift.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is mild brain shrinkage, which is normal for your age. There is no bleeding in the brain. There is bleeding around the brain surface, particularly in the grooves on both sides. The brain is centered normally.",Neurology,Radiology Report,high
1355,"23 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 23-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1356,"65 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 65-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1357,"LFTs: AST 497 (H), ALT 367 (H), ALP 128, T.Bili 4.2 (H), Albumin 3.7.","Your liver blood test results: Liver enzymes (AST 497, ALT 367) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 4.2 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.7.",Gastroenterology,Lab Result,high
1358,"86 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 86-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1359,CXR PA: Bilateral pleural effusions. Widened mediastinum. Right-sided pneumothorax. Pacemaker leads in appropriate position. No pneumothorax.,"Chest X-ray results: There is fluid collecting around both lungs. The space between the lungs appears wider than normal, which needs further evaluation. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The pacemaker wires are in the correct position. There is no collapsed lung.",Pulmonology,Radiology Report,high
1360,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
1361,"32 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 32-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1362,"70 y/o M with PMH of gout, s/p TKR, CKD Stage 3, COPD, osteoporosis, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Low potassium diet. D/C on Eliquis 5mg BID, glipizide 5mg BID AC, warfarin 5mg daily, omeprazole 20mg AC breakfast. F/U PCP in 1 week.","A 70-year-old man with a history of gout, prior knee replacement, moderate kidney disease, chronic lung disease, and weak bones [osteoporosis] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) Eliquis 5mg twice daily [blood thinner]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the primary care doctor in 1 week.",Pulmonology,Discharge Summary,high
1363,"LFTs: AST 304 (H), ALT 55 (H), ALP 244, T.Bili 4.1 (H), Albumin 2.4.","Your liver blood test results: Liver enzymes (AST 304, ALT 55) are mildly elevated (normal is under 40). Bilirubin is high at 4.1 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.4 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
1364,"26 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 26-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1365,"Rx: Tab montelukast 10mg QHS. Tab furosemide 40mg BID. Tab entresto 49/51mg BID. Adv: low salt diet, fluid restriction 1.5L/day. F/U 1 week with wound check.",Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) Entresto 49/51mg twice daily [heart failure medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 1 week to have the wound checked.,Cardiology,Prescription,medium
1366,"Rx: Tab metformin 1000mg BID. albuterol MDI 2 puffs Q4-6H PRN. Lantus 20U QHS. Tab Eliquis 5mg BID. Tab amlodipine 10mg daily. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with wound check.","Your medicines: (1) metformin 1000mg twice daily with meals [blood sugar medicine]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (3) Lantus insulin 20 units at bedtime [long-acting insulin]. (4) Eliquis 5mg twice daily [blood thinner]. (5) amlodipine 10mg once daily [blood pressure medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week to have the wound checked.",Endocrinology,Prescription,high
1367,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
1368,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,low
1369,"81 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 81-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1370,"43 y/o M with PMH of ICD in situ, SLE, RA on MTX, PPM in situ, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on clopidogrel 75mg daily, metoprolol succinate 50mg daily, atorvastatin 40mg QHS, metformin 1000mg BID. F/U neurology in 2 weeks.","A 43-year-old man with a history of implanted heart defibrillator, lupus, rheumatoid arthritis [on immune-suppressing medicine], and implanted pacemaker was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
1371,"64 y/o M with PMH of SLE, s/p TKR, s/p CABG, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on carvedilol 12.5mg BID, empagliflozin 10mg daily, amlodipine 10mg daily, lisinopril 20mg daily. F/U hematology in 2 weeks.","A 64-year-old man with a history of lupus, prior knee replacement, and prior heart bypass surgery was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
1372,"US Abdomen: No focal hepatic lesion. Ascites moderate amount. Moderate right hydronephrosis. CBD 12mm, dilated.","Abdominal ultrasound results: No tumors or masses were found in the liver. There is a moderate amount of fluid in the belly [ascites]. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
1373,"45 y/o M with PMH of GERD, HTN, COPD, DM2, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on Dulcolax 10mg QHS PRN, Lantus 20U QHS. F/U orthopedics in 6 weeks with X-ray.","A 45-year-old man with a history of acid reflux, high blood pressure, chronic lung disease, and type 2 diabetes was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Neurology,Discharge Summary,high
1374,"84 y/o M with PMH of CKD Stage 3, CAD, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Compression stockings when ambulating. D/C on ferrous sulfate 325mg BID, gabapentin 300mg TID, amlodipine 5mg daily. F/U neurology in 2 weeks.","A 84-year-old man with a history of moderate kidney disease, and coronary artery disease [heart artery blockages] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Neurology,Discharge Summary,high
1375,"58 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 58-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1376,"Rx: Tab methotrexate 15mg weekly. Tab ciprofloxacin 500mg BID x 5 days. Tab pantoprazole 40mg AC breakfast. Tab lisinopril 20mg daily. Adv: high fiber diet, adequate hydration. F/U 1 week with wound check.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. (4) lisinopril 20mg once daily [blood pressure medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
1377,"27 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 27-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1378,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. No acute intracranial hemorrhage. 4cm right subdural hematoma with 5mm midline shift. No mass effect. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There is no bleeding in the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
1379,"Rx: Tab hydroxychloroquine 200mg BID. Tab empagliflozin 10mg daily. Adv: fall precautions, home safety evaluation. F/U 1 week with wound check.","Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week to have the wound checked.",Endocrinology,Prescription,medium
1380,"52 y/o F with PMH of CKD Stage 4, OA, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on furosemide 40mg BID, hydroxychloroquine 200mg BID, lisinopril 20mg daily. F/U nephrology in 1 week.","A 52-year-old woman with a history of advanced kidney disease, and arthritis [osteoarthritis] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the kidney doctor in 1 week.",Orthopedics,Discharge Summary,high
1381,"26 y/o M with PMH of BPH, PPM in situ, DM2, OSA on CPAP, cirrhosis, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Low potassium diet. D/C on ASA 81mg daily, atorvastatin 80mg QHS, azithromycin 500mg day 1 then 250mg x 4 days, prednisone taper, Spiriva 18mcg daily. F/U nephrology in 5 days.","A 26-year-old man with a history of enlarged prostate, implanted pacemaker, type 2 diabetes, sleep apnea [uses a breathing machine at night], and liver scarring [cirrhosis] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (5) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the kidney doctor in 5 days.",Pulmonology,Discharge Summary,high
1382,CXR PA: Port-a-cath in appropriate position. NG tube tip in stomach. Right-sided pneumothorax. Moderate right pleural effusion.,Chest X-ray results: The implanted medication port is in the correct position. The feeding/drainage tube tip is correctly positioned in the stomach. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There is a moderate amount of fluid around the right lung.,Pulmonology,Radiology Report,high
1383,"Thyroid panel: TSH 0.46 (N), Free T4 1.2.",Your thyroid test results: TSH is normal at 0.46. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
1384,"22 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 22-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1385,"23 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 23-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
1386,"59 y/o F with PMH of HTN, Parkinson's disease, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on metformin 1000mg BID, furosemide 40mg daily, metoprolol succinate 50mg daily, albuterol MDI 2 puffs Q4-6H PRN. F/U surgery in 10 days.","A 59-year-old woman with a history of high blood pressure, and Parkinson's disease was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the surgeon in 10 days.",Nephrology,Discharge Summary,high
1387,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,high
1388,"LFTs: AST 230 (H), ALT 111 (H), ALP 225, T.Bili 1.9 (H), Albumin 3.2.","Your liver blood test results: Liver enzymes (AST 230, ALT 111) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is mildly elevated at 1.9. Albumin is low at 3.2 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
1389,Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab ASA 81mg daily. Tab glipizide 5mg BID AC. Avoid grapefruit juice Adv: wound care with daily dressing changes. F/U 2 weeks.,"Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) glipizide 5mg twice daily before meals [helps release insulin]. Do not drink grapefruit juice as it interferes with this medication Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
1390,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1391,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab amlodipine 10mg daily. Avoid grapefruit juice. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) amlodipine 10mg once daily [blood pressure medicine]. Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
1392,"US Abdomen: Right kidney 10.5cm, no hydronephrosis. Moderate right hydronephrosis. Spleen 11cm, normal. Simple renal cysts bilaterally. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: Right kidney is normal size with no blockage. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The spleen is a normal size. Both kidneys have harmless fluid-filled cysts. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
1393,"47 y/o M with PMH of A-fib, DVT/PE on warfarin, PPM in situ, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on hydroxychloroquine 200mg BID, prednisone taper. F/U PCP in 1 week.","A 47-year-old man with a history of irregular heartbeat [atrial fibrillation], blood clots [on blood thinner warfarin], and implanted pacemaker was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the primary care doctor in 1 week.",General Surgery,Discharge Summary,high
1394,"66 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 66-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1395,"59 y/o M with PMH of ESRD on HD, CAD, HTN, OA, CKD Stage 4, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on metformin 1000mg BID, Lantus 20U QHS, ferrous sulfate 325mg BID, lisinopril 10mg daily. F/U nephrology in 5 days.","A 59-year-old man with a history of kidney failure requiring dialysis, coronary artery disease [heart artery blockages], high blood pressure, arthritis [osteoarthritis], and advanced kidney disease was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the kidney doctor in 5 days.",Neurology,Discharge Summary,high
1396,"Rx: Tab amlodipine 5mg daily. Tab atorvastatin 40mg QHS. Tab metformin 1000mg BID. Tab calcium + vitamin D 600/400 daily. Tab entresto 49/51mg BID. Avoid NSAIDs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) calcium plus vitamin D once daily [bone strengthening]. (5) Entresto 49/51mg twice daily [heart failure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,high
1397,"64 y/o M with PMH of gout, SLE, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Dulcolax 10mg QHS PRN, amoxicillin 500mg TID x 10 days, Augmentin 875/125 BID x 7 days, calcium + vitamin D 600/400 daily, Spiriva 18mcg daily. F/U endocrine in 1 week.","A 64-year-old man with a history of gout, and lupus was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
1398,"46 y/o M with PMH of OSA on CPAP, DM2, OA, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on Augmentin 875/125 BID x 7 days, Humalog per SSI, ibuprofen 400mg Q6H PRN with food. F/U cardiology in 2 weeks.","A 46-year-old man with a history of sleep apnea [uses a breathing machine at night], type 2 diabetes, and arthritis [osteoarthritis] was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
1399,Rx: Tab omeprazole 20mg AC breakfast. Tab furosemide 40mg BID. Humalog per SSI. Avoid NSAIDs. F/U 1 week with wound check.,Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) Humalog insulin before meals as directed [fast-acting insulin]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 week to have the wound checked.,Cardiology,Prescription,medium
1400,"36 y/o M with PMH of BPH, CKD Stage 3, RA on MTX, PAD, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Strict I&O, daily weights. D/C on empagliflozin 10mg daily, Lantus 20U QHS, latanoprost 0.005% OU QHS, Humalog per SSI, lisinopril 20mg daily. F/U surgery in 2 weeks for drain removal.","A 36-year-old man with a history of enlarged prostate, moderate kidney disease, rheumatoid arthritis [on immune-suppressing medicine], and poor blood flow in the legs [peripheral artery disease] was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (4) Humalog insulin before meals as directed [fast-acting insulin]; (5) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Pulmonology,Discharge Summary,high
1401,"25 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 25-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1402,"38 y/o M with PMH of A-fib, SLE, ICD in situ, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on metformin 1000mg BID, ciprofloxacin 500mg BID x 5 days, ASA 81mg daily, methotrexate 15mg weekly, Eliquis 5mg BID. F/U cardiology in 2 weeks.","A 38-year-old man with a history of irregular heartbeat [atrial fibrillation], lupus, and implanted heart defibrillator was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) baby aspirin 81mg once daily [prevents blood clots]; (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (5) Eliquis 5mg twice daily [blood thinner]. Follow-up with the heart doctor in 2 weeks.",Neurology,Discharge Summary,high
1403,Procedure: TURP for BPH. Pt 64 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 64-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
1404,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1405,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab entresto 49/51mg BID. Tab Xarelto 20mg daily with dinner. prednisone taper. Tab ASA 81mg daily. Adv: low potassium diet. F/U 1 week with CBC, CMP.","Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) Xarelto 20mg once daily with dinner [blood thinner]. (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (5) baby aspirin 81mg once daily [prevents blood clots]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
1406,"83 y/o F with PMH of HTN, CHF, COPD, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on rosuvastatin 10mg QHS, amlodipine 5mg daily, methotrexate 15mg weekly, escitalopram 10mg daily, losartan 50mg daily. F/U surgery in 10 days.","A 83-year-old woman with a history of high blood pressure, heart failure, and chronic lung disease was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) amlodipine 5mg once daily [blood pressure medicine]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (5) losartan 50mg once daily [blood pressure medicine]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
1407,"50 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 50-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1408,"MRI Lumbar Spine: No compression fracture. Multilevel degenerative disc disease. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Conus medullaris at L1, normal.","MRI of the lower back results: No bones are broken or collapsed. Multiple discs in the spine are showing wear and aging. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
1409,"41 y/o F with PMH of HFrEF (EF 30%), seizure disorder on Keppra, HLD, osteoporosis, OA, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on lisinopril 20mg daily, tramadol 50mg Q6H PRN pain. F/U hematology in 2 weeks.","A 41-year-old woman with a history of heart failure with weak pumping (30%), seizure disorder [on Keppra], high cholesterol, weak bones [osteoporosis], and arthritis [osteoarthritis] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
1410,"44 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 44-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1411,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Subarachnoid hemorrhage in bilateral sylvian fissures. No mass effect.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is bleeding around the brain surface, particularly in the grooves on both sides. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
1412,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1413,Rx: Tab lisinopril 10mg daily. Tab ciprofloxacin 500mg BID x 5 days. Avoid grapefruit juice. F/U 2 weeks with INR.,Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks for a blood thinner level check [INR].,Pediatrics,Prescription,medium
1414,"Rx: Tab atorvastatin 40mg QHS. Tab carvedilol 12.5mg BID. Avoid grapefruit juice Adv: avoid alcohol, hepatotoxic drugs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) carvedilol 12.5mg twice daily [heart medicine]. Do not drink grapefruit juice as it interferes with this medication Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
1415,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. L4-L5 disc herniation with moderate bilateral foraminal stenosis. C5-C6 disc herniation with cord compression.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
1416,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1417,"Rx: Tab sertraline 50mg daily. Spiriva 18mcg daily. Adv: wound care with daily dressing changes. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) Spiriva inhaler once daily [long-acting lung medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Pulmonology,Prescription,medium
1418,HbA1c: 8.8% (H). FBS: 199 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.8%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 199, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
1419,MRI Lumbar Spine: Central canal stenosis at L3-L4. L5-S1 disc desiccation with mild bulge.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
1420,Delivery Note: G?P? at 38+2 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1421,"MRI Lumbar Spine: Conus medullaris at L1, normal. Central canal stenosis at L3-L4.","MRI of the lower back results: The spinal cord ends at a normal level. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
1422,"54 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 54-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1423,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1424,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. Central canal stenosis at L3-L4.,"MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
1425,"Rx: Tab clopidogrel 75mg daily. Tab furosemide 40mg daily. Tab lisinopril 20mg daily. Tab furosemide 40mg BID. Tab sertraline 50mg daily. Adv: low potassium diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) lisinopril 20mg once daily [blood pressure medicine]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
1426,"86 y/o M with PMH of seizure disorder on Keppra, gout, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on atorvastatin 40mg QHS, Spiriva 18mcg daily, Humalog per SSI. F/U INR check in 3 days.","A 86-year-old man with a history of seizure disorder [on Keppra], and gout was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up for a blood thinner level check in 3 days.",Pulmonology,Discharge Summary,high
1427,Procedure: ORIF L distal radius. Pt 29 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 29-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1428,"83 y/o F with PMH of ICD in situ, OSA on CPAP, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Strict I&O, daily weights. D/C on tramadol 50mg Q6H PRN pain, potassium chloride 20mEq daily, omeprazole 20mg AC breakfast, carvedilol 12.5mg BID, prednisone taper. F/U surgery in 2 weeks for drain removal.","A 83-year-old woman with a history of implanted heart defibrillator, and sleep apnea [uses a breathing machine at night] was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]; (4) carvedilol 12.5mg twice daily [heart medicine]; (5) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the surgeon in 2 weeks to remove the drain.",Endocrinology,Discharge Summary,high
1429,"Rx: Tab metoprolol succinate 50mg daily. Tab sertraline 50mg daily. Lantus 20U QHS. Adv: fall precautions, home safety evaluation Adv: elevate affected limb, compression stockings. F/U 1 week with wound check.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. (3) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
1430,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,low
1431,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. Chronic lacunar infarcts in bilateral basal ganglia. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There are signs of small old strokes in the deep parts of the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain.",Neurology,Radiology Report,high
1432,"78 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 78-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1433,"51 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 51-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
1434,"US Abdomen: Spleen 11cm, normal. CBD 5mm, not dilated. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. GB sludge, no stones. Ascites moderate amount. Spleen 16cm, splenomegaly.","Abdominal ultrasound results: The spleen is a normal size. The bile duct is normal size [not blocked]. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The gallbladder contains thickened bile [sludge] but no stones. There is a moderate amount of fluid in the belly [ascites]. The spleen is enlarged [splenomegaly].",Gastroenterology,Radiology Report,high
1435,"US Abdomen: Pancreas unremarkable. Left kidney 8cm, cortical thinning consistent with CKD. Simple renal cysts bilaterally.","Abdominal ultrasound results: The pancreas looks normal. Left kidney is small with thin outer layer, consistent with chronic kidney disease. Both kidneys have harmless fluid-filled cysts.",Gastroenterology,Radiology Report,high
1436,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. Right kidney 10.5cm, no hydronephrosis. No focal hepatic lesion. GB sludge, no stones.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Right kidney is normal size with no blockage. No tumors or masses were found in the liver. The gallbladder contains thickened bile [sludge] but no stones.",Gastroenterology,Radiology Report,high
1437,"53 y/o M with PMH of CKD Stage 3, PAD, HFpEF, s/p TKR, PPM in situ, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on ciprofloxacin 500mg BID x 5 days, latanoprost 0.005% OU QHS, calcium + vitamin D 600/400 daily, escitalopram 10mg daily, omeprazole 20mg AC breakfast. F/U wound care in 3 days.","A 53-year-old man with a history of moderate kidney disease, poor blood flow in the legs [peripheral artery disease], heart failure with stiff heart muscle, prior knee replacement, and implanted pacemaker was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) calcium plus vitamin D once daily [bone strengthening]; (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (5) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up at the wound care clinic in 3 days.",Gastroenterology,Discharge Summary,high
1438,"46 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 46-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1439,"41 y/o F with PMH of anemia, gout, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on ondansetron 4mg Q8H PRN N/V, carvedilol 12.5mg BID. F/U surgery in 2 weeks for drain removal.","A 41-year-old woman with a history of low blood count [anemia], and gout was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
1440,Procedure: ORIF L distal radius. Pt 82 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 82-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1441,"60 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 60-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1442,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1443,"68 y/o M with PMH of DVT/PE on warfarin, cirrhosis, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on latanoprost 0.005% OU QHS, losartan 50mg daily, ondansetron 4mg Q8H PRN N/V, omeprazole 20mg AC breakfast, Spiriva 18mcg daily. F/U PCP in 2 weeks.","A 68-year-old man with a history of blood clots [on blood thinner warfarin], and liver scarring [cirrhosis] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) losartan 50mg once daily [blood pressure medicine]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]; (5) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the primary care doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
1444,"29 y/o M with PMH of s/p CABG, PPM in situ, anemia, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on Spiriva 18mcg daily, levothyroxine 75mcg daily on empty stomach. F/U PCP in 1 week.","A 29-year-old man with a history of prior heart bypass surgery, implanted pacemaker, and low blood count [anemia] was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the primary care doctor in 1 week.",Infectious Disease,Discharge Summary,high
1445,"84 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 84-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1446,Rx: Tab hydroxychloroquine 200mg BID. Tab clopidogrel 75mg daily. Lantus 20U QHS. Adv: low potassium diet. F/U 1 week with wound check.,"Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
1447,"Rx: Tab acetaminophen 650mg Q6H PRN. albuterol MDI 2 puffs Q4-6H PRN. Tab Xarelto 20mg daily with dinner. Tab ciprofloxacin 500mg BID x 5 days. Adv: smoking cessation, pulmonary rehab. F/U 2 weeks.",Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (3) Xarelto 20mg once daily with dinner [blood thinner]. (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back for a check-up in 2 weeks.,Pulmonology,Prescription,high
1448,"38 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 38-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1449,Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab ASA 81mg daily. Tab levothyroxine 75mcg daily on empty stomach. Spiriva 18mcg daily. Adv: low potassium diet. F/U 1 week with wound check.,"Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (4) Spiriva inhaler once daily [long-acting lung medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week to have the wound checked.",Pulmonology,Prescription,high
1450,"52 y/o F with PMH of ESRD on HD, osteoporosis, cirrhosis, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on hydroxychloroquine 200mg BID, lisinopril 10mg daily, furosemide 40mg BID, amlodipine 5mg daily, latanoprost 0.005% OU QHS. F/U INR check in 3 days.","A 52-year-old woman with a history of kidney failure requiring dialysis, weak bones [osteoporosis], and liver scarring [cirrhosis] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) amlodipine 5mg once daily [blood pressure medicine]; (5) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Follow-up for a blood thinner level check in 3 days.",Psychiatry,Discharge Summary,high
1451,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1452,Procedure: Laparoscopic appendectomy. Pt 64 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 64-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1453,"BMP: Na 123 (L), K 4.0 (N), BUN 49, Cr 5.1 (H), Glucose 283.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.0. Creatinine is elevated at 5.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 283 (high).",Nephrology,Lab Result,high
1454,"LFTs: AST 335 (H), ALT 316 (H), ALP 239, T.Bili 6.7 (H), Albumin 1.6.","Your liver blood test results: Liver enzymes (AST 335, ALT 316) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.7 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 1.6 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
1455,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1456,CXR PA: Mild cardiomegaly. Sternotomy wires intact. Moderate right pleural effusion. Cardiomegaly with CTR >0.5. Right middle lobe atelectasis.,"Chest X-ray results: The heart is slightly larger than normal. The wires from prior heart surgery are intact. There is a moderate amount of fluid around the right lung. The heart appears larger than normal. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
1457,"Rx: Tab methotrexate 15mg weekly. Tab acetaminophen 650mg Q6H PRN. Tab Eliquis 5mg BID. Tab calcium + vitamin D 600/400 daily. Tab omeprazole 20mg AC breakfast. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 month with repeat imaging.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) Eliquis 5mg twice daily [blood thinner]. (4) calcium plus vitamin D once daily [bone strengthening]. (5) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 month — a repeat scan will be ordered.",General,Prescription,high
1458,"87 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 87-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1459,CXR PA: ET tube 3cm above carina. Osseous structures intact. Moderate right pleural effusion. Mild cardiomegaly. Bilateral pleural effusions.,Chest X-ray results: The breathing tube is in good position. The bones look normal with no fractures. There is a moderate amount of fluid around the right lung. The heart is slightly larger than normal. There is fluid collecting around both lungs.,Pulmonology,Radiology Report,high
1460,"CBC: WBC 3.1 (L), Hgb 15.7 (N), Plt 169 (N).","Your blood count results: White blood cells are 3.1 (low, meaning your immune system may be weakened). Hemoglobin is normal at 15.7. Platelets are 169, which is normal.",Hematology,Lab Result,high
1461,"71 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 71-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1462,"CBC: WBC 16.1 (H), Hgb 13.7 (N), Plt 476 (H).","Your blood count results: White blood cells are 16.1 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 13.7. Platelets are 476, which is high — your blood may clot too easily.",Hematology,Lab Result,high
1463,"65 y/o M with PMH of anemia, HTN, CHF, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Strict I&O, daily weights. D/C on levothyroxine 75mcg daily on empty stomach, Augmentin 875/125 BID x 7 days, omeprazole 20mg AC breakfast. F/U PCP in 2 weeks.","A 65-year-old man with a history of low blood count [anemia], high blood pressure, and heart failure was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
1464,Procedure: Colonoscopy with polypectomy. Pt 34 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 34-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1465,"80 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 80-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
1466,"Rx: Tab amlodipine 5mg daily. albuterol MDI 2 puffs Q4-6H PRN. Tab latanoprost 0.005% OU QHS. Adv: weight bearing exercise, calcium/vit D supplementation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
1467,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. No acute intracranial hemorrhage. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There is no bleeding in the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
1468,"Rx: Tab spironolactone 25mg daily. Tab atorvastatin 80mg QHS. Tab glipizide 5mg BID AC. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab amlodipine 5mg daily. Adv: low salt diet, fluid restriction 1.5L/day. F/U 6 weeks with LFTs.","Your medicines: (1) spironolactone 25mg once daily [heart-protecting water pill]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (3) glipizide 5mg twice daily before meals [helps release insulin]. (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (5) amlodipine 5mg once daily [blood pressure medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
1469,"64 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 64-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1470,"29 y/o M with PMH of s/p CABG, DM1, OSA on CPAP, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on lisinopril 10mg daily, clopidogrel 75mg daily, hydroxychloroquine 200mg BID. F/U INR check in 3 days.","A 29-year-old man with a history of prior heart bypass surgery, type 1 diabetes, and sleep apnea [uses a breathing machine at night] was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up for a blood thinner level check in 3 days.",Endocrinology,Discharge Summary,high
1471,"28 y/o F with PMH of RA on MTX, h/o TIA, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on escitalopram 10mg daily, losartan 50mg daily, hydroxychloroquine 200mg BID. F/U pulmonology in 2 weeks.","A 28-year-old woman with a history of rheumatoid arthritis [on immune-suppressing medicine], and history of mini-stroke was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) losartan 50mg once daily [blood pressure medicine]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the lung doctor in 2 weeks.",Cardiology,Discharge Summary,high
1472,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Humalog per SSI. Tab metformin 500mg BID. Tab clopidogrel 75mg daily. Adv: weight bearing exercise, calcium/vit D supplementation Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",Endocrinology,Prescription,high
1473,"CBC: WBC 5.8 (N), Hgb 7.1 (L), Plt 428 (H).","Your blood count results: White blood cells are 5.8 (normal). Hemoglobin is low at 7.1, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 428, which is high — your blood may clot too easily.",Hematology,Lab Result,high
1474,Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab atorvastatin 40mg QHS. Tab Augmentin 875/125 BID x 7 days. Tab atorvastatin 80mg QHS. Tab montelukast 10mg QHS. Adv: low potassium diet Adv: wound care with daily dressing changes. F/U 1 week with wound check.,"Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (5) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
1475,"Rx: Tab warfarin 5mg daily. Tab pantoprazole 40mg AC breakfast. Tab tramadol 50mg Q6H PRN pain. Tab Xarelto 20mg daily with dinner. Adv: avoid alcohol, hepatotoxic drugs Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (4) Xarelto 20mg once daily with dinner [blood thinner]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Hematology,Prescription,high
1476,"76 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 76-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1477,"Rx: Tab atorvastatin 80mg QHS. Humalog per SSI. Tab escitalopram 10mg daily. Avoid NSAIDs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
1478,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
1479,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab lisinopril 10mg daily. Do not stop abruptly, taper as directed. F/U 6 weeks with LFTs.",Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,medium
1480,"55 y/o M with PMH of s/p TKR, anxiety, OSA on CPAP, GERD, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on furosemide 40mg daily, amlodipine 10mg daily, metoprolol succinate 50mg daily. F/U surgery in 2 weeks for drain removal.","A 55-year-old man with a history of prior knee replacement, anxiety, sleep apnea [uses a breathing machine at night], and acid reflux was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
1481,MRI Lumbar Spine: Multilevel degenerative disc disease. Facet joint hypertrophy at L4-L5. Central canal stenosis at L3-L4. L5-S1 disc desiccation with mild bulge.,"MRI of the lower back results: Multiple discs in the spine are showing wear and aging. The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
1482,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1483,"91 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 91-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1484,"40 y/o F with PMH of gout, BPH, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on acetaminophen 650mg Q6H PRN, amoxicillin 500mg TID x 10 days. F/U PCP in 2 weeks.","A 40-year-old woman with a history of gout, and enlarged prostate was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
1485,"52 y/o M with PMH of h/o TIA, h/o CVA, hypothyroidism, obesity (BMI 38), HLD, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on metoprolol 25mg BID, ASA 81mg daily, furosemide 40mg daily, hydroxychloroquine 200mg BID, pregabalin 75mg BID. F/U endocrine in 1 week.","A 52-year-old man with a history of history of mini-stroke, history of stroke, underactive thyroid, obesity, and high cholesterol was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (5) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Infectious Disease,Discharge Summary,high
1486,Procedure: Laparoscopic appendectomy. Pt 32 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 32-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1487,"69 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 69-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1488,"23 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 23-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1489,"Rx: Tab furosemide 40mg daily. Tab warfarin 5mg daily. Avoid grapefruit juice. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Do not drink grapefruit juice as it interferes with this medication. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
1490,CT Head without contrast: No mass effect. Chronic lacunar infarcts in bilateral basal ganglia. No midline shift. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There are signs of small old strokes in the deep parts of the brain. The brain is centered normally. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
1491,"43 y/o F with PMH of s/p TKR, obesity (BMI 38), GERD, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on lisinopril 20mg daily, timolol 0.5% OU BID, prednisone taper, omeprazole 20mg AC breakfast, atorvastatin 80mg QHS. F/U hematology in 2 weeks.","A 43-year-old woman with a history of prior knee replacement, obesity, and acid reflux was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]; (5) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
1492,Procedure: Laparoscopic cholecystectomy. Pt 61 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 61-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1493,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab amoxicillin 500mg TID x 10 days. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks.","Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back for a check-up in 2 weeks.",Pulmonology,Prescription,medium
1494,Procedure: R TKA. Pt 31 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 31-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1495,HbA1c: 12.1% (H). FBS: 88 mg/dL (N).,"Your diabetes blood test results: HbA1c is 12.1%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 88, which is normal (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1496,"70 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 70-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1497,"42 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 42-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1498,"66 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 66-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
1499,"26 y/o M with PMH of s/p THR, asthma, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on metoprolol succinate 50mg daily, sertraline 50mg daily, rosuvastatin 10mg QHS, tramadol 50mg Q6H PRN pain, azithromycin 500mg day 1 then 250mg x 4 days. F/U cardiology in 2 weeks.","A 26-year-old man with a history of prior hip replacement, and asthma was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (5) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the heart doctor in 2 weeks.",General Surgery,Discharge Summary,high
1500,"CBC: WBC 14.2 (H), Hgb 11.0 (L), Plt 365 (N).","Your blood count results: White blood cells are 14.2 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 11.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 365, which is normal.",Hematology,Lab Result,high
1501,"74 y/o M with PMH of PAD, anemia, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on ciprofloxacin 500mg BID x 5 days, amlodipine 10mg daily, warfarin 5mg daily, tramadol 50mg Q6H PRN pain, ibuprofen 400mg Q6H PRN with food. F/U cardiology in 2 weeks.","A 74-year-old man with a history of poor blood flow in the legs [peripheral artery disease], and low blood count [anemia] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (5) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the heart doctor in 2 weeks.",Neurology,Discharge Summary,high
1502,HbA1c: 6.2% (H). FBS: 388 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.2%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 388, which is high (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,high
1503,"LFTs: AST 251 (H), ALT 507 (H), ALP 123, T.Bili 3.8 (H), Albumin 4.5.","Your liver blood test results: Liver enzymes (AST 251, ALT 507) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 3.8 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.5.",Gastroenterology,Lab Result,high
1504,"38 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 38-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
1505,"Rx: Tab metoprolol 25mg BID. Tab empagliflozin 10mg daily. Tab acetaminophen 650mg Q6H PRN. Tab latanoprost 0.005% OU QHS. Adv: SMBG BID, diabetic diet Adv: fall precautions, home safety evaluation. F/U 2 weeks with INR.","Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
1506,"BMP: Na 126 (L), K 6.2 (H), BUN 57, Cr 7.3 (H), Glucose 102.","Your blood chemistry results: Sodium is low at 126 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.2 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 7.3 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 102 (high).",Nephrology,Lab Result,high
1507,"BMP: Na 140 (N), K 4.3 (N), BUN 84, Cr 5.9 (H), Glucose 400.","Your blood chemistry results: Sodium is normal at 140. Potassium is normal at 4.3. Creatinine is elevated at 5.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 400 (high).",Nephrology,Lab Result,high
1508,"69 y/o M with PMH of PAD, CHF, obesity (BMI 38), admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on spironolactone 25mg daily, losartan 50mg daily, amlodipine 10mg daily. F/U GI in 1 week.","A 69-year-old man with a history of poor blood flow in the legs [peripheral artery disease], heart failure, and obesity was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) losartan 50mg once daily [blood pressure medicine]; (3) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the stomach doctor in 1 week.",Psychiatry,Discharge Summary,high
1509,"CBC: WBC 7.0 (N), Hgb 16.4 (N), Plt 137 (L).","Your blood count results: White blood cells are 7.0 (normal). Hemoglobin is normal at 16.4. Platelets are 137, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
1510,"73 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 73-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1511,"73 y/o F with PMH of h/o CVA, HFrEF (EF 30%), admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on clopidogrel 75mg daily, Humalog per SSI, calcium + vitamin D 600/400 daily. F/U nephrology in 5 days.","A 73-year-old woman with a history of history of stroke, and heart failure with weak pumping (30%) was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the kidney doctor in 5 days.",General Surgery,Discharge Summary,high
1512,"31 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 31-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1513,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
1514,"72 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 72-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1515,"Rx: Tab methotrexate 15mg weekly. Tab entresto 49/51mg BID. Adv: fall precautions, home safety evaluation. F/U 6 weeks with LFTs.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) Entresto 49/51mg twice daily [heart failure medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
1516,"64 y/o M with PMH of Parkinson's disease, cirrhosis, ESRD on HD, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on latanoprost 0.005% OU QHS, ferrous sulfate 325mg BID. F/U neurology in 2 weeks.","A 64-year-old man with a history of Parkinson's disease, liver scarring [cirrhosis], and kidney failure requiring dialysis was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the brain/nerve doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
1517,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. No mass effect. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Paranasal sinuses clear. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There are no tumors or masses pushing on the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The sinuses are clear with no infection. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
1518,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Mild generalized cerebral atrophy appropriate for age. No midline shift. No acute intracranial hemorrhage. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is mild brain shrinkage, which is normal for your age. The brain is centered normally. There is no bleeding in the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
1519,Procedure: Laparoscopic appendectomy. Pt 31 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 31-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1520,"32 y/o M with PMH of DVT/PE on warfarin, obesity (BMI 38), CKD Stage 3, PPM in situ, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on carvedilol 12.5mg BID, Spiriva 18mcg daily. F/U hematology in 2 weeks.","A 32-year-old man with a history of blood clots [on blood thinner warfarin], obesity, moderate kidney disease, and implanted pacemaker was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Urology,Discharge Summary,high
1521,"BMP: Na 123 (L), K 6.8 (H), BUN 27, Cr 6.4 (H), Glucose 250.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.8 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 6.4 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 250 (high).",Nephrology,Lab Result,high
1522,HbA1c: 13.4% (H). FBS: 388 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.4%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 388, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1523,"CBC: WBC 14.8 (H), Hgb 8.4 (L), Plt 269 (N).","Your blood count results: White blood cells are 14.8 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 8.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 269, which is normal.",Hematology,Lab Result,high
1524,CXR PA: Elevated left hemidiaphragm. Clear lung fields bilaterally. Port-a-cath in appropriate position. Right-sided pneumothorax. Left lower lobe consolidation.,Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. Both lungs look clear with no problems. The implanted medication port is in the correct position. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There is an area in the lower left lung that appears infected.,Pulmonology,Radiology Report,high
1525,"46 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 46-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1526,"Lipid panel: TC 200, LDL 64, HDL 34, TG 116.","Your cholesterol results: Total cholesterol is 200. LDL (bad cholesterol) is at goal (64). HDL (good cholesterol) is too low at 34 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are normal at 116.",Cardiology,Lab Result,high
1527,"67 y/o F with PMH of OA, PPM in situ, s/p TKR, HTN, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on amlodipine 5mg daily, empagliflozin 10mg daily, calcium + vitamin D 600/400 daily. F/U orthopedics in 6 weeks with X-ray.","A 67-year-old woman with a history of arthritis [osteoarthritis], implanted pacemaker, prior knee replacement, and high blood pressure was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Pulmonology,Discharge Summary,high
1528,HbA1c: 11.6% (H). FBS: 246 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.6%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 246, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1529,Procedure: ORIF L distal radius. Pt 70 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 70-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1530,"US Abdomen: CBD 5mm, not dilated. Pancreas unremarkable. GB sludge, no stones. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Left kidney 8cm, cortical thinning consistent with CKD. CBD 12mm, dilated.","Abdominal ultrasound results: The bile duct is normal size [not blocked]. The pancreas looks normal. The gallbladder contains thickened bile [sludge] but no stones. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
1531,"LFTs: AST 286 (H), ALT 202 (H), ALP 261, T.Bili 7.2 (H), Albumin 3.1.","Your liver blood test results: Liver enzymes (AST 286, ALT 202) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 7.2 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 3.1 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
1532,"Rx: Tab glipizide 5mg BID AC. Tab potassium chloride 20mEq daily. Tab amlodipine 10mg daily. Adv: low potassium diet Adv: low salt low sugar diet, regular exercise. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) glipizide 5mg twice daily before meals [helps release insulin]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) amlodipine 10mg once daily [blood pressure medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
1533,HbA1c: 11.7% (H). FBS: 132 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.7%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 132, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1534,Procedure: ORIF L distal radius. Pt 22 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 22-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1535,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Acute ischemic infarct in R MCA territory. Paranasal sinuses clear.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The sinuses are clear with no infection.",Neurology,Radiology Report,high
1536,"35 y/o F with PMH of s/p TKR, GERD, hypothyroidism, s/p CABG, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on atorvastatin 40mg QHS, Humalog per SSI, Lantus 20U QHS, amlodipine 10mg daily, Eliquis 5mg BID. F/U neurology in 2 weeks.","A 35-year-old woman with a history of prior knee replacement, acid reflux, underactive thyroid, and prior heart bypass surgery was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) Lantus insulin 20 units at bedtime [long-acting insulin]; (4) amlodipine 10mg once daily [blood pressure medicine]; (5) Eliquis 5mg twice daily [blood thinner]. Follow-up with the brain/nerve doctor in 2 weeks.",Endocrinology,Discharge Summary,high
1537,"51 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 51-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1538,"90 y/o M with PMH of CKD Stage 3, Parkinson's disease, CAD, anxiety, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on metformin 500mg BID, gabapentin 300mg TID, albuterol MDI 2 puffs Q4-6H PRN, ferrous sulfate 325mg BID. F/U endocrine in 1 week.","A 90-year-old man with a history of moderate kidney disease, Parkinson's disease, coronary artery disease [heart artery blockages], and anxiety was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the hormone/diabetes doctor in 1 week.",Gastroenterology,Discharge Summary,high
1539,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age. Chronic lacunar infarcts in bilateral basal ganglia. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age. There are signs of small old strokes in the deep parts of the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
1540,"Rx: Tab furosemide 40mg BID. Tab amlodipine 10mg daily. Tab losartan 50mg daily. Tab empagliflozin 10mg daily. Tab metformin 500mg BID. Adv: wound care with daily dressing changes Adv: smoking cessation, pulmonary rehab. F/U PCP in 1 week for BP recheck.","Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) losartan 50mg once daily [blood pressure medicine]. (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (5) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
1541,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. Simple renal cysts bilaterally. No focal hepatic lesion. Left kidney 8cm, cortical thinning consistent with CKD.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Both kidneys have harmless fluid-filled cysts. No tumors or masses were found in the liver. Left kidney is small with thin outer layer, consistent with chronic kidney disease.",Gastroenterology,Radiology Report,high
1542,"Rx: Tab latanoprost 0.005% OU QHS. Tab hydroxychloroquine 200mg BID. Lantus 20U QHS. Adv: low salt low sugar diet, regular exercise Avoid grapefruit juice. F/U 6 weeks with LFTs.","Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Do not drink grapefruit juice as it interferes with this medication. Come back in 6 weeks for liver function blood tests.",Endocrinology,Prescription,medium
1543,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab pantoprazole 40mg AC breakfast. Tab latanoprost 0.005% OU QHS. Tab metformin 500mg BID. Adv: SMBG BID, diabetic diet Do not stop abruptly, taper as directed. F/U 1 month with repeat imaging.",Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (4) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 month — a repeat scan will be ordered.,Gastroenterology,Prescription,high
1544,"85 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 85-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1545,CXR PA: Patchy bilateral infiltrates. Moderate right pleural effusion. Left lower lobe consolidation. No pneumothorax.,Chest X-ray results: There are scattered cloudy patches in both lungs suggesting infection or inflammation. There is a moderate amount of fluid around the right lung. There is an area in the lower left lung that appears infected. There is no collapsed lung.,Pulmonology,Radiology Report,high
1546,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
1547,"33 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 33-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
1548,"29 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 29-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1549,"91 y/o F with PMH of depression, anxiety, PAD, Parkinson's disease, CKD Stage 4, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on calcium + vitamin D 600/400 daily, ondansetron 4mg Q8H PRN N/V, atorvastatin 40mg QHS. F/U PCP in 1 week.","A 91-year-old woman with a history of depression, anxiety, poor blood flow in the legs [peripheral artery disease], Parkinson's disease, and advanced kidney disease was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) calcium plus vitamin D once daily [bone strengthening]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the primary care doctor in 1 week.",Gastroenterology,Discharge Summary,high
1550,"85 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 85-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1551,"Thyroid panel: TSH 11.03 (H), Free T4 2.8.","Your thyroid test results: TSH is elevated at 11.03 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
1552,"Rx: prednisone taper. Tab pregabalin 75mg BID. Tab empagliflozin 10mg daily. Adv: high fiber diet, adequate hydration Avoid NSAIDs. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Neurology,Prescription,medium
1553,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
1554,CT Head without contrast: Paranasal sinuses clear. No mass effect. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Chronic lacunar infarcts in bilateral basal ganglia.,CT scan of the head results: The sinuses are clear with no infection. There are no tumors or masses pushing on the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There are signs of small old strokes in the deep parts of the brain.,Neurology,Radiology Report,high
1555,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
1556,"65 y/o M with PMH of Parkinson's disease, DVT/PE on warfarin, RA on MTX, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Strict I&O, daily weights. D/C on ferrous sulfate 325mg BID, ASA 81mg daily, montelukast 10mg QHS. F/U nephrology in 1 week.","A 65-year-old man with a history of Parkinson's disease, blood clots [on blood thinner warfarin], and rheumatoid arthritis [on immune-suppressing medicine] was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the kidney doctor in 1 week.",Infectious Disease,Discharge Summary,high
1557,"54 y/o M with PMH of seizure disorder on Keppra, RA on MTX, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on metformin 1000mg BID, ciprofloxacin 500mg BID x 5 days, azithromycin 500mg day 1 then 250mg x 4 days. F/U hematology in 2 weeks.","A 54-year-old man with a history of seizure disorder [on Keppra], and rheumatoid arthritis [on immune-suppressing medicine] was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
1558,Delivery Note: G?P? at 38+2 weeks. SVD. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1559,"30 y/o M with PMH of gout, A-fib, hypothyroidism, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on tramadol 50mg Q6H PRN pain, latanoprost 0.005% OU QHS, losartan 50mg daily, Dulcolax 10mg QHS PRN, ibuprofen 400mg Q6H PRN with food. F/U surgery in 2 weeks for drain removal.","A 30-year-old man with a history of gout, irregular heartbeat [atrial fibrillation], and underactive thyroid was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) losartan 50mg once daily [blood pressure medicine]; (4) Dulcolax 10mg at bedtime as needed [for constipation]; (5) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the surgeon in 2 weeks to remove the drain.",Hematology,Discharge Summary,high
1560,"90 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 90-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
1561,"35 y/o M with PMH of PAD, cirrhosis, SLE, COPD, s/p CABG, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on gabapentin 300mg TID, carvedilol 12.5mg BID, pregabalin 75mg BID. F/U pulmonology in 2 weeks.","A 35-year-old man with a history of poor blood flow in the legs [peripheral artery disease], liver scarring [cirrhosis], lupus, chronic lung disease, and prior heart bypass surgery was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the lung doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
1562,"MRI Lumbar Spine: Conus medullaris at L1, normal. Facet joint hypertrophy at L4-L5.",MRI of the lower back results: The spinal cord ends at a normal level. The small joints in the spine at L4-L5 are enlarged from arthritis.,Orthopedics,Radiology Report,high
1563,Rx: Tab Augmentin 875/125 BID x 7 days. Tab warfarin 5mg daily. albuterol MDI 2 puffs Q4-6H PRN. Avoid grapefruit juice. F/U PCP in 1 week for BP recheck.,Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Do not drink grapefruit juice as it interferes with this medication. See your primary care doctor in 1 week to recheck blood pressure.,Pulmonology,Prescription,medium
1564,CXR PA: Sternotomy wires intact. Elevated left hemidiaphragm. Mild cardiomegaly. No pneumothorax. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: The wires from prior heart surgery are intact. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The heart is slightly larger than normal. There is no collapsed lung. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
1565,"82 y/o M with PMH of OA, seizure disorder on Keppra, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on montelukast 10mg QHS, Lantus 20U QHS, potassium chloride 20mEq daily, ciprofloxacin 500mg BID x 5 days, lisinopril 20mg daily. F/U surgery in 10 days.","A 82-year-old man with a history of arthritis [osteoarthritis], and seizure disorder [on Keppra] was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (5) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the surgeon in 10 days.",Pulmonology,Discharge Summary,high
1566,"BMP: Na 133 (L), K 4.2 (N), BUN 20, Cr 0.9 (N), Glucose 198.","Your blood chemistry results: Sodium is low at 133 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.2. Creatinine is normal at 0.9. Blood sugar is 198 (high).",Nephrology,Lab Result,high
1567,CXR PA: Moderate right pleural effusion. Increased interstitial markings suggesting pulmonary edema. No pneumothorax. Compression fracture T12.,"Chest X-ray results: There is a moderate amount of fluid around the right lung. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There is no collapsed lung. There is a compression fracture [collapsed bone] in the lower spine at T12.",Pulmonology,Radiology Report,high
1568,"43 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 43-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
1569,CXR PA: Sternotomy wires intact. Widened mediastinum. Cardiomegaly with CTR >0.5. Port-a-cath in appropriate position.,"Chest X-ray results: The wires from prior heart surgery are intact. The space between the lungs appears wider than normal, which needs further evaluation. The heart appears larger than normal. The implanted medication port is in the correct position.",Pulmonology,Radiology Report,high
1570,"49 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 49-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
1571,Procedure: TURP for BPH. Pt 67 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 67-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
1572,"88 y/o F with PMH of hypothyroidism, ICD in situ, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on escitalopram 10mg daily, gabapentin 300mg TID. F/U PCP in 1 week.","A 88-year-old woman with a history of underactive thyroid, and implanted heart defibrillator was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the primary care doctor in 1 week.",Neurology,Discharge Summary,high
1573,"29 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 29-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1574,"43 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 43-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1575,"Rx: Tab atorvastatin 80mg QHS. Tab metoprolol 25mg BID. Tab furosemide 40mg BID. Adv: low salt low sugar diet, regular exercise Adv: high fiber diet, adequate hydration. F/U 1 month with repeat imaging.","Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) furosemide (Lasix) 40mg twice daily [water pill]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
1576,Procedure: Port-a-cath placement. Pt 76 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 76-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
1577,"Thyroid panel: TSH 14.15 (H), Free T4 2.0.","Your thyroid test results: TSH is elevated at 14.15 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
1578,Procedure: PCI with DES to LAD. Pt 48 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 48-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
1579,"BMP: Na 125 (L), K 5.8 (H), BUN 7, Cr 7.9 (H), Glucose 137.","Your blood chemistry results: Sodium is low at 125 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 5.8 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 7.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 137 (high).",Nephrology,Lab Result,high
1580,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. Subarachnoid hemorrhage in bilateral sylvian fissures. Chronic lacunar infarcts in bilateral basal ganglia. No midline shift.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There is bleeding around the brain surface, particularly in the grooves on both sides. There are signs of small old strokes in the deep parts of the brain. The brain is centered normally.",Neurology,Radiology Report,high
1581,MRI Lumbar Spine: Multilevel degenerative disc disease. Central canal stenosis at L3-L4.,"MRI of the lower back results: Multiple discs in the spine are showing wear and aging. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
1582,"82 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 82-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1583,"29 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 29-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1584,"68 y/o F with PMH of hypothyroidism, RA on MTX, CHF, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Strict I&O, daily weights. D/C on atorvastatin 80mg QHS, metformin 1000mg BID, glipizide 5mg BID AC, metformin 500mg BID, Augmentin 875/125 BID x 7 days. F/U INR check in 3 days.","A 68-year-old woman with a history of underactive thyroid, rheumatoid arthritis [on immune-suppressing medicine], and heart failure was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) metformin 500mg twice daily with meals [blood sugar medicine]; (5) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up for a blood thinner level check in 3 days.",Infectious Disease,Discharge Summary,high
1585,"Rx: Tab entresto 49/51mg BID. Tab amlodipine 10mg daily. Avoid grapefruit juice Adv: high fiber diet, adequate hydration. F/U PCP in 1 week for BP recheck.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. Do not drink grapefruit juice as it interferes with this medication Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
1586,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1587,"BMP: Na 134 (L), K 6.1 (H), BUN 38, Cr 4.2 (H), Glucose 305.","Your blood chemistry results: Sodium is low at 134 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.1 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 4.2 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 305 (high).",Nephrology,Lab Result,high
1588,"LFTs: AST 325 (H), ALT 326 (H), ALP 80, T.Bili 7.6 (H), Albumin 4.7.","Your liver blood test results: Liver enzymes (AST 325, ALT 326) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 7.6 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.7.",Gastroenterology,Lab Result,high
1589,"33 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 33-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1590,CXR PA: Sternotomy wires intact. Increased interstitial markings suggesting pulmonary edema. No pneumothorax. Moderate right pleural effusion. Port-a-cath in appropriate position.,"Chest X-ray results: The wires from prior heart surgery are intact. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There is no collapsed lung. There is a moderate amount of fluid around the right lung. The implanted medication port is in the correct position.",Pulmonology,Radiology Report,high
1591,Delivery Note: G?P? at 40+0 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1592,"83 y/o M with PMH of HFpEF, OA, PAD, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Low potassium diet. D/C on montelukast 10mg QHS, ciprofloxacin 500mg BID x 5 days. F/U PCP in 2 weeks.","A 83-year-old man with a history of heart failure with stiff heart muscle, arthritis [osteoarthritis], and poor blood flow in the legs [peripheral artery disease] was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Follow-up with the primary care doctor in 2 weeks.",Pulmonology,Discharge Summary,high
1593,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab omeprazole 20mg AC breakfast. Tab acetaminophen 650mg Q6H PRN. Adv: low salt low sugar diet, regular exercise Avoid NSAIDs. F/U 2 weeks.","Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back for a check-up in 2 weeks.",Gastroenterology,Prescription,medium
1594,CXR PA: Elevated left hemidiaphragm. Port-a-cath in appropriate position. Osseous structures intact. No pneumothorax.,Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. The implanted medication port is in the correct position. The bones look normal with no fractures. There is no collapsed lung.,Pulmonology,Radiology Report,high
1595,"82 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 82-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
1596,"69 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 69-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1597,HbA1c: 5.4% (N). FBS: 253 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.4%, which is normal — you do not have diabetes. Fasting blood sugar was 253, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
1598,"33 y/o F with PMH of cirrhosis, CHF, CAD, anxiety, ESRD on HD, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on amlodipine 5mg daily, Dulcolax 10mg QHS PRN. F/U endocrine in 1 week.","A 33-year-old woman with a history of liver scarring [cirrhosis], heart failure, coronary artery disease [heart artery blockages], anxiety, and kidney failure requiring dialysis was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
1599,"Rx: Tab Xarelto 20mg daily with dinner. Tab lisinopril 10mg daily. Tab spironolactone 25mg daily. Do not stop abruptly, taper as directed. F/U PCP in 1 week for BP recheck.",Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) spironolactone 25mg once daily [heart-protecting water pill]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
1600,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab ASA 81mg daily. Adv: DASH diet, daily BP monitoring. F/U PCP in 1 week for BP recheck.","Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) baby aspirin 81mg once daily [prevents blood clots]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
1601,CXR PA: Left lower lobe consolidation. Cardiomegaly with CTR >0.5. Bilateral hilar lymphadenopathy. Elevated left hemidiaphragm. Moderate right pleural effusion.,"Chest X-ray results: There is an area in the lower left lung that appears infected. The heart appears larger than normal. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The left side of the breathing muscle [diaphragm] is sitting higher than normal. There is a moderate amount of fluid around the right lung.",Pulmonology,Radiology Report,high
1602,"Rx: Tab rosuvastatin 10mg QHS. Tab amoxicillin 500mg TID x 10 days. Tab metoprolol 25mg BID. Tab furosemide 40mg daily. Adv: wound care with daily dressing changes Adv: DASH diet, daily BP monitoring. F/U 1 month with repeat imaging.","Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
1603,"44 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 44-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1604,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab montelukast 10mg QHS. Tab Xarelto 20mg daily with dinner. Adv: smoking cessation, pulmonary rehab. F/U 6 weeks with LFTs.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) Xarelto 20mg once daily with dinner [blood thinner]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 6 weeks for liver function blood tests.",Pulmonology,Prescription,medium
1605,"28 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 28-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1606,"57 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 57-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1607,"75 y/o F with PMH of GERD, DM1, ICD in situ, HFpEF, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on ciprofloxacin 500mg BID x 5 days, atorvastatin 40mg QHS, omeprazole 20mg AC breakfast, hydroxychloroquine 200mg BID. F/U wound care in 3 days.","A 75-year-old woman with a history of acid reflux, type 1 diabetes, implanted heart defibrillator, and heart failure with stiff heart muscle was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]; (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up at the wound care clinic in 3 days.",Urology,Discharge Summary,high
1608,"35 y/o M with PMH of BPH, DVT/PE on warfarin, CKD Stage 3, anemia, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on tramadol 50mg Q6H PRN pain, ibuprofen 400mg Q6H PRN with food, rosuvastatin 10mg QHS. F/U PCP in 2 weeks.","A 35-year-old man with a history of enlarged prostate, blood clots [on blood thinner warfarin], moderate kidney disease, and low blood count [anemia] was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the primary care doctor in 2 weeks.",General Surgery,Discharge Summary,high
1609,"23 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 23-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
1610,"79 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 79-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1611,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. No midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. The brain is centered normally. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
1612,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
1613,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
1614,"CBC: WBC 15.5 (H), Hgb 9.6 (L), Plt 32 (L).","Your blood count results: White blood cells are 15.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 9.6, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 32, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
1615,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab amoxicillin 500mg TID x 10 days. Tab furosemide 40mg daily. Adv: avoid alcohol, hepatotoxic drugs Adv: low salt diet, fluid restriction 1.5L/day. F/U 1 month with repeat imaging.",Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,medium
1616,"33 y/o M with PMH of hypothyroidism, SLE, h/o TIA, HFpEF, BPH, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Strict I&O, daily weights. D/C on escitalopram 10mg daily, hydroxychloroquine 200mg BID. F/U GI in 1 week.","A 33-year-old man with a history of underactive thyroid, lupus, history of mini-stroke, heart failure with stiff heart muscle, and enlarged prostate was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
1617,"CBC: WBC 19.0 (H), Hgb 17.3 (H), Plt 268 (N).","Your blood count results: White blood cells are 19.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is elevated at 17.3. Platelets are 268, which is normal.",Hematology,Lab Result,high
1618,"54 y/o M with PMH of CKD Stage 4, CAD, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Compression stockings when ambulating. D/C on amlodipine 5mg daily, carvedilol 12.5mg BID, ferrous sulfate 325mg BID, gabapentin 300mg TID, pantoprazole 40mg AC breakfast. F/U nephrology in 5 days.","A 54-year-old man with a history of advanced kidney disease, and coronary artery disease [heart artery blockages] was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (5) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the kidney doctor in 5 days.",Gastroenterology,Discharge Summary,high
1619,"Rx: Tab metformin 500mg BID. Tab hydroxychloroquine 200mg BID. Adv: low salt low sugar diet, regular exercise Adv: SMBG BID, diabetic diet. F/U 1 month with repeat imaging.","Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 month — a repeat scan will be ordered.",Pediatrics,Prescription,medium
1620,CT Head without contrast: No midline shift. Paranasal sinuses clear. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: The brain is centered normally. The sinuses are clear with no infection. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
1621,"BMP: Na 145 (N), K 3.2 (L), BUN 14, Cr 1.9 (H), Glucose 68.","Your blood chemistry results: Sodium is normal at 145. Potassium is low at 3.2 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 1.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 68 (low).",Nephrology,Lab Result,high
1622,"33 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 33-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1623,HbA1c: 10.8% (H). FBS: 280 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.8%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 280, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1624,"43 y/o M with PMH of DM1, PPM in situ, h/o TIA, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Low potassium diet. D/C on glipizide 5mg BID AC, losartan 50mg daily, ASA 81mg daily. F/U endocrine in 1 week.","A 43-year-old man with a history of type 1 diabetes, implanted pacemaker, and history of mini-stroke was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) losartan 50mg once daily [blood pressure medicine]; (3) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
1625,HbA1c: 5.1% (N). FBS: 327 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.1%, which is normal — you do not have diabetes. Fasting blood sugar was 327, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
1626,"62 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 62-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
1627,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,low
1628,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,low
1629,CT Head without contrast: No mass effect. No midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,CT scan of the head results: There are no tumors or masses pushing on the brain. The brain is centered normally. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.,Neurology,Radiology Report,high
1630,"Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab tramadol 50mg Q6H PRN pain. Tab pregabalin 75mg BID. Tab ASA 81mg daily. Adv: smoking cessation, pulmonary rehab Adv: SMBG BID, diabetic diet. F/U 1 month with repeat imaging.",Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) pregabalin 75mg twice daily [nerve pain medicine]. (4) baby aspirin 81mg once daily [prevents blood clots]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 month — a repeat scan will be ordered.,General,Prescription,high
1631,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
1632,"Rx: Lantus 20U QHS. Tab amlodipine 5mg daily. Tab timolol 0.5% OU BID. Adv: smoking cessation, pulmonary rehab Adv: avoid alcohol, hepatotoxic drugs. F/U 1 month with repeat imaging.",Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,medium
1633,"41 y/o M with PMH of PPM in situ, obesity (BMI 38), admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on ibuprofen 400mg Q6H PRN with food, atorvastatin 80mg QHS, calcium + vitamin D 600/400 daily, metoprolol succinate 50mg daily. F/U INR check in 3 days.","A 41-year-old man with a history of implanted pacemaker, and obesity was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) calcium plus vitamin D once daily [bone strengthening]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up for a blood thinner level check in 3 days.",Infectious Disease,Discharge Summary,high
1634,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1635,"82 y/o M with PMH of PAD, DM1, s/p CABG, CKD Stage 4, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on azithromycin 500mg day 1 then 250mg x 4 days, Lantus 20U QHS, entresto 49/51mg BID. F/U PCP in 1 week.","A 82-year-old man with a history of poor blood flow in the legs [peripheral artery disease], type 1 diabetes, prior heart bypass surgery, and advanced kidney disease was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the primary care doctor in 1 week.",Neurology,Discharge Summary,high
1636,CXR PA: Right lower lobe consolidation. ET tube 3cm above carina. Osseous structures intact. Sternotomy wires intact. Cardiomegaly with CTR >0.5.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. The breathing tube is in good position. The bones look normal with no fractures. The wires from prior heart surgery are intact. The heart appears larger than normal.",Pulmonology,Radiology Report,high
1637,CXR PA: No pneumothorax. Right lower lobe consolidation. Widened mediastinum. No cardiomegaly. Bilateral pleural effusions.,"Chest X-ray results: There is no collapsed lung. There is an area in the lower right lung that appears infected, suggesting pneumonia. The space between the lungs appears wider than normal, which needs further evaluation. The heart is a normal size. There is fluid collecting around both lungs.",Pulmonology,Radiology Report,high
1638,"Rx: Tab metoprolol 25mg BID. Tab ciprofloxacin 500mg BID x 5 days. Tab ASA 81mg daily. Tab metoprolol succinate 50mg daily. Adv: high fiber diet, adequate hydration. F/U 1 week with wound check.","Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (3) baby aspirin 81mg once daily [prevents blood clots]. (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
1639,"US Abdomen: Spleen 11cm, normal. GB sludge, no stones. Left kidney 8cm, cortical thinning consistent with CKD.","Abdominal ultrasound results: The spleen is a normal size. The gallbladder contains thickened bile [sludge] but no stones. Left kidney is small with thin outer layer, consistent with chronic kidney disease.",Gastroenterology,Radiology Report,high
1640,"57 y/o M with PMH of gout, DM2, GERD, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on ASA 81mg daily, pantoprazole 40mg AC breakfast. F/U endocrine in 1 week.","A 57-year-old man with a history of gout, type 2 diabetes, and acid reflux was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
1641,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1642,"83 y/o F with PMH of s/p THR, CAD, CKD Stage 3, cirrhosis, osteoporosis, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on atorvastatin 80mg QHS, methotrexate 15mg weekly, Spiriva 18mcg daily, azithromycin 500mg day 1 then 250mg x 4 days. F/U GI in 1 week.","A 83-year-old woman with a history of prior hip replacement, coronary artery disease [heart artery blockages], moderate kidney disease, liver scarring [cirrhosis], and weak bones [osteoporosis] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (3) Spiriva inhaler once daily [long-acting lung medicine]; (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the stomach doctor in 1 week.",Neurology,Discharge Summary,high
1643,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1644,"87 y/o M with PMH of asthma, OSA on CPAP, DM2, obesity (BMI 38), admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on Spiriva 18mcg daily, Dulcolax 10mg QHS PRN, empagliflozin 10mg daily, amlodipine 10mg daily, pregabalin 75mg BID. F/U surgery in 10 days.","A 87-year-old man with a history of asthma, sleep apnea [uses a breathing machine at night], type 2 diabetes, and obesity was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (4) amlodipine 10mg once daily [blood pressure medicine]; (5) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
1645,Delivery Note: G?P? at 38+2 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1646,"Rx: Tab rosuvastatin 10mg QHS. Tab spironolactone 25mg daily. Tab metoprolol succinate 50mg daily. Adv: elevate affected limb, compression stockings. F/U 6 weeks with LFTs.",Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,medium
1647,"Rx: Tab pantoprazole 40mg AC breakfast. Tab lisinopril 20mg daily. Tab amoxicillin 500mg TID x 10 days. Adv: avoid alcohol, hepatotoxic drugs. F/U PCP in 1 week for BP recheck.",Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) lisinopril 20mg once daily [blood pressure medicine]. (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
1648,"LFTs: AST 201 (H), ALT 137 (H), ALP 49, T.Bili 1.7 (H), Albumin 3.5.","Your liver blood test results: Liver enzymes (AST 201, ALT 137) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is mildly elevated at 1.7. Albumin is normal at 3.5.",Gastroenterology,Lab Result,high
1649,Rx: Tab gabapentin 300mg TID. Tab ondansetron 4mg Q8H PRN N/V. albuterol MDI 2 puffs Q4-6H PRN. Tab ibuprofen 400mg Q6H PRN with food. Tab metformin 500mg BID. Adv: low potassium diet. F/U 1 month with repeat imaging.,"Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (5) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 month — a repeat scan will be ordered.",General,Prescription,high
1650,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1651,CXR PA: Clear lung fields bilaterally. Pacemaker leads in appropriate position. Right lower lobe consolidation.,"Chest X-ray results: Both lungs look clear with no problems. The pacemaker wires are in the correct position. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
1652,"56 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 56-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1653,"39 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 39-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1654,Rx: Tab ASA 81mg daily. Tab methotrexate 15mg weekly. albuterol MDI 2 puffs Q4-6H PRN. Tab pregabalin 75mg BID. Avoid grapefruit juice. F/U PCP in 1 week for BP recheck.,Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) pregabalin 75mg twice daily [nerve pain medicine]. Do not drink grapefruit juice as it interferes with this medication. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,high
1655,"67 y/o M with PMH of DM2, anxiety, gout, ICD in situ, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Compression stockings when ambulating. D/C on ferrous sulfate 325mg BID, ASA 81mg daily, clopidogrel 75mg daily, omeprazole 20mg AC breakfast. F/U nephrology in 5 days.","A 67-year-old man with a history of type 2 diabetes, anxiety, gout, and implanted heart defibrillator was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the kidney doctor in 5 days.",Endocrinology,Discharge Summary,high
1656,"42 y/o M with PMH of DM1, h/o CVA, depression, GERD, PAD, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on latanoprost 0.005% OU QHS, hydroxychloroquine 200mg BID, Humalog per SSI, metoprolol succinate 50mg daily. F/U nephrology in 5 days.","A 42-year-old man with a history of type 1 diabetes, history of stroke, depression, acid reflux, and poor blood flow in the legs [peripheral artery disease] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) Humalog insulin before meals as directed [fast-acting insulin]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the kidney doctor in 5 days.",Gastroenterology,Discharge Summary,high
1657,"30 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 30-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1658,CT Head without contrast: No acute intracranial hemorrhage. Mild generalized cerebral atrophy appropriate for age. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: There is no bleeding in the brain. There is mild brain shrinkage, which is normal for your age. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
1659,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab montelukast 10mg QHS. Tab Eliquis 5mg BID. Tab hydroxychloroquine 200mg BID. Tab Augmentin 875/125 BID x 7 days. Avoid NSAIDs Adv: avoid alcohol, hepatotoxic drugs. F/U 1 month with repeat imaging.",Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) Eliquis 5mg twice daily [blood thinner]. (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (5) Augmentin 875mg twice daily for 7 days [antibiotic]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 month — a repeat scan will be ordered.,Pulmonology,Prescription,high
1660,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab clopidogrel 75mg daily. Tab carvedilol 12.5mg BID. Adv: DASH diet, daily BP monitoring. F/U 1 week with CBC, CMP.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) carvedilol 12.5mg twice daily [heart medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,medium
1661,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab Eliquis 5mg BID. Tab levothyroxine 75mcg daily on empty stomach. Tab clopidogrel 75mg daily. Do not stop abruptly, taper as directed. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) Eliquis 5mg twice daily [blood thinner]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,high
1662,Rx: Tab pregabalin 75mg BID. Tab methotrexate 15mg weekly. Tab furosemide 40mg BID. Avoid grapefruit juice. F/U 2 weeks with INR.,Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) furosemide (Lasix) 40mg twice daily [water pill]. Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,medium
1663,"59 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 59-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1664,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1665,"Rx: Tab metformin 1000mg BID. Tab tramadol 50mg Q6H PRN pain. prednisone taper. Adv: elevate affected limb, compression stockings. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) metformin 1000mg twice daily with meals [blood sugar medicine]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Endocrinology,Prescription,medium
1666,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab metoprolol 25mg BID. Do not stop abruptly, taper as directed. F/U 2 weeks.",Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
1667,"23 y/o F with PMH of CKD Stage 3, Parkinson's disease, RA on MTX, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on metoprolol succinate 50mg daily, levothyroxine 75mcg daily on empty stomach. F/U endocrine in 1 week.","A 23-year-old woman with a history of moderate kidney disease, Parkinson's disease, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Nephrology,Discharge Summary,high
1668,HbA1c: 11.2% (H). FBS: 291 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.2%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 291, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1669,"Rx: Tab hydroxychloroquine 200mg BID. albuterol MDI 2 puffs Q4-6H PRN. Tab tramadol 50mg Q6H PRN pain. Tab Xarelto 20mg daily with dinner. Tab lisinopril 20mg daily. Adv: wound care with daily dressing changes. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (4) Xarelto 20mg once daily with dinner [blood thinner]. (5) lisinopril 20mg once daily [blood pressure medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
1670,"42 y/o F with PMH of asthma, anxiety, OA, HFpEF, h/o TIA, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Low potassium diet. D/C on furosemide 40mg BID, gabapentin 300mg TID, losartan 50mg daily. F/U endocrine in 1 week.","A 42-year-old woman with a history of asthma, anxiety, arthritis [osteoarthritis], heart failure with stiff heart muscle, and history of mini-stroke was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) losartan 50mg once daily [blood pressure medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Infectious Disease,Discharge Summary,high
1671,Rx: Tab spironolactone 25mg daily. Tab calcium + vitamin D 600/400 daily. Adv: wound care with daily dressing changes. F/U 2 weeks with INR.,"Your medicines: (1) spironolactone 25mg once daily [heart-protecting water pill]. (2) calcium plus vitamin D once daily [bone strengthening]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
1672,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1673,CXR PA: Elevated left hemidiaphragm. NG tube tip in stomach. Pacemaker leads in appropriate position.,Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. The feeding/drainage tube tip is correctly positioned in the stomach. The pacemaker wires are in the correct position.,Pulmonology,Radiology Report,high
1674,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1675,"Rx: Tab metoprolol succinate 50mg daily. Tab atorvastatin 40mg QHS. Tab lisinopril 20mg daily. Tab entresto 49/51mg BID. Adv: low potassium diet Adv: SMBG BID, diabetic diet. F/U 1 week with wound check.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) lisinopril 20mg once daily [blood pressure medicine]. (4) Entresto 49/51mg twice daily [heart failure medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
1676,"Rx: Tab atorvastatin 80mg QHS. Tab Dulcolax 10mg QHS PRN. Tab Augmentin 875/125 BID x 7 days. Adv: smoking cessation, pulmonary rehab. F/U 2 weeks.",Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
1677,Procedure: ORIF L distal radius. Pt 53 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 53-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1678,"Lipid panel: TC 157, LDL 97, HDL 68, TG 204.",Your cholesterol results: Total cholesterol is 157. LDL (bad cholesterol) is at goal (97). HDL (good cholesterol) is good at 68. Triglycerides are high at 204.,Cardiology,Lab Result,high
1679,"US Abdomen: Moderate right hydronephrosis. Left kidney 8cm, cortical thinning consistent with CKD. GB wall thickening with stones, positive Murphy's sign. GB sludge, no stones. Simple renal cysts bilaterally.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The gallbladder contains thickened bile [sludge] but no stones. Both kidneys have harmless fluid-filled cysts.",Gastroenterology,Radiology Report,high
1680,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Subarachnoid hemorrhage in bilateral sylvian fissures. No mass effect. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There is bleeding around the brain surface, particularly in the grooves on both sides. There are no tumors or masses pushing on the brain. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
1681,"BMP: Na 127 (L), K 6.7 (H), BUN 86, Cr 1.6 (H), Glucose 297.","Your blood chemistry results: Sodium is low at 127 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.7 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 1.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 297 (high).",Nephrology,Lab Result,high
1682,"Rx: Tab ferrous sulfate 325mg BID. Tab pregabalin 75mg BID. Tab acetaminophen 650mg Q6H PRN. Tab amoxicillin 500mg TID x 10 days. Avoid NSAIDs Adv: SMBG BID, diabetic diet. F/U 1 week with wound check.",Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week to have the wound checked.,General,Prescription,high
1683,"56 y/o M with PMH of SLE, HLD, OA, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on potassium chloride 20mEq daily, atorvastatin 80mg QHS, empagliflozin 10mg daily. F/U surgery in 2 weeks for drain removal.","A 56-year-old man with a history of lupus, high cholesterol, and arthritis [osteoarthritis] was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
1684,Procedure: TURP for BPH. Pt 40 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 40-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
1685,"Rx: Tab furosemide 40mg daily. Tab Augmentin 875/125 BID x 7 days. Tab ondansetron 4mg Q8H PRN N/V. Tab amlodipine 10mg daily. Adv: elevate affected limb, compression stockings. F/U INR in 3 days.",Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) amlodipine 10mg once daily [blood pressure medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
1686,"37 y/o M with PMH of hypothyroidism, A-fib, h/o CVA, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on clopidogrel 75mg daily, lisinopril 20mg daily, atorvastatin 40mg QHS, carvedilol 12.5mg BID, levothyroxine 75mcg daily on empty stomach. F/U GI in 1 week.","A 37-year-old man with a history of underactive thyroid, irregular heartbeat [atrial fibrillation], and history of stroke was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]; (4) carvedilol 12.5mg twice daily [heart medicine]; (5) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
1687,"BMP: Na 149 (H), K 4.4 (N), BUN 83, Cr 1.8 (H), Glucose 349.","Your blood chemistry results: Sodium is high at 149, meaning you may be dehydrated. Potassium is normal at 4.4. Creatinine is elevated at 1.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 349 (high).",Nephrology,Lab Result,high
1688,"BMP: Na 139 (N), K 4.5 (N), BUN 21, Cr 2.1 (H), Glucose 397.","Your blood chemistry results: Sodium is normal at 139. Potassium is normal at 4.5. Creatinine is elevated at 2.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 397 (high).",Nephrology,Lab Result,high
1689,Procedure: Laparoscopic appendectomy. Pt 36 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 36-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1690,"Thyroid panel: TSH 4.78 (H), Free T4 2.1.","Your thyroid test results: TSH is elevated at 4.78 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
1691,"Thyroid panel: TSH 4.59 (H), Free T4 0.9.","Your thyroid test results: TSH is elevated at 4.59 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
1692,HbA1c: 7.8% (H). FBS: 204 mg/dL (H).,"Your diabetes blood test results: HbA1c is 7.8%, which is above the target of 7.0%. Your blood sugar has been somewhat poorly controlled over the past 3 months. Fasting blood sugar was 204, which is high (normal is 70-100). Your diabetes medicines may need adjustment. Discuss with your doctor.",Endocrinology,Lab Result,high
1693,"91 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 91-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1694,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Acute ischemic infarct in R MCA territory. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
1695,"52 y/o M with PMH of cirrhosis, anemia, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on ASA 81mg daily, furosemide 40mg daily. F/U endocrine in 1 week.","A 52-year-old man with a history of liver scarring [cirrhosis], and low blood count [anemia] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Follow-up with the hormone/diabetes doctor in 1 week.",Orthopedics,Discharge Summary,high
1696,"Rx: Tab gabapentin 300mg TID. Tab Eliquis 5mg BID. Tab Dulcolax 10mg QHS PRN. Tab timolol 0.5% OU BID. Adv: low potassium diet Adv: smoking cessation, pulmonary rehab. F/U INR in 3 days.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) Eliquis 5mg twice daily [blood thinner]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 3 days for a blood thinner level check [INR].",Neurology,Prescription,high
1697,"Lipid panel: TC 239, LDL 194, HDL 72, TG 203.","Your cholesterol results: Total cholesterol is 239. LDL (bad cholesterol) is very high at 194 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 72. Triglycerides are high at 203.",Cardiology,Lab Result,high
1698,"35 y/o F with PMH of cirrhosis, s/p TKR, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on hydroxychloroquine 200mg BID, carvedilol 12.5mg BID. F/U wound care in 3 days.","A 35-year-old woman with a history of liver scarring [cirrhosis], and prior knee replacement was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) carvedilol 12.5mg twice daily [heart medicine]. Follow-up at the wound care clinic in 3 days.",Infectious Disease,Discharge Summary,high
1699,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
1700,"63 y/o M with PMH of HFpEF, CKD Stage 3, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on pregabalin 75mg BID, ASA 81mg daily. F/U surgery in 10 days.","A 63-year-old man with a history of heart failure with stiff heart muscle, and moderate kidney disease was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the surgeon in 10 days.",Infectious Disease,Discharge Summary,high
1701,"Rx: Tab rosuvastatin 10mg QHS. Tab furosemide 40mg daily. Humalog per SSI. Tab amoxicillin 500mg TID x 10 days. Tab ibuprofen 400mg Q6H PRN with food. Adv: DASH diet, daily BP monitoring Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with INR.","Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) Humalog insulin before meals as directed [fast-acting insulin]. (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (5) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
1702,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1703,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. No mass effect. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There are no tumors or masses pushing on the brain. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
1704,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
1705,"68 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 68-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1706,"65 y/o F with PMH of s/p TKR, OA, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on potassium chloride 20mEq daily, escitalopram 10mg daily, Augmentin 875/125 BID x 7 days. F/U surgery in 10 days.","A 65-year-old woman with a history of prior knee replacement, and arthritis [osteoarthritis] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the surgeon in 10 days.",Psychiatry,Discharge Summary,high
1707,"Rx: Tab gabapentin 300mg TID. Tab metoprolol succinate 50mg daily. Tab sertraline 50mg daily. Do not stop abruptly, taper as directed Adv: low potassium diet. F/U 1 week with CBC, CMP.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,medium
1708,"45 y/o F with PMH of seizure disorder on Keppra, Parkinson's disease, HTN, OSA on CPAP, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on prednisone taper, acetaminophen 650mg Q6H PRN, clopidogrel 75mg daily. F/U PCP in 2 weeks.","A 45-year-old woman with a history of seizure disorder [on Keppra], Parkinson's disease, high blood pressure, and sleep apnea [uses a breathing machine at night] was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
1709,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage. Paranasal sinuses clear. No midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain. The sinuses are clear with no infection. The brain is centered normally. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
1710,CXR PA: Right-sided pneumothorax. Sternotomy wires intact. Hyperinflated lungs consistent with COPD. Right middle lobe atelectasis. Clear lung fields bilaterally.,"Chest X-ray results: The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The wires from prior heart surgery are intact. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. Both lungs look clear with no problems.",Pulmonology,Radiology Report,high
1711,"CBC: WBC 5.1 (N), Hgb 17.9 (H), Plt 339 (N).","Your blood count results: White blood cells are 5.1 (normal). Hemoglobin is elevated at 17.9. Platelets are 339, which is normal.",Hematology,Lab Result,high
1712,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1713,"Rx: Tab Xarelto 20mg daily with dinner. Tab clopidogrel 75mg daily. Adv: fall precautions, home safety evaluation Avoid NSAIDs. F/U 1 week with CBC, CMP.","Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,medium
1714,"25 y/o M with PMH of osteoporosis, CKD Stage 3, HTN, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Strict I&O, daily weights. D/C on azithromycin 500mg day 1 then 250mg x 4 days, carvedilol 12.5mg BID, entresto 49/51mg BID. F/U PCP in 2 weeks.","A 25-year-old man with a history of weak bones [osteoporosis], moderate kidney disease, and high blood pressure was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the primary care doctor in 2 weeks.",Endocrinology,Discharge Summary,high
1715,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
1716,"46 y/o M with PMH of DM2, depression, CKD Stage 3, hypothyroidism, ICD in situ, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on atorvastatin 40mg QHS, Xarelto 20mg daily with dinner, ferrous sulfate 325mg BID. F/U PCP in 1 week.","A 46-year-old man with a history of type 2 diabetes, depression, moderate kidney disease, underactive thyroid, and implanted heart defibrillator was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the primary care doctor in 1 week.",Pulmonology,Discharge Summary,high
1717,"CBC: WBC 15.7 (H), Hgb 7.5 (L), Plt 318 (N).","Your blood count results: White blood cells are 15.7 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 7.5, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 318, which is normal.",Hematology,Lab Result,high
1718,"69 y/o F with PMH of s/p THR, anxiety, depression, DVT/PE on warfarin, CHF, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on amlodipine 5mg daily, clopidogrel 75mg daily. F/U hematology in 2 weeks.","A 69-year-old woman with a history of prior hip replacement, anxiety, depression, blood clots [on blood thinner warfarin], and heart failure was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. Follow-up with the blood disorder doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
1719,"34 y/o F with PMH of asthma, BPH, s/p TKR, Parkinson's disease, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on atorvastatin 40mg QHS, Eliquis 5mg BID, ibuprofen 400mg Q6H PRN with food, Augmentin 875/125 BID x 7 days, glipizide 5mg BID AC. F/U GI in 1 week.","A 34-year-old woman with a history of asthma, enlarged prostate, prior knee replacement, and Parkinson's disease was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) Eliquis 5mg twice daily [blood thinner]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]; (5) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
1720,"84 y/o M with PMH of hypothyroidism, ICD in situ, HFpEF, HFrEF (EF 30%), admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on ondansetron 4mg Q8H PRN N/V, carvedilol 12.5mg BID, ferrous sulfate 325mg BID, pregabalin 75mg BID. F/U surgery in 2 weeks for drain removal.","A 84-year-old man with a history of underactive thyroid, implanted heart defibrillator, heart failure with stiff heart muscle, and heart failure with weak pumping (30%) was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
1721,"US Abdomen: GB sludge, no stones. Simple renal cysts bilaterally. Ascites moderate amount. CBD 5mm, not dilated.",Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. Both kidneys have harmless fluid-filled cysts. There is a moderate amount of fluid in the belly [ascites]. The bile duct is normal size [not blocked].,Gastroenterology,Radiology Report,high
1722,"79 y/o M with PMH of gout, OA, HLD, CAD, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Xarelto 20mg daily with dinner, escitalopram 10mg daily, timolol 0.5% OU BID, Dulcolax 10mg QHS PRN, ibuprofen 400mg Q6H PRN with food. F/U GI in 1 week.","A 79-year-old man with a history of gout, arthritis [osteoarthritis], high cholesterol, and coronary artery disease [heart artery blockages] was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (4) Dulcolax 10mg at bedtime as needed [for constipation]; (5) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the stomach doctor in 1 week.",Infectious Disease,Discharge Summary,high
1723,CXR PA: Pacemaker leads in appropriate position. Cardiomegaly with CTR >0.5. Moderate right pleural effusion. Port-a-cath in appropriate position. Left lower lobe consolidation.,Chest X-ray results: The pacemaker wires are in the correct position. The heart appears larger than normal. There is a moderate amount of fluid around the right lung. The implanted medication port is in the correct position. There is an area in the lower left lung that appears infected.,Pulmonology,Radiology Report,high
1724,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1725,"MRI Lumbar Spine: No compression fracture. Conus medullaris at L1, normal. C5-C6 disc herniation with cord compression.","MRI of the lower back results: No bones are broken or collapsed. The spinal cord ends at a normal level. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
1726,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab gabapentin 300mg TID. Tab levothyroxine 75mcg daily on empty stomach. Tab warfarin 5mg daily. Adv: avoid alcohol, hepatotoxic drugs. F/U INR in 3 days.",Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 3 days for a blood thinner level check [INR].,Neurology,Prescription,high
1727,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,high
1728,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,high
1729,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,low
1730,"76 y/o M with PMH of A-fib, HFrEF (EF 30%), OSA on CPAP, GERD, ICD in situ, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Humalog per SSI, atorvastatin 40mg QHS, atorvastatin 80mg QHS. F/U hematology in 2 weeks.","A 76-year-old man with a history of irregular heartbeat [atrial fibrillation], heart failure with weak pumping (30%), sleep apnea [uses a breathing machine at night], acid reflux, and implanted heart defibrillator was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Humalog insulin before meals as directed [fast-acting insulin]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
1731,CXR PA: Mild cardiomegaly. No pneumothorax. Small left pleural effusion.,Chest X-ray results: The heart is slightly larger than normal. There is no collapsed lung. There is a small amount of fluid around the left lung.,Pulmonology,Radiology Report,high
1732,"MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. Conus medullaris at L1, normal.","MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
1733,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,high
1734,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
1735,"Thyroid panel: TSH 0.28 (L), Free T4 2.1.","Your thyroid test results: TSH is low at 0.28 (normal 0.4-4.5), meaning your thyroid is overactive [hyperthyroidism]. Free T4 is high — consistent with an overactive thyroid.",Endocrinology,Lab Result,high
1736,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab clopidogrel 75mg daily. Tab hydroxychloroquine 200mg BID. Tab ferrous sulfate 325mg BID. Tab entresto 49/51mg BID. Adv: SMBG BID, diabetic diet Avoid grapefruit juice. F/U 1 week with wound check.",Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (5) Entresto 49/51mg twice daily [heart failure medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Do not drink grapefruit juice as it interferes with this medication. Come back in 1 week to have the wound checked.,Cardiology,Prescription,high
1737,CXR PA: Osseous structures intact. Hyperinflated lungs consistent with COPD. ET tube 3cm above carina. No pneumothorax. Cardiomegaly with CTR >0.5.,"Chest X-ray results: The bones look normal with no fractures. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The breathing tube is in good position. There is no collapsed lung. The heart appears larger than normal.",Pulmonology,Radiology Report,high
1738,"Rx: Tab escitalopram 10mg daily. Tab tramadol 50mg Q6H PRN pain. Tab atorvastatin 40mg QHS. Tab timolol 0.5% OU BID. Tab Augmentin 875/125 BID x 7 days. Avoid grapefruit juice Adv: SMBG BID, diabetic diet. F/U 2 weeks with INR.",Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) atorvastatin 40mg at bedtime [cholesterol medicine]. (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (5) Augmentin 875mg twice daily for 7 days [antibiotic]. Do not drink grapefruit juice as it interferes with this medication Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
1739,"76 y/o M with PMH of hypothyroidism, HLD, s/p THR, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on Augmentin 875/125 BID x 7 days, albuterol MDI 2 puffs Q4-6H PRN, metformin 500mg BID, entresto 49/51mg BID. F/U endocrine in 1 week.","A 76-year-old man with a history of underactive thyroid, high cholesterol, and prior hip replacement was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (3) metformin 500mg twice daily with meals [blood sugar medicine]; (4) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Gastroenterology,Discharge Summary,high
1740,MRI Lumbar Spine: Central canal stenosis at L3-L4. Facet joint hypertrophy at L4-L5. L5-S1 disc desiccation with mild bulge.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. The small joints in the spine at L4-L5 are enlarged from arthritis. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
1741,"Rx: Tab glipizide 5mg BID AC. Tab Augmentin 875/125 BID x 7 days. Tab carvedilol 12.5mg BID. Tab hydroxychloroquine 200mg BID. Tab entresto 49/51mg BID. Adv: DASH diet, daily BP monitoring Adv: wound care with daily dressing changes. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) glipizide 5mg twice daily before meals [helps release insulin]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. (3) carvedilol 12.5mg twice daily [heart medicine]. (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (5) Entresto 49/51mg twice daily [heart failure medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
1742,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Subarachnoid hemorrhage in bilateral sylvian fissures. No acute intracranial hemorrhage.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is bleeding around the brain surface, particularly in the grooves on both sides. There is no bleeding in the brain.",Neurology,Radiology Report,high
1743,"Rx: Tab ASA 81mg daily. Tab lisinopril 10mg daily. Tab potassium chloride 20mEq daily. Tab ibuprofen 400mg Q6H PRN with food. Tab furosemide 40mg BID. Adv: low potassium diet Do not stop abruptly, taper as directed. F/U 1 month with repeat imaging.","Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (5) furosemide (Lasix) 40mg twice daily [water pill]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
1744,"59 y/o M with PMH of CKD Stage 4, A-fib, DVT/PE on warfarin, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Compression stockings when ambulating. D/C on gabapentin 300mg TID, sertraline 50mg daily, Dulcolax 10mg QHS PRN, Eliquis 5mg BID. F/U pulmonology in 2 weeks.","A 59-year-old man with a history of advanced kidney disease, irregular heartbeat [atrial fibrillation], and blood clots [on blood thinner warfarin] was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]; (3) Dulcolax 10mg at bedtime as needed [for constipation]; (4) Eliquis 5mg twice daily [blood thinner]. Follow-up with the lung doctor in 2 weeks.",General Surgery,Discharge Summary,high
1745,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,high
1746,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,low
1747,"Rx: Tab furosemide 40mg daily. Tab atorvastatin 40mg QHS. Avoid grapefruit juice Adv: DASH diet, daily BP monitoring. F/U 6 weeks with LFTs.","Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. Do not drink grapefruit juice as it interferes with this medication Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
1748,HbA1c: 11.2% (H). FBS: 143 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.2%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 143, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1749,"Rx: Tab metoprolol succinate 50mg daily. Tab metoprolol 25mg BID. Tab Dulcolax 10mg QHS PRN. albuterol MDI 2 puffs Q4-6H PRN. Tab Augmentin 875/125 BID x 7 days. Adv: low salt low sugar diet, regular exercise. F/U PCP in 1 week for BP recheck.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (5) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
1750,"Rx: Tab Xarelto 20mg daily with dinner. Lantus 20U QHS. Adv: weight bearing exercise, calcium/vit D supplementation Adv: fall precautions, home safety evaluation. F/U 2 weeks.","Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back for a check-up in 2 weeks.",Endocrinology,Prescription,medium
1751,"76 y/o M with PMH of BPH, OSA on CPAP, gout, CHF, DM1, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on pregabalin 75mg BID, ibuprofen 400mg Q6H PRN with food, Humalog per SSI, tramadol 50mg Q6H PRN pain. F/U surgery in 2 weeks for drain removal.","A 76-year-old man with a history of enlarged prostate, sleep apnea [uses a breathing machine at night], gout, heart failure, and type 1 diabetes was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) Humalog insulin before meals as directed [fast-acting insulin]; (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the surgeon in 2 weeks to remove the drain.",Pulmonology,Discharge Summary,high
1752,"43 y/o F with PMH of CAD, OA, s/p THR, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on amlodipine 5mg daily, losartan 50mg daily, metformin 1000mg BID, ferrous sulfate 325mg BID. F/U wound care in 3 days.","A 43-year-old woman with a history of coronary artery disease [heart artery blockages], arthritis [osteoarthritis], and prior hip replacement was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) losartan 50mg once daily [blood pressure medicine]; (3) metformin 1000mg twice daily with meals [blood sugar medicine]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up at the wound care clinic in 3 days.",Gastroenterology,Discharge Summary,high
1753,"Rx: Tab lisinopril 10mg daily. Tab methotrexate 15mg weekly. Tab metoprolol 25mg BID. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab Xarelto 20mg daily with dinner. Avoid NSAIDs Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with wound check.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (5) Xarelto 20mg once daily with dinner [blood thinner]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
1754,Rx: Tab furosemide 40mg BID. Tab Dulcolax 10mg QHS PRN. Avoid grapefruit juice. F/U 6 weeks with LFTs.,Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. Do not drink grapefruit juice as it interferes with this medication. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,medium
1755,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. No compression fracture.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
1756,"70 y/o M with PMH of Parkinson's disease, PPM in situ, asthma, DM1, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on albuterol MDI 2 puffs Q4-6H PRN, atorvastatin 40mg QHS, ASA 81mg daily, amlodipine 5mg daily, Spiriva 18mcg daily. F/U endocrine in 1 week.","A 70-year-old man with a history of Parkinson's disease, implanted pacemaker, asthma, and type 1 diabetes was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) baby aspirin 81mg once daily [prevents blood clots]; (4) amlodipine 5mg once daily [blood pressure medicine]; (5) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",General Surgery,Discharge Summary,high
1757,"70 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 70-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
1758,Procedure: PCI with DES to LAD. Pt 31 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 31-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
1759,"36 y/o M with PMH of DM1, PPM in situ, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on escitalopram 10mg daily, metformin 500mg BID, metoprolol 25mg BID. F/U hematology in 2 weeks.","A 36-year-old man with a history of type 1 diabetes, and implanted pacemaker was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) metformin 500mg twice daily with meals [blood sugar medicine]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the blood disorder doctor in 2 weeks.",General Surgery,Discharge Summary,high
1760,"70 y/o M with PMH of h/o TIA, PPM in situ, s/p CABG, CHF, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on escitalopram 10mg daily, pregabalin 75mg BID, Spiriva 18mcg daily. F/U cardiology in 2 weeks.","A 70-year-old man with a history of history of mini-stroke, implanted pacemaker, prior heart bypass surgery, and heart failure was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the heart doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
1761,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
1762,"Thyroid panel: TSH 7.52 (H), Free T4 0.6.","Your thyroid test results: TSH is elevated at 7.52 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is low — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
1763,"Rx: Tab ferrous sulfate 325mg BID. Tab ciprofloxacin 500mg BID x 5 days. Tab sertraline 50mg daily. Tab furosemide 40mg BID. Tab amlodipine 5mg daily. Do not stop abruptly, taper as directed. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) amlodipine 5mg once daily [blood pressure medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,high
1764,Procedure: Laparoscopic appendectomy. Pt 67 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 67-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1765,"CBC: WBC 2.5 (L), Hgb 7.6 (L), Plt 229 (N).","Your blood count results: White blood cells are 2.5 (low, meaning your immune system may be weakened). Hemoglobin is low at 7.6, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 229, which is normal.",Hematology,Lab Result,high
1766,"87 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 87-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1767,"32 y/o M with PMH of osteoporosis, HFrEF (EF 30%), CKD Stage 4, gout, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on latanoprost 0.005% OU QHS, gabapentin 300mg TID, Eliquis 5mg BID. F/U cardiology in 2 weeks.","A 32-year-old man with a history of weak bones [osteoporosis], heart failure with weak pumping (30%), advanced kidney disease, and gout was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) Eliquis 5mg twice daily [blood thinner]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
1768,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. No midline shift. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. The brain is centered normally. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
1769,Procedure: Colonoscopy with polypectomy. Pt 51 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 51-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1770,"47 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 47-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1771,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,medium
1772,"US Abdomen: Pancreas unremarkable. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. CBD 12mm, dilated. CBD 5mm, not dilated. Moderate right hydronephrosis. Spleen 11cm, normal.","Abdominal ultrasound results: The pancreas looks normal. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The bile duct is wider than normal [dilated], which may indicate a blockage. The bile duct is normal size [not blocked]. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The spleen is a normal size.",Gastroenterology,Radiology Report,high
1773,"73 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 73-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1774,"Rx: Tab pantoprazole 40mg AC breakfast. Tab ferrous sulfate 325mg BID. Tab warfarin 5mg daily. Tab atorvastatin 80mg QHS. Tab Eliquis 5mg BID. Adv: DASH diet, daily BP monitoring Adv: high fiber diet, adequate hydration. F/U 2 weeks.","Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (5) Eliquis 5mg twice daily [blood thinner]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back for a check-up in 2 weeks.",Hematology,Prescription,high
1775,"37 y/o F with PMH of CAD, PPM in situ, BPH, ICD in situ, h/o CVA, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on furosemide 40mg daily, azithromycin 500mg day 1 then 250mg x 4 days, ibuprofen 400mg Q6H PRN with food, levothyroxine 75mcg daily on empty stomach, potassium chloride 20mEq daily. F/U surgery in 10 days.","A 37-year-old woman with a history of coronary artery disease [heart artery blockages], implanted pacemaker, enlarged prostate, implanted heart defibrillator, and history of stroke was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (5) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
1776,Procedure: R TKA. Pt 46 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 46-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1777,"90 y/o M with PMH of hypothyroidism, h/o CVA, OA, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on amlodipine 10mg daily, glipizide 5mg BID AC, spironolactone 25mg daily, Humalog per SSI. F/U oncology in 1 week.","A 90-year-old man with a history of underactive thyroid, history of stroke, and arthritis [osteoarthritis] was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) spironolactone 25mg once daily [heart-protecting water pill]; (4) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the cancer doctor in 1 week.",General Surgery,Discharge Summary,high
1778,"31 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 31-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
1779,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1780,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab methotrexate 15mg weekly. Tab Xarelto 20mg daily with dinner. Tab potassium chloride 20mEq daily. Adv: weight bearing exercise, calcium/vit D supplementation. F/U INR in 3 days.","Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) Xarelto 20mg once daily with dinner [blood thinner]. (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 3 days for a blood thinner level check [INR].",Infectious Disease,Prescription,high
1781,CXR PA: Right lower lobe consolidation. NG tube tip in stomach. Compression fracture T12.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. The feeding/drainage tube tip is correctly positioned in the stomach. There is a compression fracture [collapsed bone] in the lower spine at T12.",Pulmonology,Radiology Report,high
1782,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1783,"59 y/o M with PMH of DVT/PE on warfarin, s/p THR, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Compression stockings when ambulating. D/C on warfarin 5mg daily, spironolactone 25mg daily. F/U wound care in 3 days.","A 59-year-old man with a history of blood clots [on blood thinner warfarin], and prior hip replacement was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
1784,"Rx: Tab metoprolol 25mg BID. Tab entresto 49/51mg BID. Tab losartan 50mg daily. Tab lisinopril 20mg daily. Tab atorvastatin 80mg QHS. Adv: fall precautions, home safety evaluation Adv: elevate affected limb, compression stockings. F/U 2 weeks.","Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) losartan 50mg once daily [blood pressure medicine]. (4) lisinopril 20mg once daily [blood pressure medicine]. (5) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: keep the affected leg elevated when resting and wear compression stockings. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
1785,CXR PA: Bilateral pleural effusions. Left lower lobe consolidation. Pacemaker leads in appropriate position. Bilateral hilar lymphadenopathy.,"Chest X-ray results: There is fluid collecting around both lungs. There is an area in the lower left lung that appears infected. The pacemaker wires are in the correct position. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
1786,"44 y/o M with PMH of osteoporosis, SLE, asthma, ICD in situ, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on albuterol MDI 2 puffs Q4-6H PRN, Xarelto 20mg daily with dinner, potassium chloride 20mEq daily, atorvastatin 40mg QHS, entresto 49/51mg BID. F/U orthopedics in 6 weeks with X-ray.","A 44-year-old man with a history of weak bones [osteoporosis], lupus, asthma, and implanted heart defibrillator was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) atorvastatin 40mg at bedtime [cholesterol medicine]; (5) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
1787,"31 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 31-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
1788,"64 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 64-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1789,MRI Lumbar Spine: No compression fracture. Central canal stenosis at L3-L4. L5-S1 disc desiccation with mild bulge.,"MRI of the lower back results: No bones are broken or collapsed. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
1790,"45 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 45-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1791,"Lipid panel: TC 306, LDL 200, HDL 28, TG 476.","Your cholesterol results: Total cholesterol is 306. LDL (bad cholesterol) is very high at 200 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is too low at 28 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 476 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
1792,"US Abdomen: Spleen 11cm, normal. CBD 5mm, not dilated. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: The spleen is a normal size. The bile duct is normal size [not blocked]. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
1793,"CBC: WBC 19.7 (H), Hgb 6.2 (L), Plt 387 (N).","Your blood count results: White blood cells are 19.7 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 6.2, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 387, which is normal.",Hematology,Lab Result,high
1794,"Rx: Tab atorvastatin 40mg QHS. Tab montelukast 10mg QHS. Adv: weight bearing exercise, calcium/vit D supplementation Adv: DASH diet, daily BP monitoring. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
1795,"25 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 25-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1796,"Lipid panel: TC 308, LDL 175, HDL 79, TG 471.","Your cholesterol results: Total cholesterol is 308. LDL (bad cholesterol) is very high at 175 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 79. Triglycerides are very high at 471 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
1797,"33 y/o M with PMH of SLE, OSA on CPAP, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on ciprofloxacin 500mg BID x 5 days, acetaminophen 650mg Q6H PRN, potassium chloride 20mEq daily, Augmentin 875/125 BID x 7 days. F/U GI in 1 week.","A 33-year-old man with a history of lupus, and sleep apnea [uses a breathing machine at night] was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the stomach doctor in 1 week.",Infectious Disease,Discharge Summary,high
1798,"85 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 85-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1799,MRI Lumbar Spine: No compression fracture. L5-S1 disc desiccation with mild bulge.,"MRI of the lower back results: No bones are broken or collapsed. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
1800,"47 y/o M with PMH of PAD, hypothyroidism, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Compression stockings when ambulating. D/C on potassium chloride 20mEq daily, losartan 50mg daily, latanoprost 0.005% OU QHS, hydroxychloroquine 200mg BID. F/U orthopedics in 6 weeks with X-ray.","A 47-year-old man with a history of poor blood flow in the legs [peripheral artery disease], and underactive thyroid was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) losartan 50mg once daily [blood pressure medicine]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Neurology,Discharge Summary,high
1801,"Rx: Tab ASA 81mg daily. Tab amoxicillin 500mg TID x 10 days. Adv: fall precautions, home safety evaluation Do not stop abruptly, taper as directed. F/U 2 weeks with INR.","Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
1802,Rx: Tab montelukast 10mg QHS. albuterol MDI 2 puffs Q4-6H PRN. Tab metoprolol succinate 50mg daily. Tab ciprofloxacin 500mg BID x 5 days. Tab calcium + vitamin D 600/400 daily. Adv: wound care with daily dressing changes. F/U 1 week with wound check.,"Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (5) calcium plus vitamin D once daily [bone strengthening]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week to have the wound checked.",Pulmonology,Prescription,high
1803,"59 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 59-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
1804,"Rx: Tab omeprazole 20mg AC breakfast. Tab sertraline 50mg daily. Adv: SMBG BID, diabetic diet. F/U 2 weeks with INR.",Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks for a blood thinner level check [INR].,Gastroenterology,Prescription,medium
1805,"BMP: Na 143 (N), K 5.1 (H), BUN 73, Cr 1.3 (H), Glucose 254.",Your blood chemistry results: Sodium is normal at 143. Potassium is high at 5.1 — needs monitoring. Creatinine is mildly elevated at 1.3. Blood sugar is 254 (high).,Nephrology,Lab Result,high
1806,"BMP: Na 123 (L), K 5.9 (H), BUN 19, Cr 4.5 (H), Glucose 194.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 5.9 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 4.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 194 (high).",Nephrology,Lab Result,high
1807,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1808,"78 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 78-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1809,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1810,"CBC: WBC 24.0 (H), Hgb 15.2 (N), Plt 195 (N).","Your blood count results: White blood cells are 24.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 15.2. Platelets are 195, which is normal.",Hematology,Lab Result,high
1811,"US Abdomen: Ascites moderate amount. Left kidney 8cm, cortical thinning consistent with CKD. Simple renal cysts bilaterally. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. Left kidney is small with thin outer layer, consistent with chronic kidney disease. Both kidneys have harmless fluid-filled cysts. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
1812,"Rx: Tab amlodipine 5mg daily. Tab escitalopram 10mg daily. Tab methotrexate 15mg weekly. Lantus 20U QHS. Adv: high fiber diet, adequate hydration Adv: smoking cessation, pulmonary rehab. F/U INR in 3 days.","Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (4) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
1813,HbA1c: 13.7% (H). FBS: 245 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.7%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 245, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1814,"48 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 48-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1815,CT Head without contrast: No acute intracranial hemorrhage. 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. No mass effect. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There is no bleeding in the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides. There are no tumors or masses pushing on the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
1816,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
1817,CXR PA: Compression fracture T12. Bilateral hilar lymphadenopathy. Bilateral pleural effusions. Pacemaker leads in appropriate position. Widened mediastinum.,"Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There is fluid collecting around both lungs. The pacemaker wires are in the correct position. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
1818,CXR PA: ET tube 3cm above carina. Elevated left hemidiaphragm. Compression fracture T12. No cardiomegaly.,Chest X-ray results: The breathing tube is in good position. The left side of the breathing muscle [diaphragm] is sitting higher than normal. There is a compression fracture [collapsed bone] in the lower spine at T12. The heart is a normal size.,Pulmonology,Radiology Report,high
1819,"70 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 70-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1820,"US Abdomen: Simple renal cysts bilaterally. CBD 12mm, dilated. Moderate right hydronephrosis. GB wall thickening with stones, positive Murphy's sign. GB sludge, no stones. Spleen 11cm, normal.","Abdominal ultrasound results: Both kidneys have harmless fluid-filled cysts. The bile duct is wider than normal [dilated], which may indicate a blockage. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The gallbladder contains thickened bile [sludge] but no stones. The spleen is a normal size.",Gastroenterology,Radiology Report,high
1821,"LFTs: AST 439 (H), ALT 478 (H), ALP 219, T.Bili 3.6 (H), Albumin 3.5.","Your liver blood test results: Liver enzymes (AST 439, ALT 478) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 3.6 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.5.",Gastroenterology,Lab Result,high
1822,"45 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 45-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1823,"Rx: Tab ferrous sulfate 325mg BID. Tab entresto 49/51mg BID. Adv: low salt low sugar diet, regular exercise. F/U PCP in 1 week for BP recheck.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) Entresto 49/51mg twice daily [heart failure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
1824,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,low
1825,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
1826,"Rx: Tab metformin 500mg BID. Tab amoxicillin 500mg TID x 10 days. Spiriva 18mcg daily. Tab hydroxychloroquine 200mg BID. Adv: low salt low sugar diet, regular exercise. F/U 1 week with wound check.","Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) Spiriva inhaler once daily [long-acting lung medicine]. (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week to have the wound checked.",Pulmonology,Prescription,high
1827,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. L5-S1 disc desiccation with mild bulge. L4-L5 disc herniation with moderate bilateral foraminal stenosis. C5-C6 disc herniation with cord compression.,"MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
1828,"Rx: Tab omeprazole 20mg AC breakfast. Tab amlodipine 5mg daily. Tab warfarin 5mg daily. Tab ASA 81mg daily. Adv: fall precautions, home safety evaluation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (4) baby aspirin 81mg once daily [prevents blood clots]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
1829,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1830,"53 y/o M with PMH of GERD, DM2, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on pantoprazole 40mg AC breakfast, rosuvastatin 10mg QHS, potassium chloride 20mEq daily, Lantus 20U QHS. F/U orthopedics in 6 weeks with X-ray.","A 53-year-old man with a history of acid reflux, and type 2 diabetes was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Neurology,Discharge Summary,high
1831,"44 y/o F with PMH of HFrEF (EF 30%), h/o TIA, seizure disorder on Keppra, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on atorvastatin 80mg QHS, amlodipine 5mg daily, entresto 49/51mg BID, ferrous sulfate 325mg BID, montelukast 10mg QHS. F/U orthopedics in 6 weeks with X-ray.","A 44-year-old woman with a history of heart failure with weak pumping (30%), history of mini-stroke, and seizure disorder [on Keppra] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) amlodipine 5mg once daily [blood pressure medicine]; (3) Entresto 49/51mg twice daily [heart failure medicine]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (5) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Psychiatry,Discharge Summary,high
1832,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1833,"US Abdomen: Spleen 16cm, splenomegaly. CBD 12mm, dilated. Simple renal cysts bilaterally. GB sludge, no stones.","Abdominal ultrasound results: The spleen is enlarged [splenomegaly]. The bile duct is wider than normal [dilated], which may indicate a blockage. Both kidneys have harmless fluid-filled cysts. The gallbladder contains thickened bile [sludge] but no stones.",Gastroenterology,Radiology Report,high
1834,"CBC: WBC 17.9 (H), Hgb 15.4 (N), Plt 222 (N).","Your blood count results: White blood cells are 17.9 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 15.4. Platelets are 222, which is normal.",Hematology,Lab Result,high
1835,"BMP: Na 120 (L), K 6.6 (H), BUN 50, Cr 3.4 (H), Glucose 109.","Your blood chemistry results: Sodium is low at 120 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.6 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 3.4 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 109 (high).",Nephrology,Lab Result,high
1836,"57 y/o F with PMH of anxiety, cirrhosis, HLD, OSA on CPAP, DM1, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Low potassium diet. D/C on acetaminophen 650mg Q6H PRN, Dulcolax 10mg QHS PRN. F/U neurology in 2 weeks.","A 57-year-old woman with a history of anxiety, liver scarring [cirrhosis], high cholesterol, sleep apnea [uses a breathing machine at night], and type 1 diabetes was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
1837,"44 y/o F with PMH of Parkinson's disease, hypothyroidism, s/p THR, OA, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on sertraline 50mg daily, Dulcolax 10mg QHS PRN, glipizide 5mg BID AC. F/U nephrology in 1 week.","A 44-year-old woman with a history of Parkinson's disease, underactive thyroid, prior hip replacement, and arthritis [osteoarthritis] was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the kidney doctor in 1 week.",Infectious Disease,Discharge Summary,high
1838,CXR PA: Small left pleural effusion. Osseous structures intact. Right lower lobe consolidation. Left lower lobe consolidation.,"Chest X-ray results: There is a small amount of fluid around the left lung. The bones look normal with no fractures. There is an area in the lower right lung that appears infected, suggesting pneumonia. There is an area in the lower left lung that appears infected.",Pulmonology,Radiology Report,high
1839,"Rx: Tab furosemide 40mg BID. Tab metoprolol succinate 50mg daily. Tab potassium chloride 20mEq daily. prednisone taper. Adv: low salt low sugar diet, regular exercise Adv: wound care with daily dressing changes. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
1840,HbA1c: 7.1% (H). FBS: 143 mg/dL (H).,"Your diabetes blood test results: HbA1c is 7.1%, which is above the target of 7.0%. Your blood sugar has been somewhat poorly controlled over the past 3 months. Fasting blood sugar was 143, which is high (normal is 70-100). Your diabetes medicines may need adjustment. Discuss with your doctor.",Endocrinology,Lab Result,high
1841,CXR PA: Compression fracture T12. Osseous structures intact. Left lower lobe consolidation. Clear lung fields bilaterally.,Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. The bones look normal with no fractures. There is an area in the lower left lung that appears infected. Both lungs look clear with no problems.,Pulmonology,Radiology Report,high
1842,"70 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 70-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1843,"68 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 68-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1844,"Rx: Tab ondansetron 4mg Q8H PRN N/V. albuterol MDI 2 puffs Q4-6H PRN. Tab tramadol 50mg Q6H PRN pain. Tab glipizide 5mg BID AC. Tab spironolactone 25mg daily. Adv: SMBG BID, diabetic diet Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with INR.",Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (4) glipizide 5mg twice daily before meals [helps release insulin]. (5) spironolactone 25mg once daily [heart-protecting water pill]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks for a blood thinner level check [INR].,General,Prescription,high
1845,"27 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 27-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
1846,"LFTs: AST 72 (H), ALT 465 (H), ALP 186, T.Bili 3.4 (H), Albumin 4.4.","Your liver blood test results: Liver enzymes (AST 72, ALT 465) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 3.4 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.4.",Gastroenterology,Lab Result,high
1847,"53 y/o M with PMH of seizure disorder on Keppra, DVT/PE on warfarin, CAD, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on metoprolol succinate 50mg daily, levothyroxine 75mcg daily on empty stomach. F/U orthopedics in 6 weeks with X-ray.","A 53-year-old man with a history of seizure disorder [on Keppra], blood clots [on blood thinner warfarin], and coronary artery disease [heart artery blockages] was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Infectious Disease,Discharge Summary,high
1848,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
1849,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab methotrexate 15mg weekly. Adv: SMBG BID, diabetic diet. F/U 6 weeks with LFTs.",Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 6 weeks for liver function blood tests.,Rheumatology,Prescription,medium
1850,Procedure: Port-a-cath placement. Pt 82 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 82-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
1851,"42 y/o M with PMH of h/o TIA, PAD, CKD Stage 3, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on potassium chloride 20mEq daily, Lantus 20U QHS. F/U wound care in 3 days.","A 42-year-old man with a history of history of mini-stroke, poor blood flow in the legs [peripheral artery disease], and moderate kidney disease was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up at the wound care clinic in 3 days.",Urology,Discharge Summary,high
1852,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
1853,"Rx: Tab rosuvastatin 10mg QHS. Tab methotrexate 15mg weekly. albuterol MDI 2 puffs Q4-6H PRN. Tab ibuprofen 400mg Q6H PRN with food. Tab amoxicillin 500mg TID x 10 days. Avoid grapefruit juice Adv: low salt diet, fluid restriction 1.5L/day. F/U PCP in 1 week for BP recheck.",Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (5) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Do not drink grapefruit juice as it interferes with this medication Advice: eat less salt and limit your total fluid intake to about 6 cups per day. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,high
1854,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
1855,"83 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 83-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1856,"LFTs: AST 205 (H), ALT 518 (H), ALP 74, T.Bili 5.9 (H), Albumin 3.0.","Your liver blood test results: Liver enzymes (AST 205, ALT 518) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 5.9 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 3.0 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
1857,Procedure: Colonoscopy with polypectomy. Pt 34 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 34-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1858,Procedure: TURP for BPH. Pt 84 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 84-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
1859,"LFTs: AST 50 (H), ALT 517 (H), ALP 182, T.Bili 6.4 (H), Albumin 2.1.","Your liver blood test results: Liver enzymes (AST 50, ALT 517) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.4 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.1 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
1860,Rx: Tab pantoprazole 40mg AC breakfast. Tab acetaminophen 650mg Q6H PRN. Tab warfarin 5mg daily. Tab rosuvastatin 10mg QHS. Avoid NSAIDs. F/U 2 weeks.,Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (4) rosuvastatin 10mg at bedtime [cholesterol medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back for a check-up in 2 weeks.,Cardiology,Prescription,high
1861,"Thyroid panel: TSH 10.6 (H), Free T4 1.8.","Your thyroid test results: TSH is elevated at 10.6 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
1862,"Rx: Tab lisinopril 10mg daily. Tab gabapentin 300mg TID. Tab glipizide 5mg BID AC. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with wound check.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (3) glipizide 5mg twice daily before meals [helps release insulin]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
1863,"CBC: WBC 6.5 (N), Hgb 10.9 (L), Plt 113 (L).","Your blood count results: White blood cells are 6.5 (normal). Hemoglobin is low at 10.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 113, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
1864,"Rx: Tab losartan 50mg daily. Tab atorvastatin 40mg QHS. Tab levothyroxine 75mcg daily on empty stomach. Tab pregabalin 75mg BID. Tab pantoprazole 40mg AC breakfast. Adv: SMBG BID, diabetic diet Avoid grapefruit juice. F/U PCP in 1 week for BP recheck.",Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (4) pregabalin 75mg twice daily [nerve pain medicine]. (5) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Do not drink grapefruit juice as it interferes with this medication. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,high
1865,"CBC: WBC 15.0 (H), Hgb 16.0 (N), Plt 215 (N).","Your blood count results: White blood cells are 15.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 16.0. Platelets are 215, which is normal.",Hematology,Lab Result,high
1866,"37 y/o F with PMH of ESRD on HD, obesity (BMI 38), HFrEF (EF 30%), DVT/PE on warfarin, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on azithromycin 500mg day 1 then 250mg x 4 days, spironolactone 25mg daily. F/U oncology in 1 week.","A 37-year-old woman with a history of kidney failure requiring dialysis, obesity, heart failure with weak pumping (30%), and blood clots [on blood thinner warfarin] was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up with the cancer doctor in 1 week.",Urology,Discharge Summary,high
1867,"38 y/o F with PMH of s/p THR, HLD, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Compression stockings when ambulating. D/C on Dulcolax 10mg QHS PRN, latanoprost 0.005% OU QHS, clopidogrel 75mg daily. F/U INR check in 3 days.","A 38-year-old woman with a history of prior hip replacement, and high cholesterol was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. Follow-up for a blood thinner level check in 3 days.",General Surgery,Discharge Summary,high
1868,"64 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 64-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1869,"79 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 79-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1870,Procedure: ORIF L distal radius. Pt 51 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 51-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1871,"40 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 40-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1872,CXR PA: Cardiomegaly with CTR >0.5. Patchy bilateral infiltrates. Sternotomy wires intact.,Chest X-ray results: The heart appears larger than normal. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The wires from prior heart surgery are intact.,Pulmonology,Radiology Report,high
1873,"26 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 26-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1874,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
1875,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,high
1876,"38 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 38-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
1877,"81 y/o M with PMH of CAD, asthma, A-fib, GERD, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Strict I&O, daily weights. D/C on warfarin 5mg daily, Eliquis 5mg BID, atorvastatin 80mg QHS, acetaminophen 650mg Q6H PRN, tramadol 50mg Q6H PRN pain. F/U nephrology in 1 week.","A 81-year-old man with a history of coronary artery disease [heart artery blockages], asthma, irregular heartbeat [atrial fibrillation], and acid reflux was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) Eliquis 5mg twice daily [blood thinner]; (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the kidney doctor in 1 week.",General Surgery,Discharge Summary,high
1878,"BMP: Na 125 (L), K 5.1 (H), BUN 69, Cr 7.4 (H), Glucose 314.","Your blood chemistry results: Sodium is low at 125 (normal 136-145), meaning too much water in your body. Potassium is high at 5.1 — needs monitoring. Creatinine is elevated at 7.4 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 314 (high).",Nephrology,Lab Result,high
1879,"LFTs: AST 240 (H), ALT 262 (H), ALP 74, T.Bili 5.3 (H), Albumin 4.5.","Your liver blood test results: Liver enzymes (AST 240, ALT 262) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 5.3 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.5.",Gastroenterology,Lab Result,high
1880,CXR PA: NG tube tip in stomach. Port-a-cath in appropriate position. Clear lung fields bilaterally.,Chest X-ray results: The feeding/drainage tube tip is correctly positioned in the stomach. The implanted medication port is in the correct position. Both lungs look clear with no problems.,Pulmonology,Radiology Report,high
1881,"79 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 79-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
1882,"Rx: Tab pregabalin 75mg BID. Tab entresto 49/51mg BID. Tab hydroxychloroquine 200mg BID. Tab clopidogrel 75mg daily. Tab gabapentin 300mg TID. Adv: SMBG BID, diabetic diet. F/U 6 weeks with LFTs.",Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. (5) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,high
1883,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
1884,"US Abdomen: CBD 12mm, dilated. Spleen 16cm, splenomegaly. GB wall thickening with stones, positive Murphy's sign. No focal hepatic lesion. CBD 5mm, not dilated.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. The spleen is enlarged [splenomegaly]. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. No tumors or masses were found in the liver. The bile duct is normal size [not blocked].",Gastroenterology,Radiology Report,high
1885,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
1886,"55 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 55-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
1887,"Rx: Tab Dulcolax 10mg QHS PRN. Tab timolol 0.5% OU BID. Tab acetaminophen 650mg Q6H PRN. Adv: low potassium diet. F/U 1 week with CBC, CMP.","Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",General,Prescription,medium
1888,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
1889,"49 y/o F with PMH of depression, obesity (BMI 38), admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on latanoprost 0.005% OU QHS, potassium chloride 20mEq daily. F/U wound care in 3 days.","A 49-year-old woman with a history of depression, and obesity was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up at the wound care clinic in 3 days.",Infectious Disease,Discharge Summary,high
1890,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab acetaminophen 650mg Q6H PRN. Tab clopidogrel 75mg daily. Tab omeprazole 20mg AC breakfast. Tab methotrexate 15mg weekly. Adv: avoid alcohol, hepatotoxic drugs. F/U 6 weeks with LFTs.",Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. (4) omeprazole 20mg before breakfast [acid-reducing medicine]. (5) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 6 weeks for liver function blood tests.,General,Prescription,high
1891,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,medium
1892,"BMP: Na 136 (N), K 4.0 (N), BUN 19, Cr 7.1 (H), Glucose 337.","Your blood chemistry results: Sodium is normal at 136. Potassium is normal at 4.0. Creatinine is elevated at 7.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 337 (high).",Nephrology,Lab Result,high
1893,"BMP: Na 143 (N), K 5.0 (N), BUN 12, Cr 2.1 (H), Glucose 281.","Your blood chemistry results: Sodium is normal at 143. Potassium is normal at 5.0. Creatinine is elevated at 2.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 281 (high).",Nephrology,Lab Result,high
1894,CXR PA: Widened mediastinum. Hyperinflated lungs consistent with COPD. Cardiomegaly with CTR >0.5. Osseous structures intact. Right lower lobe consolidation.,"Chest X-ray results: The space between the lungs appears wider than normal, which needs further evaluation. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The heart appears larger than normal. The bones look normal with no fractures. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
1895,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,medium
1896,"66 y/o M with PMH of DVT/PE on warfarin, ESRD on HD, OSA on CPAP, BPH, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Low potassium diet. D/C on atorvastatin 40mg QHS, glipizide 5mg BID AC, hydroxychloroquine 200mg BID. F/U surgery in 2 weeks for drain removal.","A 66-year-old man with a history of blood clots [on blood thinner warfarin], kidney failure requiring dialysis, sleep apnea [uses a breathing machine at night], and enlarged prostate was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the surgeon in 2 weeks to remove the drain.",Pulmonology,Discharge Summary,high
1897,"36 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 36-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1898,Procedure: ORIF L distal radius. Pt 31 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 31-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1899,"Rx: Tab sertraline 50mg daily. Tab atorvastatin 40mg QHS. Tab entresto 49/51mg BID. Tab calcium + vitamin D 600/400 daily. Adv: DASH diet, daily BP monitoring Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) Entresto 49/51mg twice daily [heart failure medicine]. (4) calcium plus vitamin D once daily [bone strengthening]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
1900,"48 y/o M with PMH of gout, COPD, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on methotrexate 15mg weekly, levothyroxine 75mcg daily on empty stomach. F/U orthopedics in 6 weeks with X-ray.","A 48-year-old man with a history of gout, and chronic lung disease was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
1901,Procedure: R TKA. Pt 78 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 78-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1902,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Chronic lacunar infarcts in bilateral basal ganglia. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are signs of small old strokes in the deep parts of the brain. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
1903,"Rx: Tab omeprazole 20mg AC breakfast. Tab amlodipine 10mg daily. Adv: high fiber diet, adequate hydration Avoid grapefruit juice. F/U 1 month with repeat imaging.","Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Do not drink grapefruit juice as it interferes with this medication. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
1904,"CBC: WBC 3.0 (L), Hgb 14.1 (N), Plt 372 (N).","Your blood count results: White blood cells are 3.0 (low, meaning your immune system may be weakened). Hemoglobin is normal at 14.1. Platelets are 372, which is normal.",Hematology,Lab Result,high
1905,CXR PA: Patchy bilateral infiltrates. Small left pleural effusion. Port-a-cath in appropriate position. Moderate right pleural effusion. Cardiomegaly with CTR >0.5.,Chest X-ray results: There are scattered cloudy patches in both lungs suggesting infection or inflammation. There is a small amount of fluid around the left lung. The implanted medication port is in the correct position. There is a moderate amount of fluid around the right lung. The heart appears larger than normal.,Pulmonology,Radiology Report,high
1906,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
1907,"LFTs: AST 313 (H), ALT 334 (H), ALP 138, T.Bili 7.4 (H), Albumin 3.5.","Your liver blood test results: Liver enzymes (AST 313, ALT 334) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 7.4 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.5.",Gastroenterology,Lab Result,high
1908,"US Abdomen: No focal hepatic lesion. Right kidney 10.5cm, no hydronephrosis. Left kidney 8cm, cortical thinning consistent with CKD. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. GB wall thickening with stones, positive Murphy's sign. CBD 12mm, dilated.","Abdominal ultrasound results: No tumors or masses were found in the liver. Right kidney is normal size with no blockage. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
1909,"CBC: WBC 8.0 (N), Hgb 9.3 (L), Plt 218 (N).","Your blood count results: White blood cells are 8.0 (normal). Hemoglobin is low at 9.3, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 218, which is normal.",Hematology,Lab Result,high
1910,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,high
1911,CXR PA: Increased interstitial markings suggesting pulmonary edema. Small left pleural effusion. Bilateral pleural effusions.,"Chest X-ray results: There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There is a small amount of fluid around the left lung. There is fluid collecting around both lungs.",Pulmonology,Radiology Report,high
1912,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
1913,"Rx: Tab timolol 0.5% OU BID. Tab ciprofloxacin 500mg BID x 5 days. Tab pregabalin 75mg BID. Tab amoxicillin 500mg TID x 10 days. prednisone taper. Adv: wound care with daily dressing changes Adv: fall precautions, home safety evaluation. F/U 2 weeks.","Your medicines: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (3) pregabalin 75mg twice daily [nerve pain medicine]. (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (5) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back for a check-up in 2 weeks.",Infectious Disease,Prescription,high
1914,"90 y/o F with PMH of CAD, HFrEF (EF 30%), seizure disorder on Keppra, HTN, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on latanoprost 0.005% OU QHS, sertraline 50mg daily, amlodipine 10mg daily, omeprazole 20mg AC breakfast, Xarelto 20mg daily with dinner. F/U wound care in 3 days.","A 90-year-old woman with a history of coronary artery disease [heart artery blockages], heart failure with weak pumping (30%), seizure disorder [on Keppra], and high blood pressure was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]; (5) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
1915,Rx: Tab empagliflozin 10mg daily. albuterol MDI 2 puffs Q4-6H PRN. Adv: low potassium diet. F/U 1 month with repeat imaging.,"Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 month — a repeat scan will be ordered.",Pulmonology,Prescription,medium
1916,"76 y/o F with PMH of s/p THR, HFrEF (EF 30%), DVT/PE on warfarin, depression, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on furosemide 40mg BID, amlodipine 5mg daily, montelukast 10mg QHS. F/U hematology in 2 weeks.","A 76-year-old woman with a history of prior hip replacement, heart failure with weak pumping (30%), blood clots [on blood thinner warfarin], and depression was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) amlodipine 5mg once daily [blood pressure medicine]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Endocrinology,Discharge Summary,high
1917,"48 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 48-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1918,"CBC: WBC 19.3 (H), Hgb 16.4 (N), Plt 492 (H).","Your blood count results: White blood cells are 19.3 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 16.4. Platelets are 492, which is high — your blood may clot too easily.",Hematology,Lab Result,high
1919,"48 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 48-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1920,Procedure: Colonoscopy with polypectomy. Pt 51 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 51-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
1921,"Thyroid panel: TSH 0.45 (N), Free T4 2.3.",Your thyroid test results: TSH is normal at 0.45. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
1922,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. Moderate right hydronephrosis. Spleen 11cm, normal. Ascites moderate amount.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The spleen is a normal size. There is a moderate amount of fluid in the belly [ascites].",Gastroenterology,Radiology Report,high
1923,"CBC: WBC 19.0 (H), Hgb 5.4 (L), Plt 147 (L).","Your blood count results: White blood cells are 19.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 5.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 147, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
1924,"Rx: Tab pantoprazole 40mg AC breakfast. Tab atorvastatin 40mg QHS. Tab tramadol 50mg Q6H PRN pain. Tab acetaminophen 650mg Q6H PRN. Spiriva 18mcg daily. Do not stop abruptly, taper as directed Adv: wound care with daily dressing changes. F/U 2 weeks with INR.","Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (5) Spiriva inhaler once daily [long-acting lung medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks for a blood thinner level check [INR].",General,Prescription,high
1925,HbA1c: 11.0% (H). FBS: 388 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.0%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 388, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1926,HbA1c: 8.5% (H). FBS: 337 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.5%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 337, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
1927,"68 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 68-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1928,"CBC: WBC 7.2 (N), Hgb 16.5 (N), Plt 469 (H).","Your blood count results: White blood cells are 7.2 (normal). Hemoglobin is normal at 16.5. Platelets are 469, which is high — your blood may clot too easily.",Hematology,Lab Result,high
1929,CT Head without contrast: No acute intracranial hemorrhage. No mass effect. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There is no bleeding in the brain. There are no tumors or masses pushing on the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
1930,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,medium
1931,Procedure: PCI with DES to LAD. Pt 70 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 70-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
1932,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
1933,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab losartan 50mg daily. Tab rosuvastatin 10mg QHS. Tab amoxicillin 500mg TID x 10 days. Adv: elevate affected limb, compression stockings Avoid grapefruit juice. F/U 1 week with wound check.",Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) losartan 50mg once daily [blood pressure medicine]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Advice: keep the affected leg elevated when resting and wear compression stockings Do not drink grapefruit juice as it interferes with this medication. Come back in 1 week to have the wound checked.,Cardiology,Prescription,high
1934,"37 y/o M with PMH of CHF, SLE, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Low potassium diet. D/C on furosemide 40mg daily, Lantus 20U QHS, acetaminophen 650mg Q6H PRN, ferrous sulfate 325mg BID. F/U neurology in 2 weeks.","A 37-year-old man with a history of heart failure, and lupus was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the brain/nerve doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
1935,"Rx: Tab potassium chloride 20mEq daily. Tab atorvastatin 40mg QHS. Tab ondansetron 4mg Q8H PRN N/V. Adv: high fiber diet, adequate hydration. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",General,Prescription,medium
1936,"38 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 38-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1937,"59 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 59-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1938,"Rx: Tab sertraline 50mg daily. Tab amlodipine 5mg daily. Tab hydroxychloroquine 200mg BID. Tab timolol 0.5% OU BID. Tab potassium chloride 20mEq daily. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (5) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
1939,"42 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 42-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1940,"59 y/o F with PMH of PAD, HTN, HFrEF (EF 30%), anemia, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on metoprolol succinate 50mg daily, ciprofloxacin 500mg BID x 5 days, Xarelto 20mg daily with dinner. F/U nephrology in 1 week.","A 59-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], high blood pressure, heart failure with weak pumping (30%), and low blood count [anemia] was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the kidney doctor in 1 week.",General Surgery,Discharge Summary,high
1941,HbA1c: 10.1% (H). FBS: 257 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.1%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 257, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1942,"LFTs: AST 458 (H), ALT 389 (H), ALP 281, T.Bili 2.8 (H), Albumin 4.0.","Your liver blood test results: Liver enzymes (AST 458, ALT 389) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 2.8 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.0.",Gastroenterology,Lab Result,high
1943,Procedure: ORIF L distal radius. Pt 54 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 54-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
1944,"81 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 81-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
1945,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1946,CXR PA: ET tube 3cm above carina. Bilateral hilar lymphadenopathy. Patchy bilateral infiltrates. Port-a-cath in appropriate position. Small left pleural effusion.,"Chest X-ray results: The breathing tube is in good position. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The implanted medication port is in the correct position. There is a small amount of fluid around the left lung.",Pulmonology,Radiology Report,high
1947,CXR PA: Clear lung fields bilaterally. Right middle lobe atelectasis. No cardiomegaly. Osseous structures intact. Left lower lobe consolidation.,"Chest X-ray results: Both lungs look clear with no problems. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The heart is a normal size. The bones look normal with no fractures. There is an area in the lower left lung that appears infected.",Pulmonology,Radiology Report,high
1948,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,high
1949,Procedure: Laparoscopic cholecystectomy. Pt 77 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 77-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
1950,"23 y/o M with PMH of cirrhosis, gout, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on amlodipine 5mg daily, glipizide 5mg BID AC, calcium + vitamin D 600/400 daily. F/U oncology in 1 week.","A 23-year-old man with a history of liver scarring [cirrhosis], and gout was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the cancer doctor in 1 week.",Nephrology,Discharge Summary,high
1951,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
1952,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab Augmentin 875/125 BID x 7 days. Tab entresto 49/51mg BID. Tab carvedilol 12.5mg BID. Adv: DASH diet, daily BP monitoring Adv: smoking cessation, pulmonary rehab. F/U 6 weeks with LFTs.","Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. (3) Entresto 49/51mg twice daily [heart failure medicine]. (4) carvedilol 12.5mg twice daily [heart medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
1953,"US Abdomen: CBD 5mm, not dilated. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Spleen 11cm, normal. No focal hepatic lesion. Moderate right hydronephrosis. GB sludge, no stones.","Abdominal ultrasound results: The bile duct is normal size [not blocked]. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The spleen is a normal size. No tumors or masses were found in the liver. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The gallbladder contains thickened bile [sludge] but no stones.",Gastroenterology,Radiology Report,high
1954,"Rx: Tab metoprolol succinate 50mg daily. Tab furosemide 40mg daily. Tab potassium chloride 20mEq daily. Tab levothyroxine 75mcg daily on empty stomach. Avoid NSAIDs Adv: DASH diet, daily BP monitoring. F/U 1 week with CBC, CMP.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
1955,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab glipizide 5mg BID AC. Tab metformin 500mg BID. Tab clopidogrel 75mg daily. Adv: avoid alcohol, hepatotoxic drugs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) glipizide 5mg twice daily before meals [helps release insulin]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Endocrinology,Prescription,high
1956,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No mass effect. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There are no tumors or masses pushing on the brain. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
1957,"44 y/o F with PMH of DVT/PE on warfarin, seizure disorder on Keppra, GERD, s/p CABG, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Strict I&O, daily weights. D/C on prednisone taper, atorvastatin 80mg QHS, amlodipine 5mg daily, latanoprost 0.005% OU QHS, timolol 0.5% OU BID. F/U wound care in 3 days.","A 44-year-old woman with a history of blood clots [on blood thinner warfarin], seizure disorder [on Keppra], acid reflux, and prior heart bypass surgery was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (5) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
1958,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
1959,HbA1c: 13.2% (H). FBS: 166 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.2%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 166, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
1960,CXR PA: No pneumothorax. Moderate right pleural effusion. Compression fracture T12.,Chest X-ray results: There is no collapsed lung. There is a moderate amount of fluid around the right lung. There is a compression fracture [collapsed bone] in the lower spine at T12.,Pulmonology,Radiology Report,high
1961,"70 y/o M with PMH of PAD, Parkinson's disease, OSA on CPAP, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on carvedilol 12.5mg BID, glipizide 5mg BID AC, albuterol MDI 2 puffs Q4-6H PRN. F/U nephrology in 1 week.","A 70-year-old man with a history of poor blood flow in the legs [peripheral artery disease], Parkinson's disease, and sleep apnea [uses a breathing machine at night] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the kidney doctor in 1 week.",Nephrology,Discharge Summary,high
1962,"BMP: Na 123 (L), K 3.6 (N), BUN 75, Cr 2.8 (H), Glucose 115.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.6. Creatinine is elevated at 2.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 115 (high).",Nephrology,Lab Result,high
1963,"74 y/o M with PMH of s/p TKR, ESRD on HD, h/o CVA, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on warfarin 5mg daily, Lantus 20U QHS. F/U orthopedics in 6 weeks with X-ray.","A 74-year-old man with a history of prior knee replacement, kidney failure requiring dialysis, and history of stroke was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Endocrinology,Discharge Summary,high
1964,"CBC: WBC 17.9 (H), Hgb 6.5 (L), Plt 265 (N).","Your blood count results: White blood cells are 17.9 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 6.5, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 265, which is normal.",Hematology,Lab Result,high
1965,"78 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 78-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
1966,"Rx: Tab clopidogrel 75mg daily. Tab lisinopril 10mg daily. Tab rosuvastatin 10mg QHS. Tab Augmentin 875/125 BID x 7 days. Adv: weight bearing exercise, calcium/vit D supplementation. F/U INR in 3 days.","Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,low
1967,"Rx: Tab metoprolol 25mg BID. Tab entresto 49/51mg BID. Tab pantoprazole 40mg AC breakfast. Tab metformin 1000mg BID. Tab rosuvastatin 10mg QHS. Adv: low salt low sugar diet, regular exercise Adv: low salt diet, fluid restriction 1.5L/day. F/U INR in 3 days.","Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. (4) metformin 1000mg twice daily with meals [blood sugar medicine]. (5) rosuvastatin 10mg at bedtime [cholesterol medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
1968,"72 y/o M with PMH of ESRD on HD, s/p CABG, depression, CKD Stage 3, obesity (BMI 38), admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on azithromycin 500mg day 1 then 250mg x 4 days, rosuvastatin 10mg QHS, carvedilol 12.5mg BID, ibuprofen 400mg Q6H PRN with food. F/U oncology in 1 week.","A 72-year-old man with a history of kidney failure requiring dialysis, prior heart bypass surgery, depression, moderate kidney disease, and obesity was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the cancer doctor in 1 week.",General Surgery,Discharge Summary,high
1969,"90 y/o F with PMH of ICD in situ, DM1, h/o TIA, DM2, seizure disorder on Keppra, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on pantoprazole 40mg AC breakfast, metoprolol succinate 50mg daily, montelukast 10mg QHS. F/U neurology in 2 weeks.","A 90-year-old woman with a history of implanted heart defibrillator, type 1 diabetes, history of mini-stroke, type 2 diabetes, and seizure disorder [on Keppra] was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Endocrinology,Discharge Summary,high
1970,"US Abdomen: GB sludge, no stones. Moderate right hydronephrosis. GB wall thickening with stones, positive Murphy's sign. CBD 12mm, dilated. Right kidney 10.5cm, no hydronephrosis.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The bile duct is wider than normal [dilated], which may indicate a blockage. Right kidney is normal size with no blockage.",Gastroenterology,Radiology Report,high
1971,"51 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 51-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1972,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab timolol 0.5% OU BID. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks.",Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back for a check-up in 2 weeks.,Pulmonology,Prescription,medium
1973,Procedure: Port-a-cath placement. Pt 51 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 51-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
1974,"77 y/o M with PMH of s/p TKR, hypothyroidism, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on Humalog per SSI, pantoprazole 40mg AC breakfast, warfarin 5mg daily, latanoprost 0.005% OU QHS, pregabalin 75mg BID. F/U hematology in 2 weeks.","A 77-year-old man with a history of prior knee replacement, and underactive thyroid was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Humalog insulin before meals as directed [fast-acting insulin]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (5) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Endocrinology,Discharge Summary,high
1975,"62 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 62-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1976,"CBC: WBC 16.8 (H), Hgb 14.0 (N), Plt 184 (N).","Your blood count results: White blood cells are 16.8 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 14.0. Platelets are 184, which is normal.",Hematology,Lab Result,high
1977,"46 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 46-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1978,"BMP: Na 135 (L), K 2.6 (L), BUN 5, Cr 4.6 (H), Glucose 364.","Your blood chemistry results: Sodium is low at 135 (normal 136-145), meaning too much water in your body. Potassium is low at 2.6 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 4.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 364 (high).",Nephrology,Lab Result,high
1979,CT Head without contrast: No midline shift. Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage. Acute ischemic infarct in R MCA territory. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: The brain is centered normally. There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
1980,"CBC: WBC 6.0 (N), Hgb 8.0 (L), Plt 317 (N).","Your blood count results: White blood cells are 6.0 (normal). Hemoglobin is low at 8.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 317, which is normal.",Hematology,Lab Result,high
1981,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab hydroxychloroquine 200mg BID. Tab carvedilol 12.5mg BID. Adv: high fiber diet, adequate hydration Adv: SMBG BID, diabetic diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) carvedilol 12.5mg twice daily [heart medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
1982,"41 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 41-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
1983,"81 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 81-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1984,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
1985,"51 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 51-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
1986,"76 y/o M with PMH of HFrEF (EF 30%), gout, s/p TKR, osteoporosis, anemia, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on metformin 1000mg BID, omeprazole 20mg AC breakfast, Augmentin 875/125 BID x 7 days. F/U cardiology in 2 weeks.","A 76-year-old man with a history of heart failure with weak pumping (30%), gout, prior knee replacement, weak bones [osteoporosis], and low blood count [anemia] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the heart doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
1987,"74 y/o F with PMH of DM2, OSA on CPAP, PAD, ICD in situ, GERD, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on amlodipine 5mg daily, furosemide 40mg daily, entresto 49/51mg BID, potassium chloride 20mEq daily, tramadol 50mg Q6H PRN pain. F/U GI in 1 week.","A 74-year-old woman with a history of type 2 diabetes, sleep apnea [uses a breathing machine at night], poor blood flow in the legs [peripheral artery disease], implanted heart defibrillator, and acid reflux was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) Entresto 49/51mg twice daily [heart failure medicine]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the stomach doctor in 1 week.",Psychiatry,Discharge Summary,high
1988,"52 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 52-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
1989,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. C5-C6 disc herniation with cord compression. No compression fracture. Central canal stenosis at L3-L4.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. No bones are broken or collapsed. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
1990,"59 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 59-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
1991,"70 y/o F with PMH of DVT/PE on warfarin, A-fib, CAD, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on hydroxychloroquine 200mg BID, pregabalin 75mg BID, glipizide 5mg BID AC, spironolactone 25mg daily, acetaminophen 650mg Q6H PRN. F/U INR check in 3 days.","A 70-year-old woman with a history of blood clots [on blood thinner warfarin], irregular heartbeat [atrial fibrillation], and coronary artery disease [heart artery blockages] was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) spironolactone 25mg once daily [heart-protecting water pill]; (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up for a blood thinner level check in 3 days.",Infectious Disease,Discharge Summary,high
1992,"70 y/o M with PMH of seizure disorder on Keppra, s/p THR, CKD Stage 4, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on metformin 1000mg BID, methotrexate 15mg weekly, ferrous sulfate 325mg BID. F/U PCP in 1 week.","A 70-year-old man with a history of seizure disorder [on Keppra], prior hip replacement, and advanced kidney disease was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the primary care doctor in 1 week.",Infectious Disease,Discharge Summary,high
1993,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,high
1994,"81 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 81-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
1995,"72 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 72-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
1996,"36 y/o F with PMH of BPH, obesity (BMI 38), admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on warfarin 5mg daily, carvedilol 12.5mg BID. F/U neurology in 2 weeks.","A 36-year-old woman with a history of enlarged prostate, and obesity was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
1997,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab omeprazole 20mg AC breakfast. Adv: SMBG BID, diabetic diet Adv: low salt diet, fluid restriction 1.5L/day. F/U 1 week with wound check.",Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 1 week to have the wound checked.,Gastroenterology,Prescription,medium
1998,"LFTs: AST 407 (H), ALT 539 (H), ALP 182, T.Bili 5.0 (H), Albumin 4.8.","Your liver blood test results: Liver enzymes (AST 407, ALT 539) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 5.0 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.8.",Gastroenterology,Lab Result,high
1999,"73 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 73-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2000,"CBC: WBC 2.2 (L), Hgb 5.6 (L), Plt 91 (L).","Your blood count results: White blood cells are 2.2 (low, meaning your immune system may be weakened). Hemoglobin is low at 5.6, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 91, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
2001,"BMP: Na 141 (N), K 3.4 (L), BUN 81, Cr 6.1 (H), Glucose 272.","Your blood chemistry results: Sodium is normal at 141. Potassium is low at 3.4 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 6.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 272 (high).",Nephrology,Lab Result,high
2002,"Rx: prednisone taper. Tab montelukast 10mg QHS. Tab lisinopril 20mg daily. Adv: DASH diet, daily BP monitoring Adv: high fiber diet, adequate hydration. F/U 1 month with repeat imaging.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) lisinopril 20mg once daily [blood pressure medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
2003,HbA1c: 11.8% (H). FBS: 146 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.8%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 146, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2004,HbA1c: 10.0% (H). FBS: 154 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.0%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 154, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2005,"39 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 39-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2006,"Rx: Tab amlodipine 5mg daily. Tab acetaminophen 650mg Q6H PRN. Tab warfarin 5mg daily. Tab furosemide 40mg BID. Tab Dulcolax 10mg QHS PRN. Adv: SMBG BID, diabetic diet. F/U 1 week with CBC, CMP.",Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,high
2007,"75 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 75-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2008,CXR PA: Port-a-cath in appropriate position. Compression fracture T12. Small left pleural effusion. Right lower lobe consolidation.,"Chest X-ray results: The implanted medication port is in the correct position. There is a compression fracture [collapsed bone] in the lower spine at T12. There is a small amount of fluid around the left lung. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
2009,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2010,"50 y/o M with PMH of h/o CVA, COPD, s/p THR, s/p CABG, Parkinson's disease, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on clopidogrel 75mg daily, lisinopril 20mg daily, azithromycin 500mg day 1 then 250mg x 4 days, tramadol 50mg Q6H PRN pain. F/U PCP in 2 weeks.","A 50-year-old man with a history of history of stroke, chronic lung disease, prior hip replacement, prior heart bypass surgery, and Parkinson's disease was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the primary care doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
2011,"62 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 62-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2012,"US Abdomen: GB sludge, no stones. Moderate right hydronephrosis. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Spleen 11cm, normal. Right kidney 10.5cm, no hydronephrosis.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The spleen is a normal size. Right kidney is normal size with no blockage.",Gastroenterology,Radiology Report,high
2013,"MRI Lumbar Spine: C5-C6 disc herniation with cord compression. Conus medullaris at L1, normal. Facet joint hypertrophy at L4-L5. Multilevel degenerative disc disease.","MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal cord ends at a normal level. The small joints in the spine at L4-L5 are enlarged from arthritis. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
2014,"32 y/o F with PMH of BPH, s/p TKR, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on latanoprost 0.005% OU QHS, Xarelto 20mg daily with dinner, hydroxychloroquine 200mg BID, ferrous sulfate 325mg BID, lisinopril 20mg daily. F/U pulmonology in 2 weeks.","A 32-year-old woman with a history of enlarged prostate, and prior knee replacement was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (5) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the lung doctor in 2 weeks.",General Surgery,Discharge Summary,high
2015,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
2016,Procedure: Laparoscopic appendectomy. Pt 64 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 64-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2017,"Rx: Tab Xarelto 20mg daily with dinner. prednisone taper. Tab levothyroxine 75mcg daily on empty stomach. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks.",Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back for a check-up in 2 weeks.,Endocrinology,Prescription,medium
2018,"42 y/o F with PMH of RA on MTX, gout, A-fib, CHF, DM2, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Compression stockings when ambulating. D/C on amlodipine 10mg daily, sertraline 50mg daily, Dulcolax 10mg QHS PRN, ondansetron 4mg Q8H PRN N/V, ciprofloxacin 500mg BID x 5 days. F/U surgery in 10 days.","A 42-year-old woman with a history of rheumatoid arthritis [on immune-suppressing medicine], gout, irregular heartbeat [atrial fibrillation], heart failure, and type 2 diabetes was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]; (3) Dulcolax 10mg at bedtime as needed [for constipation]; (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (5) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
2019,CT Head without contrast: Acute ischemic infarct in R MCA territory. No mass effect. Chronic lacunar infarcts in bilateral basal ganglia. No midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are no tumors or masses pushing on the brain. There are signs of small old strokes in the deep parts of the brain. The brain is centered normally. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
2020,"66 y/o F with PMH of HTN, h/o TIA, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on pregabalin 75mg BID, ibuprofen 400mg Q6H PRN with food, rosuvastatin 10mg QHS. F/U endocrine in 1 week.","A 66-year-old woman with a history of high blood pressure, and history of mini-stroke was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Orthopedics,Discharge Summary,high
2021,"82 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 82-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2022,CXR PA: Bilateral hilar lymphadenopathy. NG tube tip in stomach. Moderate right pleural effusion. No pneumothorax. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The feeding/drainage tube tip is correctly positioned in the stomach. There is a moderate amount of fluid around the right lung. There is no collapsed lung. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
2023,"Rx: Tab sertraline 50mg daily. Spiriva 18mcg daily. Tab calcium + vitamin D 600/400 daily. Tab ondansetron 4mg Q8H PRN N/V. Tab warfarin 5mg daily. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) calcium plus vitamin D once daily [bone strengthening]. (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (5) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Pediatrics,Prescription,low
2024,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
2025,"31 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 31-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2026,"28 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 28-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2027,"23 y/o M with PMH of HTN, SLE, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Low potassium diet. D/C on ibuprofen 400mg Q6H PRN with food, gabapentin 300mg TID. F/U oncology in 1 week.","A 23-year-old man with a history of high blood pressure, and lupus was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the cancer doctor in 1 week.",Pulmonology,Discharge Summary,high
2028,"Rx: Tab entresto 49/51mg BID. Tab amoxicillin 500mg TID x 10 days. Humalog per SSI. Adv: avoid alcohol, hepatotoxic drugs Do not stop abruptly, taper as directed. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) Humalog insulin before meals as directed [fast-acting insulin]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
2029,"Rx: Tab amlodipine 10mg daily. Tab calcium + vitamin D 600/400 daily. Tab carvedilol 12.5mg BID. Adv: avoid alcohol, hepatotoxic drugs Adv: wound care with daily dressing changes. F/U INR in 3 days.","Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) calcium plus vitamin D once daily [bone strengthening]. (3) carvedilol 12.5mg twice daily [heart medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
2030,"Rx: Tab metformin 1000mg BID. Tab escitalopram 10mg daily. Adv: SMBG BID, diabetic diet. F/U 2 weeks with INR.",Your medicines: (1) metformin 1000mg twice daily with meals [blood sugar medicine]. (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks for a blood thinner level check [INR].,Endocrinology,Prescription,medium
2031,"80 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 80-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
2032,"Thyroid panel: TSH 10.3 (H), Free T4 2.8.","Your thyroid test results: TSH is elevated at 10.3 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2033,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. No compression fracture.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
2034,"BMP: Na 123 (L), K 5.5 (H), BUN 70, Cr 6.0 (H), Glucose 174.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is high at 5.5 — needs monitoring. Creatinine is elevated at 6.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 174 (high).",Nephrology,Lab Result,high
2035,"86 y/o M with PMH of HTN, HFpEF, HLD, s/p TKR, gout, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on escitalopram 10mg daily, methotrexate 15mg weekly, metformin 1000mg BID, potassium chloride 20mEq daily, amoxicillin 500mg TID x 10 days. F/U GI in 1 week.","A 86-year-old man with a history of high blood pressure, heart failure with stiff heart muscle, high cholesterol, prior knee replacement, and gout was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (3) metformin 1000mg twice daily with meals [blood sugar medicine]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (5) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
2036,Procedure: R TKA. Pt 40 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 40-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2037,CXR PA: Bilateral hilar lymphadenopathy. Left lower lobe consolidation. Cardiomegaly with CTR >0.5.,"Chest X-ray results: There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There is an area in the lower left lung that appears infected. The heart appears larger than normal.",Pulmonology,Radiology Report,high
2038,"70 y/o M with PMH of gout, h/o CVA, hypothyroidism, HLD, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on ondansetron 4mg Q8H PRN N/V, ibuprofen 400mg Q6H PRN with food. F/U orthopedics in 6 weeks with X-ray.","A 70-year-old man with a history of gout, history of stroke, underactive thyroid, and high cholesterol was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Infectious Disease,Discharge Summary,high
2039,"77 y/o F with PMH of A-fib, DM2, CHF, Parkinson's disease, s/p TKR, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on ASA 81mg daily, metoprolol 25mg BID, spironolactone 25mg daily, pantoprazole 40mg AC breakfast. F/U hematology in 2 weeks.","A 77-year-old woman with a history of irregular heartbeat [atrial fibrillation], type 2 diabetes, heart failure, Parkinson's disease, and prior knee replacement was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (3) spironolactone 25mg once daily [heart-protecting water pill]; (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
2040,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. No midline shift. No acute intracranial hemorrhage.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. The brain is centered normally. There is no bleeding in the brain.",Neurology,Radiology Report,high
2041,"86 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 86-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
2042,"Thyroid panel: TSH 10.82 (H), Free T4 2.5.","Your thyroid test results: TSH is elevated at 10.82 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2043,"Rx: Tab warfarin 5mg daily. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: fall precautions, home safety evaluation Do not stop abruptly, taper as directed. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Infectious Disease,Prescription,medium
2044,Procedure: Laparoscopic appendectomy. Pt 91 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 91-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2045,"44 y/o F with PMH of HTN, GERD, HFpEF, RA on MTX, DM1, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on ciprofloxacin 500mg BID x 5 days, metformin 500mg BID, ibuprofen 400mg Q6H PRN with food. F/U PCP in 1 week.","A 44-year-old woman with a history of high blood pressure, acid reflux, heart failure with stiff heart muscle, rheumatoid arthritis [on immune-suppressing medicine], and type 1 diabetes was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) metformin 500mg twice daily with meals [blood sugar medicine]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the primary care doctor in 1 week.",General Surgery,Discharge Summary,high
2046,Rx: Tab rosuvastatin 10mg QHS. Tab levothyroxine 75mcg daily on empty stomach. Tab latanoprost 0.005% OU QHS. Avoid NSAIDs. F/U 2 weeks with INR.,Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,medium
2047,"BMP: Na 146 (H), K 3.7 (N), BUN 14, Cr 5.2 (H), Glucose 299.","Your blood chemistry results: Sodium is high at 146, meaning you may be dehydrated. Potassium is normal at 3.7. Creatinine is elevated at 5.2 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 299 (high).",Nephrology,Lab Result,high
2048,CXR PA: Small left pleural effusion. Right-sided pneumothorax. Right middle lobe atelectasis. Widened mediastinum.,"Chest X-ray results: There is a small amount of fluid around the left lung. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
2049,"Lipid panel: TC 194, LDL 198, HDL 74, TG 340.","Your cholesterol results: Total cholesterol is 194. LDL (bad cholesterol) is very high at 198 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 74. Triglycerides are very high at 340 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
2050,"75 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 75-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
2051,"Rx: Tab clopidogrel 75mg daily. Tab spironolactone 25mg daily. Tab metoprolol 25mg BID. Avoid NSAIDs Adv: smoking cessation, pulmonary rehab. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
2052,CT Head without contrast: No midline shift. No acute intracranial hemorrhage. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: The brain is centered normally. There is no bleeding in the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
2053,"Rx: Tab sertraline 50mg daily. Tab clopidogrel 75mg daily. Tab amoxicillin 500mg TID x 10 days. Lantus 20U QHS. Tab omeprazole 20mg AC breakfast. Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks with INR.",Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (4) Lantus insulin 20 units at bedtime [long-acting insulin]. (5) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
2054,HbA1c: 12.4% (H). FBS: 174 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.4%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 174, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2055,CXR PA: NG tube tip in stomach. Compression fracture T12. Bilateral hilar lymphadenopathy. Port-a-cath in appropriate position. Widened mediastinum.,"Chest X-ray results: The feeding/drainage tube tip is correctly positioned in the stomach. There is a compression fracture [collapsed bone] in the lower spine at T12. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The implanted medication port is in the correct position. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
2056,"53 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 53-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2057,"52 y/o M with PMH of HFpEF, depression, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on lisinopril 20mg daily, amlodipine 10mg daily, pantoprazole 40mg AC breakfast. F/U neurology in 2 weeks.","A 52-year-old man with a history of heart failure with stiff heart muscle, and depression was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2058,"87 y/o M with PMH of RA on MTX, gout, HTN, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on empagliflozin 10mg daily, prednisone taper, pantoprazole 40mg AC breakfast, metformin 1000mg BID. F/U PCP in 2 weeks.","A 87-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], gout, and high blood pressure was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
2059,"37 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 37-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
2060,CXR PA: Mild cardiomegaly. Compression fracture T12. Right lower lobe consolidation.,"Chest X-ray results: The heart is slightly larger than normal. There is a compression fracture [collapsed bone] in the lower spine at T12. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
2061,"LFTs: AST 192 (H), ALT 445 (H), ALP 274, T.Bili 1.7 (H), Albumin 2.5.","Your liver blood test results: Liver enzymes (AST 192, ALT 445) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.7. Albumin is low at 2.5 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
2062,"40 y/o M with PMH of s/p THR, OSA on CPAP, ESRD on HD, CHF, anemia, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on sertraline 50mg daily, amoxicillin 500mg TID x 10 days, rosuvastatin 10mg QHS. F/U nephrology in 1 week.","A 40-year-old man with a history of prior hip replacement, sleep apnea [uses a breathing machine at night], kidney failure requiring dialysis, heart failure, and low blood count [anemia] was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the kidney doctor in 1 week.",Cardiology,Discharge Summary,high
2063,Procedure: ORIF L distal radius. Pt 60 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 60-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2064,Procedure: Colonoscopy with polypectomy. Pt 84 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 84-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2065,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
2066,"49 y/o M with PMH of gout, COPD, RA on MTX, ICD in situ, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on lisinopril 10mg daily, Humalog per SSI, clopidogrel 75mg daily, Augmentin 875/125 BID x 7 days. F/U PCP in 1 week.","A 49-year-old man with a history of gout, chronic lung disease, rheumatoid arthritis [on immune-suppressing medicine], and implanted heart defibrillator was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the primary care doctor in 1 week.",Neurology,Discharge Summary,high
2067,"83 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 83-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2068,"85 y/o M with PMH of Parkinson's disease, SLE, HTN, s/p TKR, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on atorvastatin 40mg QHS, montelukast 10mg QHS, amlodipine 10mg daily. F/U oncology in 1 week.","A 85-year-old man with a history of Parkinson's disease, lupus, high blood pressure, and prior knee replacement was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]; (3) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the cancer doctor in 1 week.",Nephrology,Discharge Summary,high
2069,"73 y/o M with PMH of BPH, s/p TKR, RA on MTX, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on escitalopram 10mg daily, gabapentin 300mg TID, ondansetron 4mg Q8H PRN N/V, Spiriva 18mcg daily, furosemide 40mg BID. F/U surgery in 10 days.","A 73-year-old man with a history of enlarged prostate, prior knee replacement, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) Spiriva inhaler once daily [long-acting lung medicine]; (5) furosemide (Lasix) 40mg twice daily [water pill]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
2070,CT Head without contrast: Acute ischemic infarct in R MCA territory. No acute intracranial hemorrhage. No mass effect.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is no bleeding in the brain. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
2071,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Acute ischemic infarct in R MCA territory. No acute intracranial hemorrhage. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is no bleeding in the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
2072,"79 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 79-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2073,CT Head without contrast: No midline shift. Paranasal sinuses clear. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: The brain is centered normally. The sinuses are clear with no infection. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
2074,"82 y/o F with PMH of anxiety, A-fib, OSA on CPAP, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Strict I&O, daily weights. D/C on ondansetron 4mg Q8H PRN N/V, pantoprazole 40mg AC breakfast, losartan 50mg daily, lisinopril 20mg daily, ciprofloxacin 500mg BID x 5 days. F/U pulmonology in 2 weeks.","A 82-year-old woman with a history of anxiety, irregular heartbeat [atrial fibrillation], and sleep apnea [uses a breathing machine at night] was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) losartan 50mg once daily [blood pressure medicine]; (4) lisinopril 20mg once daily [blood pressure medicine]; (5) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Follow-up with the lung doctor in 2 weeks.",General Surgery,Discharge Summary,high
2075,"38 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 38-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2076,"55 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 55-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2077,"91 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 91-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2078,"CBC: WBC 18.0 (H), Hgb 15.4 (N), Plt 497 (H).","Your blood count results: White blood cells are 18.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 15.4. Platelets are 497, which is high — your blood may clot too easily.",Hematology,Lab Result,high
2079,"62 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 62-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2080,"Rx: prednisone taper. Tab metoprolol 25mg BID. Tab atorvastatin 80mg QHS. Adv: SMBG BID, diabetic diet. F/U 2 weeks.",Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
2081,"87 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 87-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2082,Procedure: EGD with biopsy. Pt 36 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 36-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2083,CT Head without contrast: No acute intracranial hemorrhage. Chronic lacunar infarcts in bilateral basal ganglia. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There is no bleeding in the brain. There are signs of small old strokes in the deep parts of the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
2084,CT Head without contrast: No midline shift. No mass effect. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: The brain is centered normally. There are no tumors or masses pushing on the brain. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
2085,Delivery Note: G?P? at 40+0 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2086,CXR PA: No pneumothorax. Hyperinflated lungs consistent with COPD. Compression fracture T12.,"Chest X-ray results: There is no collapsed lung. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There is a compression fracture [collapsed bone] in the lower spine at T12.",Pulmonology,Radiology Report,high
2087,"46 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 46-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2088,"23 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 23-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
2089,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2090,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
2091,Procedure: Laparoscopic cholecystectomy. Pt 76 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 76-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2092,"29 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 29-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
2093,"30 y/o M with PMH of hypothyroidism, h/o TIA, obesity (BMI 38), PAD, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on atorvastatin 80mg QHS, empagliflozin 10mg daily, Dulcolax 10mg QHS PRN, Spiriva 18mcg daily. F/U pulmonology in 2 weeks.","A 30-year-old man with a history of underactive thyroid, history of mini-stroke, obesity, and poor blood flow in the legs [peripheral artery disease] was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) Dulcolax 10mg at bedtime as needed [for constipation]; (4) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the lung doctor in 2 weeks.",Pulmonology,Discharge Summary,high
2094,CXR PA: Right middle lobe atelectasis. Compression fracture T12. Patchy bilateral infiltrates. Widened mediastinum. Port-a-cath in appropriate position.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is a compression fracture [collapsed bone] in the lower spine at T12. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The space between the lungs appears wider than normal, which needs further evaluation. The implanted medication port is in the correct position.",Pulmonology,Radiology Report,high
2095,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab montelukast 10mg QHS. Tab acetaminophen 650mg Q6H PRN. Tab ASA 81mg daily. Tab lisinopril 10mg daily. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with CBC, CMP.","Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (4) baby aspirin 81mg once daily [prevents blood clots]. (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
2096,"89 y/o F with PMH of HFrEF (EF 30%), Parkinson's disease, PAD, gout, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Strict I&O, daily weights. D/C on pantoprazole 40mg AC breakfast, pregabalin 75mg BID, metoprolol succinate 50mg daily, Spiriva 18mcg daily, methotrexate 15mg weekly. F/U orthopedics in 6 weeks with X-ray.","A 89-year-old woman with a history of heart failure with weak pumping (30%), Parkinson's disease, poor blood flow in the legs [peripheral artery disease], and gout was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (4) Spiriva inhaler once daily [long-acting lung medicine]; (5) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Neurology,Discharge Summary,high
2097,"Rx: Tab lisinopril 20mg daily. Spiriva 18mcg daily. Tab methotrexate 15mg weekly. Tab entresto 49/51mg BID. Tab furosemide 40mg daily. Adv: fall precautions, home safety evaluation Do not stop abruptly, taper as directed. F/U 2 weeks.","Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (4) Entresto 49/51mg twice daily [heart failure medicine]. (5) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
2098,"61 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 61-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2099,Procedure: Port-a-cath placement. Pt 83 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 83-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
2100,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2101,"43 y/o F with PMH of h/o CVA, DVT/PE on warfarin, s/p CABG, depression, anemia, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on levothyroxine 75mcg daily on empty stomach, furosemide 40mg daily, rosuvastatin 10mg QHS, montelukast 10mg QHS, omeprazole 20mg AC breakfast. F/U cardiology in 2 weeks.","A 43-year-old woman with a history of history of stroke, blood clots [on blood thinner warfarin], prior heart bypass surgery, depression, and low blood count [anemia] was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) montelukast 10mg at bedtime [asthma/allergy medicine]; (5) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the heart doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2102,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2103,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
2104,"76 y/o F with PMH of Parkinson's disease, anemia, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on potassium chloride 20mEq daily, pantoprazole 40mg AC breakfast, rosuvastatin 10mg QHS, carvedilol 12.5mg BID. F/U hematology in 2 weeks.","A 76-year-old woman with a history of Parkinson's disease, and low blood count [anemia] was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the blood disorder doctor in 2 weeks.",General Surgery,Discharge Summary,high
2105,"Rx: Tab sertraline 50mg daily. Tab furosemide 40mg BID. Tab omeprazole 20mg AC breakfast. Tab lisinopril 20mg daily. Tab furosemide 40mg daily. Adv: fall precautions, home safety evaluation. F/U 2 weeks.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) omeprazole 20mg before breakfast [acid-reducing medicine]. (4) lisinopril 20mg once daily [blood pressure medicine]. (5) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
2106,MRI Lumbar Spine: Central canal stenosis at L3-L4. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
2107,"Thyroid panel: TSH 3.76 (N), Free T4 1.9.",Your thyroid test results: TSH is normal at 3.76. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
2108,CT Head without contrast: Acute ischemic infarct in R MCA territory. Subarachnoid hemorrhage in bilateral sylvian fissures. Paranasal sinuses clear. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is bleeding around the brain surface, particularly in the grooves on both sides. The sinuses are clear with no infection. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
2109,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab ondansetron 4mg Q8H PRN N/V. Tab pantoprazole 40mg AC breakfast. Adv: high fiber diet, adequate hydration Avoid grapefruit juice. F/U INR in 3 days.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Do not drink grapefruit juice as it interferes with this medication. Come back in 3 days for a blood thinner level check [INR].",Gastroenterology,Prescription,medium
2110,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage. No mass effect. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain. There are no tumors or masses pushing on the brain. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
2111,"Lipid panel: TC 230, LDL 178, HDL 76, TG 257.","Your cholesterol results: Total cholesterol is 230. LDL (bad cholesterol) is very high at 178 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 76. Triglycerides are high at 257.",Cardiology,Lab Result,high
2112,Procedure: Laparoscopic cholecystectomy. Pt 82 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 82-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2113,"Rx: Tab potassium chloride 20mEq daily. Tab rosuvastatin 10mg QHS. Spiriva 18mcg daily. Tab latanoprost 0.005% OU QHS. Tab amlodipine 5mg daily. Adv: smoking cessation, pulmonary rehab. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) Spiriva inhaler once daily [long-acting lung medicine]. (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (5) amlodipine 5mg once daily [blood pressure medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,high
2114,Procedure: PCI with DES to LAD. Pt 69 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 69-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
2115,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab Dulcolax 10mg QHS PRN. Do not stop abruptly, taper as directed. F/U 2 weeks.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back for a check-up in 2 weeks.",Infectious Disease,Prescription,medium
2116,"BMP: Na 145 (N), K 4.2 (N), BUN 6, Cr 0.9 (N), Glucose 168.",Your blood chemistry results: Sodium is normal at 145. Potassium is normal at 4.2. Creatinine is normal at 0.9. Blood sugar is 168 (high).,Nephrology,Lab Result,medium
2117,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Tab omeprazole 20mg AC breakfast. Adv: low potassium diet Adv: low salt low sugar diet, regular exercise. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Gastroenterology,Prescription,medium
2118,MRI Lumbar Spine: Multilevel degenerative disc disease. Facet joint hypertrophy at L4-L5. L4-L5 disc herniation with moderate bilateral foraminal stenosis. C5-C6 disc herniation with cord compression.,"MRI of the lower back results: Multiple discs in the spine are showing wear and aging. The small joints in the spine at L4-L5 are enlarged from arthritis. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
2119,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Multilevel degenerative disc disease. No compression fracture.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. Multiple discs in the spine are showing wear and aging. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
2120,"33 y/o F with PMH of ESRD on HD, DM2, s/p CABG, ICD in situ, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on methotrexate 15mg weekly, carvedilol 12.5mg BID, calcium + vitamin D 600/400 daily. F/U orthopedics in 6 weeks with X-ray.","A 33-year-old woman with a history of kidney failure requiring dialysis, type 2 diabetes, prior heart bypass surgery, and implanted heart defibrillator was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
2121,Rx: Tab Eliquis 5mg BID. Tab lisinopril 20mg daily. Avoid NSAIDs Avoid grapefruit juice. F/U PCP in 1 week for BP recheck.,Your medicines: (1) Eliquis 5mg twice daily [blood thinner]. (2) lisinopril 20mg once daily [blood pressure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Do not drink grapefruit juice as it interferes with this medication. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
2122,"22 y/o F with PMH of HLD, CHF, OA, A-fib, seizure disorder on Keppra, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on latanoprost 0.005% OU QHS, spironolactone 25mg daily. F/U INR check in 3 days.","A 22-year-old woman with a history of high cholesterol, heart failure, arthritis [osteoarthritis], irregular heartbeat [atrial fibrillation], and seizure disorder [on Keppra] was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
2123,CXR PA: Port-a-cath in appropriate position. Small left pleural effusion. Right lower lobe consolidation.,"Chest X-ray results: The implanted medication port is in the correct position. There is a small amount of fluid around the left lung. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
2124,"Rx: Tab clopidogrel 75mg daily. Tab atorvastatin 80mg QHS. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks.",Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
2125,"22 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 22-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2126,"Rx: Tab Eliquis 5mg BID. Tab metformin 1000mg BID. Avoid NSAIDs Adv: high fiber diet, adequate hydration. F/U 1 month with repeat imaging.","Your medicines: (1) Eliquis 5mg twice daily [blood thinner]. (2) metformin 1000mg twice daily with meals [blood sugar medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 month — a repeat scan will be ordered.",Endocrinology,Prescription,medium
2127,"56 y/o F with PMH of SLE, GERD, CAD, OSA on CPAP, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on atorvastatin 40mg QHS, azithromycin 500mg day 1 then 250mg x 4 days, pregabalin 75mg BID, ciprofloxacin 500mg BID x 5 days. F/U wound care in 3 days.","A 56-year-old woman with a history of lupus, acid reflux, coronary artery disease [heart artery blockages], and sleep apnea [uses a breathing machine at night] was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) pregabalin 75mg twice daily [nerve pain medicine]; (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Follow-up at the wound care clinic in 3 days.",Pulmonology,Discharge Summary,high
2128,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,low
2129,"76 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 76-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
2130,"41 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 41-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2131,"Rx: Spiriva 18mcg daily. Tab metoprolol succinate 50mg daily. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab omeprazole 20mg AC breakfast. Tab tramadol 50mg Q6H PRN pain. Adv: fall precautions, home safety evaluation Adv: SMBG BID, diabetic diet. F/U 1 week with wound check.","Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (4) omeprazole 20mg before breakfast [acid-reducing medicine]. (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
2132,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
2133,"53 y/o F with PMH of h/o TIA, obesity (BMI 38), ESRD on HD, DM2, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on Eliquis 5mg BID, azithromycin 500mg day 1 then 250mg x 4 days, carvedilol 12.5mg BID, empagliflozin 10mg daily. F/U pulmonology in 2 weeks.","A 53-year-old woman with a history of history of mini-stroke, obesity, kidney failure requiring dialysis, and type 2 diabetes was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Eliquis 5mg twice daily [blood thinner]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the lung doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
2134,"59 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 59-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2135,"Rx: prednisone taper. Tab metoprolol 25mg BID. Adv: wound care with daily dressing changes. F/U 1 week with CBC, CMP.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,medium
2136,"26 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 26-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2137,"BMP: Na 138 (N), K 5.2 (H), BUN 83, Cr 2.6 (H), Glucose 329.","Your blood chemistry results: Sodium is normal at 138. Potassium is high at 5.2 — needs monitoring. Creatinine is elevated at 2.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 329 (high).",Nephrology,Lab Result,high
2138,CXR PA: Hyperinflated lungs consistent with COPD. Right middle lobe atelectasis. Left lower lobe consolidation.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is an area in the lower left lung that appears infected.",Pulmonology,Radiology Report,high
2139,"LFTs: AST 227 (H), ALT 443 (H), ALP 136, T.Bili 1.9 (H), Albumin 4.3.","Your liver blood test results: Liver enzymes (AST 227, ALT 443) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.9. Albumin is normal at 4.3.",Gastroenterology,Lab Result,high
2140,Procedure: PCI with DES to LAD. Pt 51 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 51-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
2141,Procedure: R TKA. Pt 84 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 84-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2142,"45 y/o F with PMH of OSA on CPAP, Parkinson's disease, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Strict I&O, daily weights. D/C on Lantus 20U QHS, escitalopram 10mg daily, Humalog per SSI, pantoprazole 40mg AC breakfast, atorvastatin 40mg QHS. F/U neurology in 2 weeks.","A 45-year-old woman with a history of sleep apnea [uses a breathing machine at night], and Parkinson's disease was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) Humalog insulin before meals as directed [fast-acting insulin]; (4) pantoprazole 40mg before breakfast [acid-reducing medicine]; (5) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Endocrinology,Discharge Summary,high
2143,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,medium
2144,"Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab amlodipine 5mg daily. Tab rosuvastatin 10mg QHS. Tab metoprolol 25mg BID. Tab warfarin 5mg daily. Adv: high fiber diet, adequate hydration Adv: DASH diet, daily BP monitoring. F/U PCP in 1 week for BP recheck.","Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (5) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
2145,Procedure: Laparoscopic appendectomy. Pt 59 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 59-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2146,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab montelukast 10mg QHS. Adv: DASH diet, daily BP monitoring. F/U 6 weeks with LFTs.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 6 weeks for liver function blood tests.",Pulmonology,Prescription,medium
2147,"Rx: Tab Xarelto 20mg daily with dinner. Tab lisinopril 20mg daily. Tab Augmentin 875/125 BID x 7 days. Tab ibuprofen 400mg Q6H PRN with food. Tab furosemide 40mg daily. Adv: low potassium diet Adv: elevate affected limb, compression stockings. F/U INR in 3 days.","Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) lisinopril 20mg once daily [blood pressure medicine]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (5) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
2148,"Rx: Tab amlodipine 10mg daily. Tab metoprolol succinate 50mg daily. albuterol MDI 2 puffs Q4-6H PRN. Avoid NSAIDs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
2149,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
2150,CXR PA: Right lower lobe consolidation. Elevated left hemidiaphragm. Pacemaker leads in appropriate position.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The pacemaker wires are in the correct position.",Pulmonology,Radiology Report,high
2151,CXR PA: No pneumothorax. Osseous structures intact. Port-a-cath in appropriate position. Mild cardiomegaly. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: There is no collapsed lung. The bones look normal with no fractures. The implanted medication port is in the correct position. The heart is slightly larger than normal. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
2152,"Rx: Tab montelukast 10mg QHS. Tab metoprolol 25mg BID. Tab acetaminophen 650mg Q6H PRN. Tab clopidogrel 75mg daily. Avoid grapefruit juice Adv: elevate affected limb, compression stockings. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Do not drink grapefruit juice as it interferes with this medication Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
2153,"Rx: Tab ASA 81mg daily. Tab entresto 49/51mg BID. Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with INR.",Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) Entresto 49/51mg twice daily [heart failure medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,medium
2154,"27 y/o M with PMH of RA on MTX, hypothyroidism, gout, asthma, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on lisinopril 10mg daily, amlodipine 10mg daily, Dulcolax 10mg QHS PRN, lisinopril 20mg daily, albuterol MDI 2 puffs Q4-6H PRN. F/U GI in 1 week.","A 27-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], underactive thyroid, gout, and asthma was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) Dulcolax 10mg at bedtime as needed [for constipation]; (4) lisinopril 20mg once daily [blood pressure medicine]; (5) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the stomach doctor in 1 week.",Gastroenterology,Discharge Summary,high
2155,"63 y/o M with PMH of seizure disorder on Keppra, obesity (BMI 38), admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on metformin 1000mg BID, glipizide 5mg BID AC. F/U neurology in 2 weeks.","A 63-year-old man with a history of seizure disorder [on Keppra], and obesity was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the brain/nerve doctor in 2 weeks.",General Surgery,Discharge Summary,high
2156,"US Abdomen: Moderate right hydronephrosis. CBD 5mm, not dilated. Spleen 11cm, normal. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The bile duct is normal size [not blocked]. The spleen is a normal size. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
2157,"67 y/o M with PMH of s/p THR, obesity (BMI 38), admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on hydroxychloroquine 200mg BID, omeprazole 20mg AC breakfast, amlodipine 10mg daily, metoprolol 25mg BID. F/U surgery in 10 days.","A 67-year-old man with a history of prior hip replacement, and obesity was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the surgeon in 10 days.",General Surgery,Discharge Summary,high
2158,"27 y/o M with PMH of HFrEF (EF 30%), DM1, gout, HFpEF, obesity (BMI 38), admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Strict I&O, daily weights. D/C on gabapentin 300mg TID, sertraline 50mg daily. F/U nephrology in 1 week.","A 27-year-old man with a history of heart failure with weak pumping (30%), type 1 diabetes, gout, heart failure with stiff heart muscle, and obesity was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the kidney doctor in 1 week.",Neurology,Discharge Summary,high
2159,CXR PA: Osseous structures intact. Left lower lobe consolidation. Sternotomy wires intact. Pacemaker leads in appropriate position.,Chest X-ray results: The bones look normal with no fractures. There is an area in the lower left lung that appears infected. The wires from prior heart surgery are intact. The pacemaker wires are in the correct position.,Pulmonology,Radiology Report,high
2160,CXR PA: Sternotomy wires intact. Mild cardiomegaly. Bilateral hilar lymphadenopathy. Pacemaker leads in appropriate position.,"Chest X-ray results: The wires from prior heart surgery are intact. The heart is slightly larger than normal. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The pacemaker wires are in the correct position.",Pulmonology,Radiology Report,high
2161,"Rx: Tab metoprolol succinate 50mg daily. Tab metformin 500mg BID. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
2162,"67 y/o F with PMH of h/o TIA, anxiety, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on lisinopril 10mg daily, latanoprost 0.005% OU QHS. F/U cardiology in 2 weeks.","A 67-year-old woman with a history of history of mini-stroke, and anxiety was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Follow-up with the heart doctor in 2 weeks.",Neurology,Discharge Summary,high
2163,"MRI Lumbar Spine: Multilevel degenerative disc disease. Conus medullaris at L1, normal. Central canal stenosis at L3-L4.","MRI of the lower back results: Multiple discs in the spine are showing wear and aging. The spinal cord ends at a normal level. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
2164,Procedure: EGD with biopsy. Pt 24 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 24-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2165,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2166,"Rx: Tab atorvastatin 80mg QHS. Tab latanoprost 0.005% OU QHS. Tab Dulcolax 10mg QHS PRN. Tab furosemide 40mg BID. Tab amlodipine 5mg daily. Adv: low salt low sugar diet, regular exercise. F/U 1 month with repeat imaging.","Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) amlodipine 5mg once daily [blood pressure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
2167,"28 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 28-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2168,"BMP: Na 125 (L), K 6.7 (H), BUN 28, Cr 1.4 (H), Glucose 64.","Your blood chemistry results: Sodium is low at 125 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.7 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is mildly elevated at 1.4. Blood sugar is 64 (low).",Nephrology,Lab Result,high
2169,Procedure: Laparoscopic appendectomy. Pt 34 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 34-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2170,"Rx: Tab metformin 1000mg BID. Tab ibuprofen 400mg Q6H PRN with food. Tab spironolactone 25mg daily. Tab furosemide 40mg BID. Tab metoprolol 25mg BID. Adv: high fiber diet, adequate hydration Adv: low salt diet, fluid restriction 1.5L/day. F/U 6 weeks with LFTs.","Your medicines: (1) metformin 1000mg twice daily with meals [blood sugar medicine]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (3) spironolactone 25mg once daily [heart-protecting water pill]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
2171,"MRI Lumbar Spine: C5-C6 disc herniation with cord compression. Facet joint hypertrophy at L4-L5. Conus medullaris at L1, normal. Multilevel degenerative disc disease.","MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal cord ends at a normal level. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
2172,"74 y/o F with PMH of A-fib, ESRD on HD, asthma, HFrEF (EF 30%), CAD, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on Augmentin 875/125 BID x 7 days, calcium + vitamin D 600/400 daily, latanoprost 0.005% OU QHS, Spiriva 18mcg daily, Dulcolax 10mg QHS PRN. F/U neurology in 2 weeks.","A 74-year-old woman with a history of irregular heartbeat [atrial fibrillation], kidney failure requiring dialysis, asthma, heart failure with weak pumping (30%), and coronary artery disease [heart artery blockages] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (4) Spiriva inhaler once daily [long-acting lung medicine]; (5) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the brain/nerve doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
2173,"30 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 30-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2174,"49 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 49-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2175,"US Abdomen: No focal hepatic lesion. CBD 5mm, not dilated. Simple renal cysts bilaterally. Spleen 11cm, normal. Moderate right hydronephrosis.","Abdominal ultrasound results: No tumors or masses were found in the liver. The bile duct is normal size [not blocked]. Both kidneys have harmless fluid-filled cysts. The spleen is a normal size. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage.",Gastroenterology,Radiology Report,high
2176,"31 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 31-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2177,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
2178,CXR PA: Bilateral hilar lymphadenopathy. Clear lung fields bilaterally. ET tube 3cm above carina. No pneumothorax. Compression fracture T12.,"Chest X-ray results: There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. Both lungs look clear with no problems. The breathing tube is in good position. There is no collapsed lung. There is a compression fracture [collapsed bone] in the lower spine at T12.",Pulmonology,Radiology Report,high
2179,CXR PA: No pneumothorax. Osseous structures intact. Widened mediastinum.,"Chest X-ray results: There is no collapsed lung. The bones look normal with no fractures. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
2180,"Rx: Tab carvedilol 12.5mg BID. Tab latanoprost 0.005% OU QHS. Tab amlodipine 5mg daily. Tab lisinopril 20mg daily. Tab furosemide 40mg BID. Adv: smoking cessation, pulmonary rehab Adv: low salt diet, fluid restriction 1.5L/day. F/U 6 weeks with LFTs.",Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (3) amlodipine 5mg once daily [blood pressure medicine]. (4) lisinopril 20mg once daily [blood pressure medicine]. (5) furosemide (Lasix) 40mg twice daily [water pill]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,high
2181,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab furosemide 40mg BID. Tab metoprolol succinate 50mg daily. Adv: high fiber diet, adequate hydration Avoid grapefruit juice. F/U 2 weeks with INR.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
2182,"45 y/o F with PMH of CKD Stage 4, HTN, h/o CVA, gout, seizure disorder on Keppra, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on furosemide 40mg daily, losartan 50mg daily, metformin 500mg BID. F/U cardiology in 2 weeks.","A 45-year-old woman with a history of advanced kidney disease, high blood pressure, history of stroke, gout, and seizure disorder [on Keppra] was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (2) losartan 50mg once daily [blood pressure medicine]; (3) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
2183,"LFTs: AST 283 (H), ALT 113 (H), ALP 287, T.Bili 5.8 (H), Albumin 1.6.","Your liver blood test results: Liver enzymes (AST 283, ALT 113) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is high at 5.8 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 1.6 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
2184,"CBC: WBC 23.3 (H), Hgb 12.7 (N), Plt 405 (H).","Your blood count results: White blood cells are 23.3 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 12.7. Platelets are 405, which is high — your blood may clot too easily.",Hematology,Lab Result,high
2185,"Rx: Tab pregabalin 75mg BID. Tab empagliflozin 10mg daily. Tab Dulcolax 10mg QHS PRN. Tab atorvastatin 80mg QHS. Adv: low potassium diet Adv: weight bearing exercise, calcium/vit D supplementation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
2186,"US Abdomen: CBD 5mm, not dilated. GB sludge, no stones. Simple renal cysts bilaterally. Spleen 16cm, splenomegaly. CBD 12mm, dilated. Moderate right hydronephrosis.","Abdominal ultrasound results: The bile duct is normal size [not blocked]. The gallbladder contains thickened bile [sludge] but no stones. Both kidneys have harmless fluid-filled cysts. The spleen is enlarged [splenomegaly]. The bile duct is wider than normal [dilated], which may indicate a blockage. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage.",Gastroenterology,Radiology Report,high
2187,"30 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 30-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2188,CXR PA: No cardiomegaly. Right middle lobe atelectasis. Pacemaker leads in appropriate position.,"Chest X-ray results: The heart is a normal size. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The pacemaker wires are in the correct position.",Pulmonology,Radiology Report,high
2189,"LFTs: AST 188 (H), ALT 542 (H), ALP 94, T.Bili 7.6 (H), Albumin 4.1.","Your liver blood test results: Liver enzymes (AST 188, ALT 542) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 7.6 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.1.",Gastroenterology,Lab Result,high
2190,"Rx: prednisone taper. Tab furosemide 40mg daily. Tab amlodipine 10mg daily. Tab ondansetron 4mg Q8H PRN N/V. Adv: fall precautions, home safety evaluation. F/U 2 weeks with INR.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) amlodipine 10mg once daily [blood pressure medicine]. (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
2191,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab ferrous sulfate 325mg BID. Tab gabapentin 300mg TID. Tab calcium + vitamin D 600/400 daily. Adv: SMBG BID, diabetic diet Do not stop abruptly, taper as directed. F/U 2 weeks with INR.",Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) calcium plus vitamin D once daily [bone strengthening]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 2 weeks for a blood thinner level check [INR].,General,Prescription,high
2192,"Rx: Tab pregabalin 75mg BID. Tab pantoprazole 40mg AC breakfast. Tab metformin 1000mg BID. Tab metoprolol 25mg BID. prednisone taper. Adv: elevate affected limb, compression stockings. F/U 1 week with CBC, CMP.",Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (5) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,high
2193,CXR PA: Left lower lobe consolidation. Sternotomy wires intact. Bilateral pleural effusions.,Chest X-ray results: There is an area in the lower left lung that appears infected. The wires from prior heart surgery are intact. There is fluid collecting around both lungs.,Pulmonology,Radiology Report,high
2194,CXR PA: Sternotomy wires intact. Clear lung fields bilaterally. Moderate right pleural effusion. Bilateral pleural effusions.,Chest X-ray results: The wires from prior heart surgery are intact. Both lungs look clear with no problems. There is a moderate amount of fluid around the right lung. There is fluid collecting around both lungs.,Pulmonology,Radiology Report,high
2195,CXR PA: Increased interstitial markings suggesting pulmonary edema. Compression fracture T12. Bilateral hilar lymphadenopathy. Bilateral pleural effusions. Left lower lobe consolidation.,"Chest X-ray results: There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There is a compression fracture [collapsed bone] in the lower spine at T12. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There is fluid collecting around both lungs. There is an area in the lower left lung that appears infected.",Pulmonology,Radiology Report,high
2196,"65 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 65-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2197,CXR PA: Left lower lobe consolidation. Right lower lobe consolidation. Right-sided pneumothorax. NG tube tip in stomach.,"Chest X-ray results: There is an area in the lower left lung that appears infected. There is an area in the lower right lung that appears infected, suggesting pneumonia. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The feeding/drainage tube tip is correctly positioned in the stomach.",Pulmonology,Radiology Report,high
2198,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,medium
2199,"66 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 66-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
2200,"Thyroid panel: TSH 7.73 (H), Free T4 2.2.","Your thyroid test results: TSH is elevated at 7.73 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2201,"57 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 57-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
2202,"CBC: WBC 3.1 (L), Hgb 12.0 (N), Plt 254 (N).","Your blood count results: White blood cells are 3.1 (low, meaning your immune system may be weakened). Hemoglobin is normal at 12.0. Platelets are 254, which is normal.",Hematology,Lab Result,high
2203,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
2204,CXR PA: Bilateral hilar lymphadenopathy. ET tube 3cm above carina. Bilateral pleural effusions.,"Chest X-ray results: There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The breathing tube is in good position. There is fluid collecting around both lungs.",Pulmonology,Radiology Report,high
2205,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
2206,"60 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 60-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2207,"Rx: Tab hydroxychloroquine 200mg BID. Tab furosemide 40mg BID. Spiriva 18mcg daily. Tab warfarin 5mg daily. prednisone taper. Adv: wound care with daily dressing changes Adv: high fiber diet, adequate hydration. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) Spiriva inhaler once daily [long-acting lung medicine]. (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (5) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Rheumatology,Prescription,high
2208,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,high
2209,"CBC: WBC 12.3 (H), Hgb 10.9 (L), Plt 178 (N).","Your blood count results: White blood cells are 12.3 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 10.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 178, which is normal.",Hematology,Lab Result,high
2210,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
2211,"50 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 50-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2212,Rx: prednisone taper. Tab montelukast 10mg QHS. Tab empagliflozin 10mg daily. Tab furosemide 40mg daily. Tab timolol 0.5% OU BID. Adv: wound care with daily dressing changes. F/U 2 weeks with INR.,"Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (5) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
2213,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. Multilevel degenerative disc disease. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. Multiple discs in the spine are showing wear and aging. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
2214,Procedure: TURP for BPH. Pt 27 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 27-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
2215,"Rx: Tab Xarelto 20mg daily with dinner. Tab rosuvastatin 10mg QHS. Tab ferrous sulfate 325mg BID. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 6 weeks with LFTs.","Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
2216,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
2217,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
2218,CXR PA: Osseous structures intact. Hyperinflated lungs consistent with COPD. Pacemaker leads in appropriate position. Right-sided pneumothorax. ET tube 3cm above carina.,"Chest X-ray results: The bones look normal with no fractures. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The pacemaker wires are in the correct position. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The breathing tube is in good position.",Pulmonology,Radiology Report,high
2219,"44 y/o M with PMH of s/p THR, DM1, OSA on CPAP, PPM in situ, cirrhosis, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on azithromycin 500mg day 1 then 250mg x 4 days, prednisone taper, amlodipine 10mg daily. F/U INR check in 3 days.","A 44-year-old man with a history of prior hip replacement, type 1 diabetes, sleep apnea [uses a breathing machine at night], implanted pacemaker, and liver scarring [cirrhosis] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) amlodipine 10mg once daily [blood pressure medicine]. Follow-up for a blood thinner level check in 3 days.",Orthopedics,Discharge Summary,high
2220,CT Head without contrast: No midline shift. Mild generalized cerebral atrophy appropriate for age. No acute intracranial hemorrhage. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: The brain is centered normally. There is mild brain shrinkage, which is normal for your age. There is no bleeding in the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
2221,"75 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 75-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2222,"50 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 50-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2223,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2224,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2225,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
2226,CXR PA: Cardiomegaly with CTR >0.5. ET tube 3cm above carina. No pneumothorax.,Chest X-ray results: The heart appears larger than normal. The breathing tube is in good position. There is no collapsed lung.,Pulmonology,Radiology Report,high
2227,"BMP: Na 150 (H), K 6.4 (H), BUN 44, Cr 6.3 (H), Glucose 120.","Your blood chemistry results: Sodium is high at 150, meaning you may be dehydrated. Potassium is dangerously high at 6.4 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 6.3 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 120 (high).",Nephrology,Lab Result,high
2228,"Rx: Tab pregabalin 75mg BID. Tab amlodipine 5mg daily. Tab atorvastatin 80mg QHS. Tab amlodipine 10mg daily. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (4) amlodipine 10mg once daily [blood pressure medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
2229,Rx: Tab atorvastatin 80mg QHS. Tab gabapentin 300mg TID. Avoid grapefruit juice. F/U 6 weeks with LFTs.,Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Do not drink grapefruit juice as it interferes with this medication. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,medium
2230,"CBC: WBC 10.1 (N), Hgb 14.1 (N), Plt 260 (N).","Your blood count results: White blood cells are 10.1 (normal). Hemoglobin is normal at 14.1. Platelets are 260, which is normal.",Hematology,Lab Result,medium
2231,"Thyroid panel: TSH 14.27 (H), Free T4 1.0.","Your thyroid test results: TSH is elevated at 14.27 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2232,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
2233,"Rx: Spiriva 18mcg daily. Tab acetaminophen 650mg Q6H PRN. Tab carvedilol 12.5mg BID. Tab amlodipine 10mg daily. Avoid NSAIDs Adv: low salt diet, fluid restriction 1.5L/day. F/U INR in 3 days.",Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) carvedilol 12.5mg twice daily [heart medicine]. (4) amlodipine 10mg once daily [blood pressure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
2234,"Lipid panel: TC 131, LDL 52, HDL 45, TG 342.",Your cholesterol results: Total cholesterol is 131. LDL (bad cholesterol) is at goal (52). HDL (good cholesterol) is good at 45. Triglycerides are very high at 342 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
2235,"44 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 44-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2236,"Rx: Tab methotrexate 15mg weekly. Tab empagliflozin 10mg daily. Tab Xarelto 20mg daily with dinner. Adv: low potassium diet Adv: DASH diet, daily BP monitoring. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) Xarelto 20mg once daily with dinner [blood thinner]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Endocrinology,Prescription,medium
2237,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
2238,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
2239,"Rx: Tab ferrous sulfate 325mg BID. Tab rosuvastatin 10mg QHS. Tab lisinopril 10mg daily. Adv: low salt diet, fluid restriction 1.5L/day. F/U PCP in 1 week for BP recheck.",Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
2240,"US Abdomen: Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Simple renal cysts bilaterally. GB wall thickening with stones, positive Murphy's sign. Spleen 16cm, splenomegaly.","Abdominal ultrasound results: The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. Both kidneys have harmless fluid-filled cysts. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The spleen is enlarged [splenomegaly].",Gastroenterology,Radiology Report,high
2241,Procedure: Colonoscopy with polypectomy. Pt 48 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 48-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2242,"26 y/o M with PMH of OA, CKD Stage 3, DM2, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on acetaminophen 650mg Q6H PRN, Spiriva 18mcg daily, metformin 1000mg BID, tramadol 50mg Q6H PRN pain. F/U PCP in 1 week.","A 26-year-old man with a history of arthritis [osteoarthritis], moderate kidney disease, and type 2 diabetes was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) metformin 1000mg twice daily with meals [blood sugar medicine]; (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the primary care doctor in 1 week.",Gastroenterology,Discharge Summary,high
2243,"74 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 74-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2244,"71 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 71-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
2245,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2246,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage. Mild generalized cerebral atrophy appropriate for age. Paranasal sinuses clear.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain. There is mild brain shrinkage, which is normal for your age. The sinuses are clear with no infection.",Neurology,Radiology Report,high
2247,"54 y/o F with PMH of HTN, PAD, RA on MTX, s/p CABG, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Compression stockings when ambulating. D/C on gabapentin 300mg TID, Eliquis 5mg BID. F/U endocrine in 1 week.","A 54-year-old woman with a history of high blood pressure, poor blood flow in the legs [peripheral artery disease], rheumatoid arthritis [on immune-suppressing medicine], and prior heart bypass surgery was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) Eliquis 5mg twice daily [blood thinner]. Follow-up with the hormone/diabetes doctor in 1 week.",Infectious Disease,Discharge Summary,high
2248,"US Abdomen: Ascites moderate amount. Right kidney 10.5cm, no hydronephrosis. CBD 5mm, not dilated. Spleen 16cm, splenomegaly. No focal hepatic lesion.",Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. Right kidney is normal size with no blockage. The bile duct is normal size [not blocked]. The spleen is enlarged [splenomegaly]. No tumors or masses were found in the liver.,Gastroenterology,Radiology Report,high
2249,"26 y/o M with PMH of BPH, SLE, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Low potassium diet. D/C on warfarin 5mg daily, metformin 1000mg BID. F/U INR check in 3 days.","A 26-year-old man with a history of enlarged prostate, and lupus was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
2250,"Rx: Tab ASA 81mg daily. Tab rosuvastatin 10mg QHS. Tab spironolactone 25mg daily. Tab escitalopram 10mg daily. Tab losartan 50mg daily. Adv: SMBG BID, diabetic diet. F/U 2 weeks with INR.",Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) spironolactone 25mg once daily [heart-protecting water pill]. (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (5) losartan 50mg once daily [blood pressure medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
2251,"US Abdomen: CBD 5mm, not dilated. Right kidney 10.5cm, no hydronephrosis. Moderate right hydronephrosis. CBD 12mm, dilated. GB sludge, no stones.","Abdominal ultrasound results: The bile duct is normal size [not blocked]. Right kidney is normal size with no blockage. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The bile duct is wider than normal [dilated], which may indicate a blockage. The gallbladder contains thickened bile [sludge] but no stones.",Gastroenterology,Radiology Report,high
2252,Procedure: ERCP with sphincterotomy. Pt 44 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 44-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2253,"CBC: WBC 21.0 (H), Hgb 10.4 (L), Plt 338 (N).","Your blood count results: White blood cells are 21.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 10.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 338, which is normal.",Hematology,Lab Result,high
2254,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
2255,Rx: Tab entresto 49/51mg BID. Tab empagliflozin 10mg daily. prednisone taper. Adv: low potassium diet. F/U INR in 3 days.,"Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
2256,CT Head without contrast: No midline shift. No acute intracranial hemorrhage. Paranasal sinuses clear.,CT scan of the head results: The brain is centered normally. There is no bleeding in the brain. The sinuses are clear with no infection.,Neurology,Radiology Report,high
2257,"69 y/o F with PMH of h/o TIA, DM2, CKD Stage 4, ICD in situ, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on carvedilol 12.5mg BID, spironolactone 25mg daily. F/U nephrology in 5 days.","A 69-year-old woman with a history of history of mini-stroke, type 2 diabetes, advanced kidney disease, and implanted heart defibrillator was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up with the kidney doctor in 5 days.",Endocrinology,Discharge Summary,high
2258,"Lipid panel: TC 241, LDL 86, HDL 44, TG 365.",Your cholesterol results: Total cholesterol is 241. LDL (bad cholesterol) is at goal (86). HDL (good cholesterol) is good at 44. Triglycerides are very high at 365 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
2259,"US Abdomen: CBD 12mm, dilated. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. CBD 5mm, not dilated. Left kidney 8cm, cortical thinning consistent with CKD. Right kidney 10.5cm, no hydronephrosis. Pancreas unremarkable.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The bile duct is normal size [not blocked]. Left kidney is small with thin outer layer, consistent with chronic kidney disease. Right kidney is normal size with no blockage. The pancreas looks normal.",Gastroenterology,Radiology Report,high
2260,"Rx: Tab Dulcolax 10mg QHS PRN. Tab Xarelto 20mg daily with dinner. Tab losartan 50mg daily. Tab furosemide 40mg BID. Tab pantoprazole 40mg AC breakfast. Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) losartan 50mg once daily [blood pressure medicine]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
2261,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
2262,"89 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 89-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2263,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,high
2264,"CBC: WBC 7.6 (N), Hgb 5.6 (L), Plt 162 (N).","Your blood count results: White blood cells are 7.6 (normal). Hemoglobin is low at 5.6, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 162, which is normal.",Hematology,Lab Result,high
2265,"Rx: Tab hydroxychloroquine 200mg BID. Tab metformin 500mg BID. Tab tramadol 50mg Q6H PRN pain. Tab pantoprazole 40mg AC breakfast. Tab clopidogrel 75mg daily. Adv: high fiber diet, adequate hydration. F/U 1 week with wound check.","Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. (5) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
2266,"67 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 67-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2267,"31 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 31-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2268,"Rx: Tab Dulcolax 10mg QHS PRN. Tab amlodipine 5mg daily. Tab metformin 1000mg BID. Adv: wound care with daily dressing changes. F/U 1 week with CBC, CMP.","Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,medium
2269,"39 y/o M with PMH of HLD, A-fib, gout, depression, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on warfarin 5mg daily, Augmentin 875/125 BID x 7 days. F/U hematology in 2 weeks.","A 39-year-old man with a history of high cholesterol, irregular heartbeat [atrial fibrillation], gout, and depression was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
2270,"49 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 49-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
2271,Procedure: ERCP with sphincterotomy. Pt 36 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 36-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2272,"60 y/o F with PMH of GERD, SLE, obesity (BMI 38), asthma, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on acetaminophen 650mg Q6H PRN, ondansetron 4mg Q8H PRN N/V, Spiriva 18mcg daily, metformin 1000mg BID, metoprolol succinate 50mg daily. F/U GI in 1 week.","A 60-year-old woman with a history of acid reflux, lupus, obesity, and asthma was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (3) Spiriva inhaler once daily [long-acting lung medicine]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]; (5) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
2273,"Thyroid panel: TSH 11.19 (H), Free T4 0.9.","Your thyroid test results: TSH is elevated at 11.19 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2274,HbA1c: 4.9% (N). FBS: 226 mg/dL (H).,"Your diabetes blood test results: HbA1c is 4.9%, which is normal — you do not have diabetes. Fasting blood sugar was 226, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
2275,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
2276,CXR PA: NG tube tip in stomach. Cardiomegaly with CTR >0.5. Bilateral hilar lymphadenopathy. No cardiomegaly. No pneumothorax.,"Chest X-ray results: The feeding/drainage tube tip is correctly positioned in the stomach. The heart appears larger than normal. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The heart is a normal size. There is no collapsed lung.",Pulmonology,Radiology Report,high
2277,"76 y/o F with PMH of obesity (BMI 38), A-fib, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on levothyroxine 75mcg daily on empty stomach, entresto 49/51mg BID, empagliflozin 10mg daily. F/U cardiology in 2 weeks.","A 76-year-old woman with a history of obesity, and irregular heartbeat [atrial fibrillation] was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the heart doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2278,Procedure: ORIF L distal radius. Pt 41 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 41-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2279,"89 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 89-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
2280,"Lipid panel: TC 227, LDL 204, HDL 60, TG 230.","Your cholesterol results: Total cholesterol is 227. LDL (bad cholesterol) is very high at 204 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 60. Triglycerides are high at 230.",Cardiology,Lab Result,high
2281,"76 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 76-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2282,"BMP: Na 121 (L), K 5.6 (H), BUN 54, Cr 6.2 (H), Glucose 266.","Your blood chemistry results: Sodium is low at 121 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 5.6 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 6.2 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 266 (high).",Nephrology,Lab Result,high
2283,"CBC: WBC 22.4 (H), Hgb 6.2 (L), Plt 437 (H).","Your blood count results: White blood cells are 22.4 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 6.2, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 437, which is high — your blood may clot too easily.",Hematology,Lab Result,high
2284,Procedure: TURP for BPH. Pt 25 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 25-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
2285,"BMP: Na 128 (L), K 4.9 (N), BUN 19, Cr 2.6 (H), Glucose 308.","Your blood chemistry results: Sodium is low at 128 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.9. Creatinine is elevated at 2.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 308 (high).",Nephrology,Lab Result,high
2286,"Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab amlodipine 10mg daily. Adv: low salt low sugar diet, regular exercise. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) amlodipine 10mg once daily [blood pressure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
2287,"Rx: Tab escitalopram 10mg daily. Tab metformin 500mg BID. Tab clopidogrel 75mg daily. Lantus 20U QHS. Adv: DASH diet, daily BP monitoring. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. (4) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Endocrinology,Prescription,high
2288,"52 y/o M with PMH of DVT/PE on warfarin, PPM in situ, seizure disorder on Keppra, osteoporosis, s/p CABG, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on tramadol 50mg Q6H PRN pain, atorvastatin 80mg QHS, amoxicillin 500mg TID x 10 days. F/U nephrology in 5 days.","A 52-year-old man with a history of blood clots [on blood thinner warfarin], implanted pacemaker, seizure disorder [on Keppra], weak bones [osteoporosis], and prior heart bypass surgery was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the kidney doctor in 5 days.",Pulmonology,Discharge Summary,high
2289,CXR PA: ET tube 3cm above carina. Compression fracture T12. Mild cardiomegaly. Port-a-cath in appropriate position.,Chest X-ray results: The breathing tube is in good position. There is a compression fracture [collapsed bone] in the lower spine at T12. The heart is slightly larger than normal. The implanted medication port is in the correct position.,Pulmonology,Radiology Report,high
2290,"Rx: Tab metoprolol 25mg BID. Tab atorvastatin 40mg QHS. Tab clopidogrel 75mg daily. Tab amoxicillin 500mg TID x 10 days. Tab glipizide 5mg BID AC. Adv: wound care with daily dressing changes Adv: SMBG BID, diabetic diet. F/U PCP in 1 week for BP recheck.","Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (5) glipizide 5mg twice daily before meals [helps release insulin]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
2291,"31 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 31-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2292,"US Abdomen: Liver 18cm, diffusely echogenic consistent with hepatic steatosis. GB wall thickening with stones, positive Murphy's sign. Spleen 16cm, splenomegaly.","Abdominal ultrasound results: The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The spleen is enlarged [splenomegaly].",Gastroenterology,Radiology Report,high
2293,Procedure: Laparoscopic appendectomy. Pt 68 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 68-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2294,"CBC: WBC 2.8 (L), Hgb 15.3 (N), Plt 353 (N).","Your blood count results: White blood cells are 2.8 (low, meaning your immune system may be weakened). Hemoglobin is normal at 15.3. Platelets are 353, which is normal.",Hematology,Lab Result,high
2295,CXR PA: Compression fracture T12. Right middle lobe atelectasis. Sternotomy wires intact. ET tube 3cm above carina. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The wires from prior heart surgery are intact. The breathing tube is in good position. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
2296,"27 y/o M with PMH of h/o TIA, HFrEF (EF 30%), admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on omeprazole 20mg AC breakfast, levothyroxine 75mcg daily on empty stomach, carvedilol 12.5mg BID, hydroxychloroquine 200mg BID. F/U nephrology in 1 week.","A 27-year-old man with a history of history of mini-stroke, and heart failure with weak pumping (30%) was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the kidney doctor in 1 week.",Nephrology,Discharge Summary,high
2297,"23 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 23-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2298,"63 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 63-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2299,"84 y/o M with PMH of RA on MTX, hypothyroidism, HLD, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Dulcolax 10mg QHS PRN, entresto 49/51mg BID. F/U PCP in 1 week.","A 84-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], underactive thyroid, and high cholesterol was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the primary care doctor in 1 week.",Cardiology,Discharge Summary,high
2300,"MRI Lumbar Spine: Multilevel degenerative disc disease. L4-L5 disc herniation with moderate bilateral foraminal stenosis. No compression fracture. Conus medullaris at L1, normal.","MRI of the lower back results: Multiple discs in the spine are showing wear and aging. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. No bones are broken or collapsed. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
2301,"48 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 48-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2302,"35 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 35-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
2303,"87 y/o M with PMH of BPH, COPD, hypothyroidism, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on atorvastatin 80mg QHS, Humalog per SSI, amlodipine 5mg daily, calcium + vitamin D 600/400 daily. F/U surgery in 2 weeks for drain removal.","A 87-year-old man with a history of enlarged prostate, chronic lung disease, and underactive thyroid was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
2304,"25 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 25-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2305,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
2306,"LFTs: AST 211 (H), ALT 53 (H), ALP 98, T.Bili 6.7 (H), Albumin 4.7.","Your liver blood test results: Liver enzymes (AST 211, ALT 53) are mildly elevated (normal is under 40). Bilirubin is high at 6.7 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.7.",Gastroenterology,Lab Result,high
2307,"LFTs: AST 378 (H), ALT 420 (H), ALP 155, T.Bili 1.8 (H), Albumin 2.3.","Your liver blood test results: Liver enzymes (AST 378, ALT 420) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.8. Albumin is low at 2.3 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
2308,"74 y/o M with PMH of OSA on CPAP, depression, asthma, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on metformin 1000mg BID, acetaminophen 650mg Q6H PRN. F/U PCP in 1 week.","A 74-year-old man with a history of sleep apnea [uses a breathing machine at night], depression, and asthma was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the primary care doctor in 1 week.",Infectious Disease,Discharge Summary,high
2309,Procedure: ERCP with sphincterotomy. Pt 86 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 86-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2310,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
2311,HbA1c: 12.1% (H). FBS: 310 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.1%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 310, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2312,CT Head without contrast: No mass effect. 4cm right subdural hematoma with 5mm midline shift. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
2313,"Thyroid panel: TSH 0.77 (N), Free T4 2.8.",Your thyroid test results: TSH is normal at 0.77. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
2314,MRI Lumbar Spine: No compression fracture. Central canal stenosis at L3-L4. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: No bones are broken or collapsed. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
2315,"Rx: Tab furosemide 40mg BID. Tab ferrous sulfate 325mg BID. Tab montelukast 10mg QHS. Do not stop abruptly, taper as directed Adv: smoking cessation, pulmonary rehab. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
2316,"42 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 42-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2317,"30 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 30-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2318,"81 y/o M with PMH of RA on MTX, PAD, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on clopidogrel 75mg daily, ciprofloxacin 500mg BID x 5 days, latanoprost 0.005% OU QHS, timolol 0.5% OU BID. F/U GI in 1 week.","A 81-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], and poor blood flow in the legs [peripheral artery disease] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up with the stomach doctor in 1 week.",Gastroenterology,Discharge Summary,high
2319,"Rx: Tab amlodipine 5mg daily. Tab ferrous sulfate 325mg BID. Tab Augmentin 875/125 BID x 7 days. Avoid grapefruit juice Adv: avoid alcohol, hepatotoxic drugs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Do not drink grapefruit juice as it interferes with this medication Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
2320,"US Abdomen: CBD 5mm, not dilated. Left kidney 8cm, cortical thinning consistent with CKD. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Spleen 11cm, normal. Pancreas unremarkable.","Abdominal ultrasound results: The bile duct is normal size [not blocked]. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The spleen is a normal size. The pancreas looks normal.",Gastroenterology,Radiology Report,high
2321,Procedure: TURP for BPH. Pt 88 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 88-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
2322,"BMP: Na 137 (N), K 6.5 (H), BUN 76, Cr 1.0 (N), Glucose 149.",Your blood chemistry results: Sodium is normal at 137. Potassium is dangerously high at 6.5 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is normal at 1.0. Blood sugar is 149 (high).,Nephrology,Lab Result,high
2323,"Thyroid panel: TSH 1.46 (N), Free T4 2.6.",Your thyroid test results: TSH is normal at 1.46. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
2324,"56 y/o F with PMH of HLD, CAD, BPH, Parkinson's disease, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on escitalopram 10mg daily, montelukast 10mg QHS, atorvastatin 40mg QHS, levothyroxine 75mcg daily on empty stomach, ferrous sulfate 325mg BID. F/U endocrine in 1 week.","A 56-year-old woman with a history of high cholesterol, coronary artery disease [heart artery blockages], enlarged prostate, and Parkinson's disease was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]; (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (5) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the hormone/diabetes doctor in 1 week.",Neurology,Discharge Summary,high
2325,HbA1c: 6.5% (H). FBS: 381 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.5%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 381, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
2326,"77 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 77-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2327,"Thyroid panel: TSH 3.37 (N), Free T4 2.5.",Your thyroid test results: TSH is normal at 3.37. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
2328,"54 y/o M with PMH of A-fib, s/p CABG, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on rosuvastatin 10mg QHS, metformin 1000mg BID, furosemide 40mg daily, methotrexate 15mg weekly. F/U PCP in 2 weeks.","A 54-year-old man with a history of irregular heartbeat [atrial fibrillation], and prior heart bypass surgery was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the primary care doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2329,Procedure: Laparoscopic appendectomy. Pt 77 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 77-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2330,"BMP: Na 134 (L), K 5.4 (H), BUN 66, Cr 2.3 (H), Glucose 220.","Your blood chemistry results: Sodium is low at 134 (normal 136-145), meaning too much water in your body. Potassium is high at 5.4 — needs monitoring. Creatinine is elevated at 2.3 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 220 (high).",Nephrology,Lab Result,high
2331,"37 y/o M with PMH of seizure disorder on Keppra, COPD, h/o CVA, hypothyroidism, ICD in situ, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on metoprolol succinate 50mg daily, empagliflozin 10mg daily, lisinopril 10mg daily, atorvastatin 80mg QHS, prednisone taper. F/U GI in 1 week.","A 37-year-old man with a history of seizure disorder [on Keppra], chronic lung disease, history of stroke, underactive thyroid, and implanted heart defibrillator was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (5) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the stomach doctor in 1 week.",Infectious Disease,Discharge Summary,high
2332,"78 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 78-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2333,"53 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 53-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2334,Rx: Tab carvedilol 12.5mg BID. Tab acetaminophen 650mg Q6H PRN. Adv: wound care with daily dressing changes. F/U INR in 3 days.,"Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
2335,"88 y/o F with PMH of s/p TKR, s/p CABG, DM2, hypothyroidism, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on timolol 0.5% OU BID, hydroxychloroquine 200mg BID, Eliquis 5mg BID, losartan 50mg daily. F/U surgery in 2 weeks for drain removal.","A 88-year-old woman with a history of prior knee replacement, prior heart bypass surgery, type 2 diabetes, and underactive thyroid was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) Eliquis 5mg twice daily [blood thinner]; (4) losartan 50mg once daily [blood pressure medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
2336,"59 y/o F with PMH of obesity (BMI 38), cirrhosis, osteoporosis, OA, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on glipizide 5mg BID AC, atorvastatin 80mg QHS. F/U surgery in 10 days.","A 59-year-old woman with a history of obesity, liver scarring [cirrhosis], weak bones [osteoporosis], and arthritis [osteoarthritis] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the surgeon in 10 days.",Nephrology,Discharge Summary,high
2337,"CBC: WBC 6.1 (N), Hgb 9.5 (L), Plt 102 (L).","Your blood count results: White blood cells are 6.1 (normal). Hemoglobin is low at 9.5, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 102, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
2338,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
2339,Procedure: TURP for BPH. Pt 35 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 35-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
2340,"28 y/o F with PMH of PAD, h/o TIA, COPD, BPH, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on metoprolol succinate 50mg daily, Humalog per SSI. F/U PCP in 1 week.","A 28-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], history of mini-stroke, chronic lung disease, and enlarged prostate was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the primary care doctor in 1 week.",Cardiology,Discharge Summary,high
2341,"MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. Conus medullaris at L1, normal. L5-S1 disc desiccation with mild bulge.","MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The spinal cord ends at a normal level. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
2342,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2343,"LFTs: AST 312 (H), ALT 525 (H), ALP 297, T.Bili 7.2 (H), Albumin 3.3.","Your liver blood test results: Liver enzymes (AST 312, ALT 525) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 7.2 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 3.3 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
2344,"Lipid panel: TC 184, LDL 120, HDL 75, TG 413.",Your cholesterol results: Total cholesterol is 184. LDL (bad cholesterol) is high at 120 (goal under 100). HDL (good cholesterol) is good at 75. Triglycerides are very high at 413 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
2345,"66 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 66-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2346,CT Head without contrast: No acute intracranial hemorrhage. No mass effect. Paranasal sinuses clear.,CT scan of the head results: There is no bleeding in the brain. There are no tumors or masses pushing on the brain. The sinuses are clear with no infection.,Neurology,Radiology Report,high
2347,"79 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 79-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2348,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab pregabalin 75mg BID. Adv: avoid alcohol, hepatotoxic drugs Adv: elevate affected limb, compression stockings. F/U 2 weeks with INR.",Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) pregabalin 75mg twice daily [nerve pain medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks for a blood thinner level check [INR].,Neurology,Prescription,medium
2349,"61 y/o M with PMH of GERD, RA on MTX, OA, s/p CABG, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Strict I&O, daily weights. D/C on acetaminophen 650mg Q6H PRN, atorvastatin 40mg QHS, furosemide 40mg BID, rosuvastatin 10mg QHS, metformin 500mg BID. F/U pulmonology in 2 weeks.","A 61-year-old man with a history of acid reflux, rheumatoid arthritis [on immune-suppressing medicine], arthritis [osteoarthritis], and prior heart bypass surgery was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]; (5) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the lung doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
2350,"Rx: Tab clopidogrel 75mg daily. prednisone taper. Avoid NSAIDs Adv: fall precautions, home safety evaluation. F/U 6 weeks with LFTs.","Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
2351,CXR PA: Increased interstitial markings suggesting pulmonary edema. Osseous structures intact. Cardiomegaly with CTR >0.5.,"Chest X-ray results: There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. The bones look normal with no fractures. The heart appears larger than normal.",Pulmonology,Radiology Report,high
2352,"Rx: Tab glipizide 5mg BID AC. Tab levothyroxine 75mcg daily on empty stomach. Adv: high fiber diet, adequate hydration Adv: low salt diet, fluid restriction 1.5L/day. F/U 6 weeks with LFTs.","Your medicines: (1) glipizide 5mg twice daily before meals [helps release insulin]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 6 weeks for liver function blood tests.",Endocrinology,Prescription,medium
2353,"Lipid panel: TC 258, LDL 108, HDL 52, TG 273.",Your cholesterol results: Total cholesterol is 258. LDL (bad cholesterol) is high at 108 (goal under 100). HDL (good cholesterol) is good at 52. Triglycerides are high at 273.,Cardiology,Lab Result,high
2354,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2355,"Rx: Tab metoprolol 25mg BID. Tab potassium chloride 20mEq daily. Tab Augmentin 875/125 BID x 7 days. Tab carvedilol 12.5mg BID. Tab warfarin 5mg daily. Adv: low potassium diet Adv: high fiber diet, adequate hydration. F/U INR in 3 days.","Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. (4) carvedilol 12.5mg twice daily [heart medicine]. (5) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
2356,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,medium
2357,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab spironolactone 25mg daily. Adv: high fiber diet, adequate hydration Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) spironolactone 25mg once daily [heart-protecting water pill]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
2358,"Rx: prednisone taper. Tab calcium + vitamin D 600/400 daily. Tab methotrexate 15mg weekly. Tab montelukast 10mg QHS. Tab furosemide 40mg daily. Adv: fall precautions, home safety evaluation. F/U 2 weeks.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) calcium plus vitamin D once daily [bone strengthening]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (4) montelukast 10mg at bedtime [asthma/allergy medicine]. (5) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back for a check-up in 2 weeks.",Rheumatology,Prescription,high
2359,HbA1c: 8.0% (H). FBS: 354 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.0%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 354, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
2360,"76 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 76-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2361,CXR PA: ET tube 3cm above carina. NG tube tip in stomach. Hyperinflated lungs consistent with COPD.,"Chest X-ray results: The breathing tube is in good position. The feeding/drainage tube tip is correctly positioned in the stomach. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema].",Pulmonology,Radiology Report,high
2362,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. Acute ischemic infarct in R MCA territory. No midline shift.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The brain is centered normally.",Neurology,Radiology Report,high
2363,"79 y/o F with PMH of HFpEF, DM1, A-fib, s/p CABG, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on omeprazole 20mg AC breakfast, ciprofloxacin 500mg BID x 5 days, tramadol 50mg Q6H PRN pain, furosemide 40mg BID. F/U neurology in 2 weeks.","A 79-year-old woman with a history of heart failure with stiff heart muscle, type 1 diabetes, irregular heartbeat [atrial fibrillation], and prior heart bypass surgery was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (4) furosemide (Lasix) 40mg twice daily [water pill]. Follow-up with the brain/nerve doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2364,Procedure: ORIF L distal radius. Pt 80 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 80-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2365,"Thyroid panel: TSH 14.94 (H), Free T4 0.4.","Your thyroid test results: TSH is elevated at 14.94 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is low — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2366,CXR PA: Right lower lobe consolidation. Widened mediastinum. ET tube 3cm above carina. Moderate right pleural effusion. Mild cardiomegaly.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. The space between the lungs appears wider than normal, which needs further evaluation. The breathing tube is in good position. There is a moderate amount of fluid around the right lung. The heart is slightly larger than normal.",Pulmonology,Radiology Report,high
2367,"30 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 30-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2368,"86 y/o M with PMH of BPH, s/p CABG, ESRD on HD, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on albuterol MDI 2 puffs Q4-6H PRN, omeprazole 20mg AC breakfast, Spiriva 18mcg daily. F/U wound care in 3 days.","A 86-year-old man with a history of enlarged prostate, prior heart bypass surgery, and kidney failure requiring dialysis was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up at the wound care clinic in 3 days.",General Surgery,Discharge Summary,high
2369,"Rx: Tab timolol 0.5% OU BID. Tab gabapentin 300mg TID. Tab Eliquis 5mg BID. Tab escitalopram 10mg daily. Tab carvedilol 12.5mg BID. Adv: elevate affected limb, compression stockings Adv: wound care with daily dressing changes. F/U 6 weeks with LFTs.","Your medicines: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (3) Eliquis 5mg twice daily [blood thinner]. (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (5) carvedilol 12.5mg twice daily [heart medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
2370,"89 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 89-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2371,Rx: Tab lisinopril 20mg daily. Tab Augmentin 875/125 BID x 7 days. Avoid grapefruit juice. F/U INR in 3 days.,Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. Do not drink grapefruit juice as it interferes with this medication. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,medium
2372,"29 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 29-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2373,"CBC: WBC 18.2 (H), Hgb 12.2 (N), Plt 116 (L).","Your blood count results: White blood cells are 18.2 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 12.2. Platelets are 116, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
2374,Rx: Tab sertraline 50mg daily. Tab pregabalin 75mg BID. prednisone taper. Tab azithromycin 500mg day 1 then 250mg x 4 days. Avoid grapefruit juice. F/U 1 month with repeat imaging.,"Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Do not drink grapefruit juice as it interferes with this medication. Come back in 1 month — a repeat scan will be ordered.",Neurology,Prescription,high
2375,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2376,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. C5-C6 disc herniation with cord compression. No compression fracture.,"MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
2377,"Rx: Tab ferrous sulfate 325mg BID. Tab spironolactone 25mg daily. Tab carvedilol 12.5mg BID. Tab metformin 500mg BID. Adv: smoking cessation, pulmonary rehab Adv: wound care with daily dressing changes. F/U 2 weeks.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) carvedilol 12.5mg twice daily [heart medicine]. (4) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
2378,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Acute ischemic infarct in R MCA territory. 4cm right subdural hematoma with 5mm midline shift. Paranasal sinuses clear. No acute intracranial hemorrhage.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. The sinuses are clear with no infection. There is no bleeding in the brain.",Neurology,Radiology Report,high
2379,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. No midline shift. No acute intracranial hemorrhage.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. The brain is centered normally. There is no bleeding in the brain.",Neurology,Radiology Report,high
2380,"38 y/o M with PMH of asthma, s/p THR, depression, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Compression stockings when ambulating. D/C on glipizide 5mg BID AC, ibuprofen 400mg Q6H PRN with food, metoprolol succinate 50mg daily, potassium chloride 20mEq daily. F/U pulmonology in 2 weeks.","A 38-year-old man with a history of asthma, prior hip replacement, and depression was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the lung doctor in 2 weeks.",Psychiatry,Discharge Summary,high
2381,"35 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 35-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2382,Procedure: EGD with biopsy. Pt 78 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 78-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2383,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab lisinopril 10mg daily. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
2384,CXR PA: Right lower lobe consolidation. Increased interstitial markings suggesting pulmonary edema. Patchy bilateral infiltrates.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There are scattered cloudy patches in both lungs suggesting infection or inflammation.",Pulmonology,Radiology Report,high
2385,"88 y/o F with PMH of h/o TIA, DM1, RA on MTX, GERD, cirrhosis, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on amlodipine 10mg daily, metformin 500mg BID. F/U cardiology in 2 weeks.","A 88-year-old woman with a history of history of mini-stroke, type 1 diabetes, rheumatoid arthritis [on immune-suppressing medicine], acid reflux, and liver scarring [cirrhosis] was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the heart doctor in 2 weeks.",Pulmonology,Discharge Summary,high
2386,"85 y/o F with PMH of SLE, Parkinson's disease, s/p CABG, gout, HFpEF, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on atorvastatin 40mg QHS, metformin 1000mg BID, pregabalin 75mg BID, omeprazole 20mg AC breakfast. F/U oncology in 1 week.","A 85-year-old woman with a history of lupus, Parkinson's disease, prior heart bypass surgery, gout, and heart failure with stiff heart muscle was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) pregabalin 75mg twice daily [nerve pain medicine]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the cancer doctor in 1 week.",General Surgery,Discharge Summary,high
2387,"BMP: Na 130 (L), K 5.5 (H), BUN 84, Cr 4.4 (H), Glucose 390.","Your blood chemistry results: Sodium is low at 130 (normal 136-145), meaning too much water in your body. Potassium is high at 5.5 — needs monitoring. Creatinine is elevated at 4.4 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 390 (high).",Nephrology,Lab Result,high
2388,Rx: Tab clopidogrel 75mg daily. Tab potassium chloride 20mEq daily. Spiriva 18mcg daily. Adv: wound care with daily dressing changes. F/U INR in 3 days.,"Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) Spiriva inhaler once daily [long-acting lung medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
2389,"Thyroid panel: TSH 11.51 (H), Free T4 2.9.","Your thyroid test results: TSH is elevated at 11.51 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2390,"52 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 52-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2391,"Rx: Tab lisinopril 20mg daily. Tab losartan 50mg daily. Adv: low potassium diet Adv: wound care with daily dressing changes. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) losartan 50mg once daily [blood pressure medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
2392,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
2393,"US Abdomen: Spleen 16cm, splenomegaly. CBD 12mm, dilated. Simple renal cysts bilaterally.","Abdominal ultrasound results: The spleen is enlarged [splenomegaly]. The bile duct is wider than normal [dilated], which may indicate a blockage. Both kidneys have harmless fluid-filled cysts.",Gastroenterology,Radiology Report,high
2394,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2395,"US Abdomen: Right kidney 10.5cm, no hydronephrosis. GB wall thickening with stones, positive Murphy's sign. Moderate right hydronephrosis. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: Right kidney is normal size with no blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
2396,"BMP: Na 125 (L), K 3.9 (N), BUN 9, Cr 3.3 (H), Glucose 124.","Your blood chemistry results: Sodium is low at 125 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.9. Creatinine is elevated at 3.3 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 124 (high).",Nephrology,Lab Result,high
2397,"38 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 38-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2398,"88 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 88-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2399,"26 y/o F with PMH of SLE, PPM in situ, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on Spiriva 18mcg daily, levothyroxine 75mcg daily on empty stomach. F/U surgery in 2 weeks for drain removal.","A 26-year-old woman with a history of lupus, and implanted pacemaker was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",General Surgery,Discharge Summary,high
2400,"MRI Lumbar Spine: Multilevel degenerative disc disease. Facet joint hypertrophy at L4-L5. Conus medullaris at L1, normal.",MRI of the lower back results: Multiple discs in the spine are showing wear and aging. The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal cord ends at a normal level.,Orthopedics,Radiology Report,high
2401,"Rx: Lantus 20U QHS. Tab clopidogrel 75mg daily. Tab pantoprazole 40mg AC breakfast. Tab pregabalin 75mg BID. Adv: smoking cessation, pulmonary rehab Adv: fall precautions, home safety evaluation. F/U 2 weeks.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. (4) pregabalin 75mg twice daily [nerve pain medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
2402,"82 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 82-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2403,"Rx: prednisone taper. Tab hydroxychloroquine 200mg BID. Tab calcium + vitamin D 600/400 daily. Tab methotrexate 15mg weekly. Adv: smoking cessation, pulmonary rehab. F/U 1 month with repeat imaging.",Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) calcium plus vitamin D once daily [bone strengthening]. (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 month — a repeat scan will be ordered.,Rheumatology,Prescription,high
2404,"74 y/o M with PMH of h/o CVA, anemia, CKD Stage 4, h/o TIA, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on escitalopram 10mg daily, amoxicillin 500mg TID x 10 days, warfarin 5mg daily. F/U surgery in 10 days.","A 74-year-old man with a history of history of stroke, low blood count [anemia], advanced kidney disease, and history of mini-stroke was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
2405,"BMP: Na 122 (L), K 3.7 (N), BUN 63, Cr 2.8 (H), Glucose 301.","Your blood chemistry results: Sodium is low at 122 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.7. Creatinine is elevated at 2.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 301 (high).",Nephrology,Lab Result,high
2406,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. Subarachnoid hemorrhage in bilateral sylvian fissures. No acute intracranial hemorrhage.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There is bleeding around the brain surface, particularly in the grooves on both sides. There is no bleeding in the brain.",Neurology,Radiology Report,high
2407,Procedure: ORIF L distal radius. Pt 65 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 65-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2408,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,low
2409,"Lipid panel: TC 171, LDL 156, HDL 67, TG 475.",Your cholesterol results: Total cholesterol is 171. LDL (bad cholesterol) is high at 156 (goal under 100). HDL (good cholesterol) is good at 67. Triglycerides are very high at 475 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
2410,Procedure: PCI with DES to LAD. Pt 77 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 77-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
2411,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2412,CXR PA: Small left pleural effusion. No cardiomegaly. Widened mediastinum. Pacemaker leads in appropriate position.,"Chest X-ray results: There is a small amount of fluid around the left lung. The heart is a normal size. The space between the lungs appears wider than normal, which needs further evaluation. The pacemaker wires are in the correct position.",Pulmonology,Radiology Report,high
2413,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab spironolactone 25mg daily. Adv: weight bearing exercise, calcium/vit D supplementation Avoid NSAIDs. F/U PCP in 1 week for BP recheck.","Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) spironolactone 25mg once daily [heart-protecting water pill]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
2414,Procedure: ORIF L distal radius. Pt 50 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 50-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2415,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Acute ischemic infarct in R MCA territory. Chronic lacunar infarcts in bilateral basal ganglia. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are signs of small old strokes in the deep parts of the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
2416,Procedure: ERCP with sphincterotomy. Pt 40 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 40-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2417,"74 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 74-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2418,"89 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 89-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2419,Rx: Tab latanoprost 0.005% OU QHS. Tab hydroxychloroquine 200mg BID. Tab metformin 1000mg BID. albuterol MDI 2 puffs Q4-6H PRN. Avoid NSAIDs. F/U 2 weeks.,Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back for a check-up in 2 weeks.,Pulmonology,Prescription,high
2420,"LFTs: AST 309 (H), ALT 39 (N), ALP 48, T.Bili 1.1 (N), Albumin 3.4.","Your liver blood test results: Liver enzymes (AST 309, ALT 39) are normal (normal is under 40). Bilirubin is normal at 1.1. Albumin is low at 3.4 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
2421,"35 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 35-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2422,"88 y/o F with PMH of HLD, s/p CABG, COPD, ICD in situ, h/o CVA, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on tramadol 50mg Q6H PRN pain, metoprolol succinate 50mg daily, lisinopril 10mg daily, warfarin 5mg daily. F/U orthopedics in 6 weeks with X-ray.","A 88-year-old woman with a history of high cholesterol, prior heart bypass surgery, chronic lung disease, implanted heart defibrillator, and history of stroke was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Orthopedics,Discharge Summary,high
2423,"61 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 61-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2424,"Lipid panel: TC 304, LDL 182, HDL 21, TG 396.","Your cholesterol results: Total cholesterol is 304. LDL (bad cholesterol) is very high at 182 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is too low at 21 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 396 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
2425,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2426,"70 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 70-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
2427,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,low
2428,"71 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 71-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2429,"80 y/o M with PMH of HLD, cirrhosis, gout, SLE, OA, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on sertraline 50mg daily, Xarelto 20mg daily with dinner, montelukast 10mg QHS, ondansetron 4mg Q8H PRN N/V, lisinopril 10mg daily. F/U nephrology in 1 week.","A 80-year-old man with a history of high cholesterol, liver scarring [cirrhosis], gout, lupus, and arthritis [osteoarthritis] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]; (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the kidney doctor in 1 week.",Pulmonology,Discharge Summary,high
2430,Procedure: R TKA. Pt 58 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 58-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2431,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. 4cm right subdural hematoma with 5mm midline shift. No mass effect.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
2432,"Rx: Lantus 20U QHS. Tab lisinopril 10mg daily. Tab acetaminophen 650mg Q6H PRN. prednisone taper. Tab lisinopril 20mg daily. Adv: low salt low sugar diet, regular exercise. F/U 1 week with wound check.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (5) lisinopril 20mg once daily [blood pressure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
2433,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
2434,"US Abdomen: Moderate right hydronephrosis. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Left kidney 8cm, cortical thinning consistent with CKD. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
2435,"75 y/o F with PMH of anxiety, hypothyroidism, s/p TKR, HLD, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on furosemide 40mg daily, Eliquis 5mg BID, ibuprofen 400mg Q6H PRN with food, metformin 500mg BID. F/U GI in 1 week.","A 75-year-old woman with a history of anxiety, underactive thyroid, prior knee replacement, and high cholesterol was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (2) Eliquis 5mg twice daily [blood thinner]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
2436,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
2437,Procedure: EGD with biopsy. Pt 62 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 62-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2438,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
2439,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Subarachnoid hemorrhage in bilateral sylvian fissures. No mass effect. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There is bleeding around the brain surface, particularly in the grooves on both sides. There are no tumors or masses pushing on the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
2440,"Rx: Tab atorvastatin 40mg QHS. Tab furosemide 40mg BID. Tab calcium + vitamin D 600/400 daily. Adv: DASH diet, daily BP monitoring Adv: avoid alcohol, hepatotoxic drugs. F/U 1 week with CBC, CMP.","Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) calcium plus vitamin D once daily [bone strengthening]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,medium
2441,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. No midline shift. Paranasal sinuses clear. Mild generalized cerebral atrophy appropriate for age. No acute intracranial hemorrhage.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. The brain is centered normally. The sinuses are clear with no infection. There is mild brain shrinkage, which is normal for your age. There is no bleeding in the brain.",Neurology,Radiology Report,high
2442,"BMP: Na 123 (L), K 6.3 (H), BUN 34, Cr 4.5 (H), Glucose 220.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.3 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 4.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 220 (high).",Nephrology,Lab Result,high
2443,"Rx: Tab atorvastatin 40mg QHS. Tab montelukast 10mg QHS. Adv: smoking cessation, pulmonary rehab. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
2444,HbA1c: 5.3% (N). FBS: 264 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.3%, which is normal — you do not have diabetes. Fasting blood sugar was 264, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
2445,"64 y/o F with PMH of OA, Parkinson's disease, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on ibuprofen 400mg Q6H PRN with food, albuterol MDI 2 puffs Q4-6H PRN, warfarin 5mg daily, metoprolol succinate 50mg daily, atorvastatin 40mg QHS. F/U pulmonology in 2 weeks.","A 64-year-old woman with a history of arthritis [osteoarthritis], and Parkinson's disease was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (5) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the lung doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2446,"63 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 63-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
2447,Procedure: PCI with DES to LAD. Pt 52 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 52-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
2448,"64 y/o M with PMH of h/o CVA, ICD in situ, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on ondansetron 4mg Q8H PRN N/V, Dulcolax 10mg QHS PRN, Humalog per SSI. F/U neurology in 2 weeks.","A 64-year-old man with a history of history of stroke, and implanted heart defibrillator was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
2449,"Rx: Tab gabapentin 300mg TID. Tab ferrous sulfate 325mg BID. Tab carvedilol 12.5mg BID. Avoid NSAIDs Adv: DASH diet, daily BP monitoring. F/U INR in 3 days.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) carvedilol 12.5mg twice daily [heart medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
2450,"Rx: Tab metoprolol succinate 50mg daily. Tab timolol 0.5% OU BID. Avoid NSAIDs. F/U 1 week with CBC, CMP.",Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,medium
2451,MRI Lumbar Spine: Central canal stenosis at L3-L4. L5-S1 disc desiccation with mild bulge. Multilevel degenerative disc disease. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. Multiple discs in the spine are showing wear and aging. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
2452,"56 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 56-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2453,"BMP: Na 136 (N), K 6.3 (H), BUN 11, Cr 3.2 (H), Glucose 366.","Your blood chemistry results: Sodium is normal at 136. Potassium is dangerously high at 6.3 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 3.2 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 366 (high).",Nephrology,Lab Result,high
2454,CXR PA: Clear lung fields bilaterally. NG tube tip in stomach. Compression fracture T12. No pneumothorax. Right-sided pneumothorax.,Chest X-ray results: Both lungs look clear with no problems. The feeding/drainage tube tip is correctly positioned in the stomach. There is a compression fracture [collapsed bone] in the lower spine at T12. There is no collapsed lung. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax].,Pulmonology,Radiology Report,high
2455,"Rx: Tab atorvastatin 80mg QHS. Tab spironolactone 25mg daily. Tab pregabalin 75mg BID. Adv: elevate affected limb, compression stockings. F/U 2 weeks.",Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) pregabalin 75mg twice daily [nerve pain medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
2456,"BMP: Na 120 (L), K 4.7 (N), BUN 15, Cr 7.8 (H), Glucose 207.","Your blood chemistry results: Sodium is low at 120 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.7. Creatinine is elevated at 7.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 207 (high).",Nephrology,Lab Result,high
2457,HbA1c: 4.9% (N). FBS: 128 mg/dL (H).,"Your diabetes blood test results: HbA1c is 4.9%, which is normal — you do not have diabetes. Fasting blood sugar was 128, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
2458,"US Abdomen: No focal hepatic lesion. CBD 12mm, dilated. Spleen 16cm, splenomegaly. Ascites moderate amount.","Abdominal ultrasound results: No tumors or masses were found in the liver. The bile duct is wider than normal [dilated], which may indicate a blockage. The spleen is enlarged [splenomegaly]. There is a moderate amount of fluid in the belly [ascites].",Gastroenterology,Radiology Report,high
2459,"Lipid panel: TC 161, LDL 63, HDL 26, TG 154.","Your cholesterol results: Total cholesterol is 161. LDL (bad cholesterol) is at goal (63). HDL (good cholesterol) is too low at 26 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are high at 154.",Cardiology,Lab Result,high
2460,"32 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 32-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2461,HbA1c: 7.8% (H). FBS: 330 mg/dL (H).,"Your diabetes blood test results: HbA1c is 7.8%, which is above the target of 7.0%. Your blood sugar has been somewhat poorly controlled over the past 3 months. Fasting blood sugar was 330, which is high (normal is 70-100). Your diabetes medicines may need adjustment. Discuss with your doctor.",Endocrinology,Lab Result,high
2462,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,high
2463,"LFTs: AST 230 (H), ALT 278 (H), ALP 204, T.Bili 0.6 (N), Albumin 3.6.","Your liver blood test results: Liver enzymes (AST 230, ALT 278) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is normal at 0.6. Albumin is normal at 3.6.",Gastroenterology,Lab Result,high
2464,"91 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 91-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2465,"72 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 72-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2466,"Lipid panel: TC 174, LDL 158, HDL 44, TG 80.",Your cholesterol results: Total cholesterol is 174. LDL (bad cholesterol) is high at 158 (goal under 100). HDL (good cholesterol) is good at 44. Triglycerides are normal at 80.,Cardiology,Lab Result,high
2467,"MRI Lumbar Spine: Conus medullaris at L1, normal. C5-C6 disc herniation with cord compression.","MRI of the lower back results: The spinal cord ends at a normal level. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
2468,"LFTs: AST 86 (H), ALT 569 (H), ALP 234, T.Bili 3.7 (H), Albumin 3.8.","Your liver blood test results: Liver enzymes (AST 86, ALT 569) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 3.7 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.8.",Gastroenterology,Lab Result,high
2469,HbA1c: 13.5% (H). FBS: 357 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.5%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 357, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2470,"30 y/o M with PMH of CKD Stage 4, SLE, ESRD on HD, BPH, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on gabapentin 300mg TID, empagliflozin 10mg daily, amoxicillin 500mg TID x 10 days. F/U PCP in 1 week.","A 30-year-old man with a history of advanced kidney disease, lupus, kidney failure requiring dialysis, and enlarged prostate was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the primary care doctor in 1 week.",Hematology,Discharge Summary,high
2471,Procedure: Laparoscopic appendectomy. Pt 79 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 79-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2472,"30 y/o M with PMH of RA on MTX, PAD, HFpEF, PPM in situ, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on omeprazole 20mg AC breakfast, ibuprofen 400mg Q6H PRN with food, atorvastatin 80mg QHS, warfarin 5mg daily. F/U INR check in 3 days.","A 30-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], poor blood flow in the legs [peripheral artery disease], heart failure with stiff heart muscle, and implanted pacemaker was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up for a blood thinner level check in 3 days.",Pulmonology,Discharge Summary,high
2473,"Rx: Tab pregabalin 75mg BID. Tab furosemide 40mg BID. prednisone taper. Adv: smoking cessation, pulmonary rehab. F/U PCP in 1 week for BP recheck.",Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
2474,"Rx: Tab pregabalin 75mg BID. Tab metoprolol succinate 50mg daily. Adv: fall precautions, home safety evaluation. F/U 6 weeks with LFTs.","Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
2475,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. No compression fracture. Multilevel degenerative disc disease.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. No bones are broken or collapsed. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
2476,"81 y/o F with PMH of CAD, CHF, s/p TKR, anxiety, osteoporosis, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on latanoprost 0.005% OU QHS, furosemide 40mg BID, metformin 500mg BID, metoprolol succinate 50mg daily, Augmentin 875/125 BID x 7 days. F/U surgery in 10 days.","A 81-year-old woman with a history of coronary artery disease [heart artery blockages], heart failure, prior knee replacement, anxiety, and weak bones [osteoporosis] was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) furosemide (Lasix) 40mg twice daily [water pill]; (3) metformin 500mg twice daily with meals [blood sugar medicine]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (5) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the surgeon in 10 days.",Pulmonology,Discharge Summary,high
2477,"MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. Central canal stenosis at L3-L4. Conus medullaris at L1, normal. Multilevel degenerative disc disease.","MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. The spinal cord ends at a normal level. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
2478,"37 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 37-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2479,"88 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 88-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2480,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. Pancreas unremarkable. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. GB sludge, no stones. Left kidney 8cm, cortical thinning consistent with CKD.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The pancreas looks normal. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The gallbladder contains thickened bile [sludge] but no stones. Left kidney is small with thin outer layer, consistent with chronic kidney disease.",Gastroenterology,Radiology Report,high
2481,CT Head without contrast: No midline shift. Mild generalized cerebral atrophy appropriate for age. Paranasal sinuses clear.,"CT scan of the head results: The brain is centered normally. There is mild brain shrinkage, which is normal for your age. The sinuses are clear with no infection.",Neurology,Radiology Report,high
2482,"Rx: Tab Eliquis 5mg BID. Tab carvedilol 12.5mg BID. Tab metformin 500mg BID. Adv: DASH diet, daily BP monitoring Adv: SMBG BID, diabetic diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Eliquis 5mg twice daily [blood thinner]. (2) carvedilol 12.5mg twice daily [heart medicine]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
2483,"40 y/o F with PMH of h/o CVA, DM1, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on metoprolol 25mg BID, metformin 1000mg BID, azithromycin 500mg day 1 then 250mg x 4 days. F/U PCP in 1 week.","A 40-year-old woman with a history of history of stroke, and type 1 diabetes was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the primary care doctor in 1 week.",Nephrology,Discharge Summary,high
2484,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
2485,"37 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 37-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2486,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
2487,CT Head without contrast: No mass effect. Mild generalized cerebral atrophy appropriate for age. No midline shift.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is mild brain shrinkage, which is normal for your age. The brain is centered normally.",Neurology,Radiology Report,high
2488,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
2489,"82 y/o F with PMH of depression, RA on MTX, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on potassium chloride 20mEq daily, pregabalin 75mg BID, losartan 50mg daily, ibuprofen 400mg Q6H PRN with food. F/U nephrology in 1 week.","A 82-year-old woman with a history of depression, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) losartan 50mg once daily [blood pressure medicine]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the kidney doctor in 1 week.",Urology,Discharge Summary,high
2490,"91 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 91-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2491,"54 y/o M with PMH of depression, BPH, ICD in situ, s/p CABG, PPM in situ, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on spironolactone 25mg daily, gabapentin 300mg TID, metformin 1000mg BID. F/U PCP in 2 weeks.","A 54-year-old man with a history of depression, enlarged prostate, implanted heart defibrillator, prior heart bypass surgery, and implanted pacemaker was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the primary care doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2492,CXR PA: No cardiomegaly. Bilateral hilar lymphadenopathy. Port-a-cath in appropriate position. Moderate right pleural effusion. Mild cardiomegaly.,"Chest X-ray results: The heart is a normal size. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The implanted medication port is in the correct position. There is a moderate amount of fluid around the right lung. The heart is slightly larger than normal.",Pulmonology,Radiology Report,high
2493,"Rx: Tab escitalopram 10mg daily. Tab losartan 50mg daily. Tab furosemide 40mg BID. Spiriva 18mcg daily. Avoid NSAIDs. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) losartan 50mg once daily [blood pressure medicine]. (3) furosemide (Lasix) 40mg twice daily [water pill]. (4) Spiriva inhaler once daily [long-acting lung medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
2494,"US Abdomen: CBD 12mm, dilated. Spleen 16cm, splenomegaly. Simple renal cysts bilaterally. No focal hepatic lesion. Right kidney 10.5cm, no hydronephrosis.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. The spleen is enlarged [splenomegaly]. Both kidneys have harmless fluid-filled cysts. No tumors or masses were found in the liver. Right kidney is normal size with no blockage.",Gastroenterology,Radiology Report,high
2495,CXR PA: Osseous structures intact. Elevated left hemidiaphragm. Patchy bilateral infiltrates. Cardiomegaly with CTR >0.5. Left lower lobe consolidation.,Chest X-ray results: The bones look normal with no fractures. The left side of the breathing muscle [diaphragm] is sitting higher than normal. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The heart appears larger than normal. There is an area in the lower left lung that appears infected.,Pulmonology,Radiology Report,high
2496,Procedure: EGD with biopsy. Pt 50 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 50-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2497,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2498,"46 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 46-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2499,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. Central canal stenosis at L3-L4. L4-L5 disc herniation with moderate bilateral foraminal stenosis. C5-C6 disc herniation with cord compression.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
2500,HbA1c: 7.1% (H). FBS: 287 mg/dL (H).,"Your diabetes blood test results: HbA1c is 7.1%, which is above the target of 7.0%. Your blood sugar has been somewhat poorly controlled over the past 3 months. Fasting blood sugar was 287, which is high (normal is 70-100). Your diabetes medicines may need adjustment. Discuss with your doctor.",Endocrinology,Lab Result,high
2501,"61 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 61-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2502,HbA1c: 12.7% (H). FBS: 156 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.7%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 156, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2503,HbA1c: 6.1% (H). FBS: 147 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.1%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 147, which is high (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,high
2504,"BMP: Na 125 (L), K 4.4 (N), BUN 9, Cr 4.3 (H), Glucose 319.","Your blood chemistry results: Sodium is low at 125 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.4. Creatinine is elevated at 4.3 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 319 (high).",Nephrology,Lab Result,high
2505,"85 y/o M with PMH of OA, s/p CABG, gout, s/p THR, HLD, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on Xarelto 20mg daily with dinner, pregabalin 75mg BID, rosuvastatin 10mg QHS. F/U nephrology in 1 week.","A 85-year-old man with a history of arthritis [osteoarthritis], prior heart bypass surgery, gout, prior hip replacement, and high cholesterol was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the kidney doctor in 1 week.",Pulmonology,Discharge Summary,high
2506,"69 y/o F with PMH of s/p CABG, DVT/PE on warfarin, COPD, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on clopidogrel 75mg daily, sertraline 50mg daily. F/U surgery in 2 weeks for drain removal.","A 69-year-old woman with a history of prior heart bypass surgery, blood clots [on blood thinner warfarin], and chronic lung disease was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Orthopedics,Discharge Summary,high
2507,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
2508,"35 y/o M with PMH of cirrhosis, GERD, PAD, COPD, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on montelukast 10mg QHS, azithromycin 500mg day 1 then 250mg x 4 days, entresto 49/51mg BID, Augmentin 875/125 BID x 7 days, ASA 81mg daily. F/U hematology in 2 weeks.","A 35-year-old man with a history of liver scarring [cirrhosis], acid reflux, poor blood flow in the legs [peripheral artery disease], and chronic lung disease was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) Entresto 49/51mg twice daily [heart failure medicine]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]; (5) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
2509,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
2510,"77 y/o F with PMH of GERD, HLD, h/o TIA, DM1, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Low potassium diet. D/C on atorvastatin 40mg QHS, gabapentin 300mg TID, metformin 500mg BID, Augmentin 875/125 BID x 7 days, entresto 49/51mg BID. F/U hematology in 2 weeks.","A 77-year-old woman with a history of acid reflux, high cholesterol, history of mini-stroke, and type 1 diabetes was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) metformin 500mg twice daily with meals [blood sugar medicine]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]; (5) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
2511,"54 y/o F with PMH of hypothyroidism, HTN, DVT/PE on warfarin, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on acetaminophen 650mg Q6H PRN, montelukast 10mg QHS. F/U pulmonology in 2 weeks.","A 54-year-old woman with a history of underactive thyroid, high blood pressure, and blood clots [on blood thinner warfarin] was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the lung doctor in 2 weeks.",Endocrinology,Discharge Summary,high
2512,"Rx: Tab gabapentin 300mg TID. Tab entresto 49/51mg BID. Tab empagliflozin 10mg daily. Tab acetaminophen 650mg Q6H PRN. Tab omeprazole 20mg AC breakfast. Adv: SMBG BID, diabetic diet. F/U 2 weeks.",Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (5) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back for a check-up in 2 weeks.,Cardiology,Prescription,high
2513,HbA1c: 5.9% (H). FBS: 78 mg/dL (N).,"Your diabetes blood test results: HbA1c is 5.9%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 78, which is normal (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,medium
2514,CXR PA: NG tube tip in stomach. Clear lung fields bilaterally. Right middle lobe atelectasis. Pacemaker leads in appropriate position.,"Chest X-ray results: The feeding/drainage tube tip is correctly positioned in the stomach. Both lungs look clear with no problems. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The pacemaker wires are in the correct position.",Pulmonology,Radiology Report,high
2515,Procedure: PCI with DES to LAD. Pt 51 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 51-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
2516,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
2517,CXR PA: Cardiomegaly with CTR >0.5. Patchy bilateral infiltrates. Widened mediastinum. ET tube 3cm above carina.,"Chest X-ray results: The heart appears larger than normal. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The space between the lungs appears wider than normal, which needs further evaluation. The breathing tube is in good position.",Pulmonology,Radiology Report,high
2518,CT Head without contrast: Acute ischemic infarct in R MCA territory. Subarachnoid hemorrhage in bilateral sylvian fissures. No midline shift.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is bleeding around the brain surface, particularly in the grooves on both sides. The brain is centered normally.",Neurology,Radiology Report,high
2519,"63 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 63-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2520,CT Head without contrast: Paranasal sinuses clear. No mass effect. No acute intracranial hemorrhage. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: The sinuses are clear with no infection. There are no tumors or masses pushing on the brain. There is no bleeding in the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
2521,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Paranasal sinuses clear. Acute ischemic infarct in R MCA territory. No acute intracranial hemorrhage.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The sinuses are clear with no infection. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is no bleeding in the brain.",Neurology,Radiology Report,high
2522,HbA1c: 12.3% (H). FBS: 74 mg/dL (N).,"Your diabetes blood test results: HbA1c is 12.3%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 74, which is normal (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2523,"72 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 72-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2524,"Rx: Tab Eliquis 5mg BID. Tab Augmentin 875/125 BID x 7 days. Tab tramadol 50mg Q6H PRN pain. Tab empagliflozin 10mg daily. Adv: SMBG BID, diabetic diet Adv: weight bearing exercise, calcium/vit D supplementation. F/U 6 weeks with LFTs.","Your medicines: (1) Eliquis 5mg twice daily [blood thinner]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 6 weeks for liver function blood tests.",Endocrinology,Prescription,high
2525,"76 y/o F with PMH of ICD in situ, OA, obesity (BMI 38), Parkinson's disease, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Strict I&O, daily weights. D/C on sertraline 50mg daily, escitalopram 10mg daily, furosemide 40mg BID, rosuvastatin 10mg QHS, methotrexate 15mg weekly. F/U wound care in 3 days.","A 76-year-old woman with a history of implanted heart defibrillator, arthritis [osteoarthritis], obesity, and Parkinson's disease was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]; (5) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up at the wound care clinic in 3 days.",Neurology,Discharge Summary,high
2526,CXR PA: Hyperinflated lungs consistent with COPD. Widened mediastinum. Mild cardiomegaly. Moderate right pleural effusion.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The space between the lungs appears wider than normal, which needs further evaluation. The heart is slightly larger than normal. There is a moderate amount of fluid around the right lung.",Pulmonology,Radiology Report,high
2527,"Rx: Tab potassium chloride 20mEq daily. Tab ondansetron 4mg Q8H PRN N/V. Tab glipizide 5mg BID AC. Do not stop abruptly, taper as directed. F/U 1 month with repeat imaging.",Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (3) glipizide 5mg twice daily before meals [helps release insulin]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 month — a repeat scan will be ordered.,General,Prescription,medium
2528,"Rx: Tab ferrous sulfate 325mg BID. Tab hydroxychloroquine 200mg BID. Tab amlodipine 5mg daily. Tab Eliquis 5mg BID. Adv: low salt diet, fluid restriction 1.5L/day Adv: weight bearing exercise, calcium/vit D supplementation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) amlodipine 5mg once daily [blood pressure medicine]. (4) Eliquis 5mg twice daily [blood thinner]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
2529,"75 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 75-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2530,"74 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 74-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
2531,Procedure: R TKA. Pt 38 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 38-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2532,"83 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 83-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2533,"Rx: Tab Eliquis 5mg BID. Tab sertraline 50mg daily. Adv: high fiber diet, adequate hydration. F/U PCP in 1 week for BP recheck.","Your medicines: (1) Eliquis 5mg twice daily [blood thinner]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. See your primary care doctor in 1 week to recheck blood pressure.",Psychiatry,Prescription,medium
2534,"83 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 83-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2535,Procedure: Laparoscopic appendectomy. Pt 45 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 45-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2536,"61 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 61-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2537,CT Head without contrast: No midline shift. Mild generalized cerebral atrophy appropriate for age. No acute intracranial hemorrhage. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: The brain is centered normally. There is mild brain shrinkage, which is normal for your age. There is no bleeding in the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
2538,"63 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 63-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2539,CT Head without contrast: No mass effect. Acute ischemic infarct in R MCA territory. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
2540,"58 y/o M with PMH of cirrhosis, h/o TIA, osteoporosis, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on potassium chloride 20mEq daily, amoxicillin 500mg TID x 10 days, rosuvastatin 10mg QHS, prednisone taper. F/U oncology in 1 week.","A 58-year-old man with a history of liver scarring [cirrhosis], history of mini-stroke, and weak bones [osteoporosis] was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the cancer doctor in 1 week.",Gastroenterology,Discharge Summary,high
2541,"Rx: Tab lisinopril 10mg daily. Humalog per SSI. Tab ondansetron 4mg Q8H PRN N/V. Tab escitalopram 10mg daily. Adv: fall precautions, home safety evaluation. F/U 6 weeks with LFTs.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
2542,"32 y/o F with PMH of CAD, CKD Stage 3, OA, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on ASA 81mg daily, Augmentin 875/125 BID x 7 days, montelukast 10mg QHS, spironolactone 25mg daily. F/U wound care in 3 days.","A 32-year-old woman with a history of coronary artery disease [heart artery blockages], moderate kidney disease, and arthritis [osteoarthritis] was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]; (4) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
2543,"31 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 31-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2544,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
2545,"Lipid panel: TC 258, LDL 137, HDL 56, TG 71.",Your cholesterol results: Total cholesterol is 258. LDL (bad cholesterol) is high at 137 (goal under 100). HDL (good cholesterol) is good at 56. Triglycerides are normal at 71.,Cardiology,Lab Result,high
2546,"US Abdomen: Pancreas unremarkable. No focal hepatic lesion. CBD 5mm, not dilated. CBD 12mm, dilated.","Abdominal ultrasound results: The pancreas looks normal. No tumors or masses were found in the liver. The bile duct is normal size [not blocked]. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
2547,"BMP: Na 142 (N), K 3.4 (L), BUN 87, Cr 4.4 (H), Glucose 367.","Your blood chemistry results: Sodium is normal at 142. Potassium is low at 3.4 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 4.4 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 367 (high).",Nephrology,Lab Result,high
2548,"50 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 50-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2549,"Rx: Tab calcium + vitamin D 600/400 daily. Tab lisinopril 10mg daily. albuterol MDI 2 puffs Q4-6H PRN. Tab Dulcolax 10mg QHS PRN. Adv: high fiber diet, adequate hydration Adv: SMBG BID, diabetic diet. F/U 1 week with CBC, CMP.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",General,Prescription,high
2550,"40 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 40-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
2551,"Rx: Tab lisinopril 10mg daily. Tab ASA 81mg daily. Tab furosemide 40mg daily. Tab atorvastatin 40mg QHS. Adv: fall precautions, home safety evaluation Adv: weight bearing exercise, calcium/vit D supplementation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (4) atorvastatin 40mg at bedtime [cholesterol medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
2552,"82 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 82-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2553,"32 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 32-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2554,Procedure: ORIF L distal radius. Pt 59 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 59-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2555,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab Xarelto 20mg daily with dinner. Tab atorvastatin 40mg QHS. Tab hydroxychloroquine 200mg BID. Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) atorvastatin 40mg at bedtime [cholesterol medicine]. (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
2556,"87 y/o M with PMH of CKD Stage 4, cirrhosis, gout, anemia, DM2, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Compression stockings when ambulating. D/C on losartan 50mg daily, furosemide 40mg BID, atorvastatin 40mg QHS. F/U surgery in 10 days.","A 87-year-old man with a history of advanced kidney disease, liver scarring [cirrhosis], gout, low blood count [anemia], and type 2 diabetes was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) furosemide (Lasix) 40mg twice daily [water pill]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
2557,"CBC: WBC 2.4 (L), Hgb 8.0 (L), Plt 250 (N).","Your blood count results: White blood cells are 2.4 (low, meaning your immune system may be weakened). Hemoglobin is low at 8.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 250, which is normal.",Hematology,Lab Result,high
2558,"60 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 60-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
2559,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. Multilevel degenerative disc disease. No compression fracture.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. Multiple discs in the spine are showing wear and aging. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
2560,"45 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 45-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2561,"27 y/o F with PMH of depression, s/p CABG, hypothyroidism, HLD, CKD Stage 3, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Humalog per SSI, latanoprost 0.005% OU QHS, calcium + vitamin D 600/400 daily, prednisone taper. F/U neurology in 2 weeks.","A 27-year-old woman with a history of depression, prior heart bypass surgery, underactive thyroid, high cholesterol, and moderate kidney disease was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Humalog insulin before meals as directed [fast-acting insulin]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) calcium plus vitamin D once daily [bone strengthening]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the brain/nerve doctor in 2 weeks.",Pulmonology,Discharge Summary,high
2562,"Rx: Tab pantoprazole 40mg AC breakfast. Tab timolol 0.5% OU BID. Tab latanoprost 0.005% OU QHS. Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",Ophthalmology,Prescription,medium
2563,"58 y/o F with PMH of PAD, DVT/PE on warfarin, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on furosemide 40mg BID, escitalopram 10mg daily, albuterol MDI 2 puffs Q4-6H PRN, sertraline 50mg daily, gabapentin 300mg TID. F/U PCP in 2 weeks.","A 58-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], and blood clots [on blood thinner warfarin] was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (4) sertraline 50mg once daily [antidepressant/anxiety medicine]; (5) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the primary care doctor in 2 weeks.",Urology,Discharge Summary,high
2564,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
2565,"22 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 22-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2566,"BMP: Na 137 (N), K 3.7 (N), BUN 77, Cr 1.9 (H), Glucose 284.","Your blood chemistry results: Sodium is normal at 137. Potassium is normal at 3.7. Creatinine is elevated at 1.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 284 (high).",Nephrology,Lab Result,high
2567,"27 y/o F with PMH of DM2, HLD, h/o CVA, obesity (BMI 38), gout, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Strict I&O, daily weights. D/C on sertraline 50mg daily, ferrous sulfate 325mg BID. F/U wound care in 3 days.","A 27-year-old woman with a history of type 2 diabetes, high cholesterol, history of stroke, obesity, and gout was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up at the wound care clinic in 3 days.",Infectious Disease,Discharge Summary,high
2568,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. No mass effect. No midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain. The brain is centered normally. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
2569,"45 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 45-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
2570,"60 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 60-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2571,"23 y/o M with PMH of seizure disorder on Keppra, gout, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on omeprazole 20mg AC breakfast, levothyroxine 75mcg daily on empty stomach. F/U endocrine in 1 week.","A 23-year-old man with a history of seizure disorder [on Keppra], and gout was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
2572,"30 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 30-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2573,"CBC: WBC 7.1 (N), Hgb 5.9 (L), Plt 498 (H).","Your blood count results: White blood cells are 7.1 (normal). Hemoglobin is low at 5.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 498, which is high — your blood may clot too easily.",Hematology,Lab Result,high
2574,"BMP: Na 149 (H), K 6.2 (H), BUN 56, Cr 1.8 (H), Glucose 292.","Your blood chemistry results: Sodium is high at 149, meaning you may be dehydrated. Potassium is dangerously high at 6.2 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 1.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 292 (high).",Nephrology,Lab Result,high
2575,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
2576,"US Abdomen: Spleen 11cm, normal. GB wall thickening with stones, positive Murphy's sign. Right kidney 10.5cm, no hydronephrosis. Pancreas unremarkable. Left kidney 8cm, cortical thinning consistent with CKD. CBD 12mm, dilated.","Abdominal ultrasound results: The spleen is a normal size. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Right kidney is normal size with no blockage. The pancreas looks normal. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
2577,"80 y/o F with PMH of OA, PPM in situ, HTN, seizure disorder on Keppra, DM1, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on entresto 49/51mg BID, calcium + vitamin D 600/400 daily, timolol 0.5% OU BID, prednisone taper, atorvastatin 80mg QHS. F/U nephrology in 5 days.","A 80-year-old woman with a history of arthritis [osteoarthritis], implanted pacemaker, high blood pressure, seizure disorder [on Keppra], and type 1 diabetes was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (5) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the kidney doctor in 5 days.",Infectious Disease,Discharge Summary,high
2578,"34 y/o F with PMH of DM2, h/o TIA, CHF, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on metformin 1000mg BID, amlodipine 5mg daily. F/U endocrine in 1 week.","A 34-year-old woman with a history of type 2 diabetes, history of mini-stroke, and heart failure was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
2579,CXR PA: Mild cardiomegaly. Patchy bilateral infiltrates. Left lower lobe consolidation. Small left pleural effusion.,Chest X-ray results: The heart is slightly larger than normal. There are scattered cloudy patches in both lungs suggesting infection or inflammation. There is an area in the lower left lung that appears infected. There is a small amount of fluid around the left lung.,Pulmonology,Radiology Report,high
2580,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. No compression fracture.,MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. No bones are broken or collapsed.,Orthopedics,Radiology Report,high
2581,"85 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 85-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2582,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
2583,"50 y/o F with PMH of CHF, cirrhosis, HLD, PPM in situ, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Low potassium diet. D/C on amoxicillin 500mg TID x 10 days, montelukast 10mg QHS, Humalog per SSI. F/U pulmonology in 2 weeks.","A 50-year-old woman with a history of heart failure, liver scarring [cirrhosis], high cholesterol, and implanted pacemaker was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]; (3) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the lung doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2584,CT Head without contrast: No midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage. Paranasal sinuses clear.,CT scan of the head results: The brain is centered normally. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain. The sinuses are clear with no infection.,Neurology,Radiology Report,high
2585,HbA1c: 10.5% (H). FBS: 244 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.5%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 244, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2586,"Rx: Tab amlodipine 5mg daily. Tab montelukast 10mg QHS. Tab sertraline 50mg daily. Tab pregabalin 75mg BID. Adv: low salt low sugar diet, regular exercise Adv: smoking cessation, pulmonary rehab. F/U 6 weeks with LFTs.","Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) pregabalin 75mg twice daily [nerve pain medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
2587,MRI Lumbar Spine: Central canal stenosis at L3-L4. No compression fracture. Facet joint hypertrophy at L4-L5. C5-C6 disc herniation with cord compression.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. No bones are broken or collapsed. The small joints in the spine at L4-L5 are enlarged from arthritis. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
2588,"33 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 33-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2589,"CBC: WBC 9.2 (N), Hgb 14.2 (N), Plt 92 (L).","Your blood count results: White blood cells are 9.2 (normal). Hemoglobin is normal at 14.2. Platelets are 92, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
2590,"72 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 72-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2591,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
2592,"85 y/o M with PMH of PAD, gout, CHF, h/o CVA, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on atorvastatin 80mg QHS, ibuprofen 400mg Q6H PRN with food, carvedilol 12.5mg BID. F/U nephrology in 1 week.","A 85-year-old man with a history of poor blood flow in the legs [peripheral artery disease], gout, heart failure, and history of stroke was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
2593,"37 y/o F with PMH of PPM in situ, Parkinson's disease, anemia, OSA on CPAP, HTN, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on Xarelto 20mg daily with dinner, glipizide 5mg BID AC, gabapentin 300mg TID, metoprolol 25mg BID, Humalog per SSI. F/U cardiology in 2 weeks.","A 37-year-old woman with a history of implanted pacemaker, Parkinson's disease, low blood count [anemia], sleep apnea [uses a breathing machine at night], and high blood pressure was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (4) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (5) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the heart doctor in 2 weeks.",Pulmonology,Discharge Summary,high
2594,"86 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 86-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2595,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,high
2596,CXR PA: Bilateral pleural effusions. Moderate right pleural effusion. No pneumothorax. Widened mediastinum. Left lower lobe consolidation.,"Chest X-ray results: There is fluid collecting around both lungs. There is a moderate amount of fluid around the right lung. There is no collapsed lung. The space between the lungs appears wider than normal, which needs further evaluation. There is an area in the lower left lung that appears infected.",Pulmonology,Radiology Report,high
2597,HbA1c: 11.7% (H). FBS: 214 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.7%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 214, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2598,Procedure: EGD with biopsy. Pt 40 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 40-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2599,"26 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 26-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
2600,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
2601,Procedure: Colonoscopy with polypectomy. Pt 86 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 86-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2602,Rx: Tab pregabalin 75mg BID. Tab latanoprost 0.005% OU QHS. Tab levothyroxine 75mcg daily on empty stomach. albuterol MDI 2 puffs Q4-6H PRN. Adv: low potassium diet. F/U 1 week with wound check.,"Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week to have the wound checked.",Pediatrics,Prescription,high
2603,"65 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 65-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2604,"83 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 83-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2605,"43 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 43-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2606,"84 y/o M with PMH of CHF, cirrhosis, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on losartan 50mg daily, pantoprazole 40mg AC breakfast, Xarelto 20mg daily with dinner, acetaminophen 650mg Q6H PRN. F/U PCP in 2 weeks.","A 84-year-old man with a history of heart failure, and liver scarring [cirrhosis] was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) Xarelto 20mg once daily with dinner [blood thinner]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
2607,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab methotrexate 15mg weekly. Tab glipizide 5mg BID AC. Tab metformin 1000mg BID. Tab pregabalin 75mg BID. Adv: SMBG BID, diabetic diet. F/U 1 week with CBC, CMP.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) glipizide 5mg twice daily before meals [helps release insulin]. (4) metformin 1000mg twice daily with meals [blood sugar medicine]. (5) pregabalin 75mg twice daily [nerve pain medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,high
2608,"69 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 69-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2609,"Rx: Tab metoprolol succinate 50mg daily. Tab acetaminophen 650mg Q6H PRN. Tab ferrous sulfate 325mg BID. Tab potassium chloride 20mEq daily. Tab pantoprazole 40mg AC breakfast. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks with INR.",Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (5) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 2 weeks for a blood thinner level check [INR].,General,Prescription,high
2610,"78 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 78-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2611,"31 y/o M with PMH of CAD, DM1, seizure disorder on Keppra, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on furosemide 40mg BID, acetaminophen 650mg Q6H PRN, sertraline 50mg daily. F/U nephrology in 5 days.","A 31-year-old man with a history of coronary artery disease [heart artery blockages], type 1 diabetes, and seizure disorder [on Keppra] was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the kidney doctor in 5 days.",Cardiology,Discharge Summary,high
2612,"58 y/o M with PMH of osteoporosis, PPM in situ, h/o CVA, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on metformin 500mg BID, Humalog per SSI, pantoprazole 40mg AC breakfast, Augmentin 875/125 BID x 7 days, rosuvastatin 10mg QHS. F/U GI in 1 week.","A 58-year-old man with a history of weak bones [osteoporosis], implanted pacemaker, and history of stroke was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]; (5) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
2613,"Thyroid panel: TSH 0.49 (N), Free T4 1.6.",Your thyroid test results: TSH is normal at 0.49. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
2614,"BMP: Na 140 (N), K 5.4 (H), BUN 61, Cr 6.0 (H), Glucose 129.","Your blood chemistry results: Sodium is normal at 140. Potassium is high at 5.4 — needs monitoring. Creatinine is elevated at 6.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 129 (high).",Nephrology,Lab Result,high
2615,"Rx: Tab Dulcolax 10mg QHS PRN. Tab Augmentin 875/125 BID x 7 days. Adv: DASH diet, daily BP monitoring Do not stop abruptly, taper as directed. F/U 2 weeks with INR.","Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 2 weeks for a blood thinner level check [INR].",Infectious Disease,Prescription,medium
2616,"25 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 25-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
2617,"50 y/o M with PMH of BPH, HTN, hypothyroidism, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on Xarelto 20mg daily with dinner, Spiriva 18mcg daily. F/U INR check in 3 days.","A 50-year-old man with a history of enlarged prostate, high blood pressure, and underactive thyroid was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
2618,CT Head without contrast: Paranasal sinuses clear. Chronic lacunar infarcts in bilateral basal ganglia. No mass effect.,CT scan of the head results: The sinuses are clear with no infection. There are signs of small old strokes in the deep parts of the brain. There are no tumors or masses pushing on the brain.,Neurology,Radiology Report,high
2619,"40 y/o M with PMH of RA on MTX, h/o CVA, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on ondansetron 4mg Q8H PRN N/V, ferrous sulfate 325mg BID, levothyroxine 75mcg daily on empty stomach. F/U wound care in 3 days.","A 40-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], and history of stroke was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up at the wound care clinic in 3 days.",Urology,Discharge Summary,high
2620,"76 y/o F with PMH of s/p TKR, CAD, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on escitalopram 10mg daily, amlodipine 10mg daily. F/U orthopedics in 6 weeks with X-ray.","A 76-year-old woman with a history of prior knee replacement, and coronary artery disease [heart artery blockages] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Orthopedics,Discharge Summary,high
2621,"Rx: Tab latanoprost 0.005% OU QHS. Tab metoprolol succinate 50mg daily. Tab omeprazole 20mg AC breakfast. Adv: avoid alcohol, hepatotoxic drugs Adv: low potassium diet. F/U 1 month with repeat imaging.","Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
2622,"MRI Lumbar Spine: Central canal stenosis at L3-L4. C5-C6 disc herniation with cord compression. Conus medullaris at L1, normal. Multilevel degenerative disc disease.","MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal cord ends at a normal level. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
2623,HbA1c: 6.4% (H). FBS: 392 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.4%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 392, which is high (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,high
2624,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Tab furosemide 40mg daily. prednisone taper. Spiriva 18mcg daily. Adv: elevate affected limb, compression stockings Do not stop abruptly, taper as directed. F/U 1 week with wound check.",Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (4) Spiriva inhaler once daily [long-acting lung medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week to have the wound checked.,Cardiology,Prescription,high
2625,"51 y/o M with PMH of DM2, COPD, DVT/PE on warfarin, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on ondansetron 4mg Q8H PRN N/V, empagliflozin 10mg daily, ciprofloxacin 500mg BID x 5 days, amlodipine 5mg daily, lisinopril 20mg daily. F/U surgery in 2 weeks for drain removal.","A 51-year-old man with a history of type 2 diabetes, chronic lung disease, and blood clots [on blood thinner warfarin] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (4) amlodipine 5mg once daily [blood pressure medicine]; (5) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Nephrology,Discharge Summary,high
2626,Rx: Lantus 20U QHS. Tab ASA 81mg daily. Tab Eliquis 5mg BID. Avoid grapefruit juice. F/U 2 weeks with INR.,Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) Eliquis 5mg twice daily [blood thinner]. Do not drink grapefruit juice as it interferes with this medication. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,medium
2627,HbA1c: 12.2% (H). FBS: 95 mg/dL (N).,"Your diabetes blood test results: HbA1c is 12.2%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 95, which is normal (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2628,"32 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 32-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2629,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Acute ischemic infarct in R MCA territory. No acute intracranial hemorrhage.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is no bleeding in the brain.",Neurology,Radiology Report,high
2630,HbA1c: 6.8% (H). FBS: 262 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.8%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 262, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
2631,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2632,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,low
2633,"28 y/o M with PMH of BPH, PAD, DM1, OSA on CPAP, s/p TKR, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on Spiriva 18mcg daily, ferrous sulfate 325mg BID. F/U nephrology in 5 days.","A 28-year-old man with a history of enlarged prostate, poor blood flow in the legs [peripheral artery disease], type 1 diabetes, sleep apnea [uses a breathing machine at night], and prior knee replacement was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the kidney doctor in 5 days.",Urology,Discharge Summary,high
2634,"46 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 46-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2635,CXR PA: Pacemaker leads in appropriate position. No cardiomegaly. Osseous structures intact. NG tube tip in stomach.,Chest X-ray results: The pacemaker wires are in the correct position. The heart is a normal size. The bones look normal with no fractures. The feeding/drainage tube tip is correctly positioned in the stomach.,Pulmonology,Radiology Report,high
2636,"CBC: WBC 4.5 (N), Hgb 13.3 (N), Plt 352 (N).","Your blood count results: White blood cells are 4.5 (normal). Hemoglobin is normal at 13.3. Platelets are 352, which is normal.",Hematology,Lab Result,medium
2637,CT Head without contrast: Paranasal sinuses clear. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Subarachnoid hemorrhage in bilateral sylvian fissures. 4cm right subdural hematoma with 5mm midline shift. No mass effect.,"CT scan of the head results: The sinuses are clear with no infection. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is bleeding around the brain surface, particularly in the grooves on both sides. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
2638,"Rx: Tab empagliflozin 10mg daily. Tab spironolactone 25mg daily. Avoid NSAIDs Adv: high fiber diet, adequate hydration. F/U 1 month with repeat imaging.","Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) spironolactone 25mg once daily [heart-protecting water pill]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
2639,"25 y/o F with PMH of CAD, anxiety, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Low potassium diet. D/C on amoxicillin 500mg TID x 10 days, entresto 49/51mg BID, pantoprazole 40mg AC breakfast, glipizide 5mg BID AC, Dulcolax 10mg QHS PRN. F/U neurology in 2 weeks.","A 25-year-old woman with a history of coronary artery disease [heart artery blockages], and anxiety was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]; (4) glipizide 5mg twice daily before meals [helps release insulin]; (5) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the brain/nerve doctor in 2 weeks.",General Surgery,Discharge Summary,high
2640,"71 y/o F with PMH of PPM in situ, DVT/PE on warfarin, osteoporosis, depression, s/p TKR, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Compression stockings when ambulating. D/C on omeprazole 20mg AC breakfast, glipizide 5mg BID AC, losartan 50mg daily, timolol 0.5% OU BID. F/U INR check in 3 days.","A 71-year-old woman with a history of implanted pacemaker, blood clots [on blood thinner warfarin], weak bones [osteoporosis], depression, and prior knee replacement was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) losartan 50mg once daily [blood pressure medicine]; (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up for a blood thinner level check in 3 days.",Endocrinology,Discharge Summary,high
2641,"83 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 83-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2642,"78 y/o M with PMH of gout, CAD, A-fib, HLD, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Strict I&O, daily weights. D/C on spironolactone 25mg daily, ASA 81mg daily. F/U hematology in 2 weeks.","A 78-year-old man with a history of gout, coronary artery disease [heart artery blockages], irregular heartbeat [atrial fibrillation], and high cholesterol was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the blood disorder doctor in 2 weeks.",Hematology,Discharge Summary,high
2643,"47 y/o M with PMH of HFrEF (EF 30%), ICD in situ, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on atorvastatin 40mg QHS, furosemide 40mg daily, lisinopril 10mg daily, losartan 50mg daily, carvedilol 12.5mg BID. F/U cardiology in 2 weeks.","A 47-year-old man with a history of heart failure with weak pumping (30%), and implanted heart defibrillator was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (4) losartan 50mg once daily [blood pressure medicine]; (5) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
2644,"90 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 90-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2645,CT Head without contrast: Acute ischemic infarct in R MCA territory. Paranasal sinuses clear. Mild generalized cerebral atrophy appropriate for age. 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The sinuses are clear with no infection. There is mild brain shrinkage, which is normal for your age. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
2646,"CBC: WBC 19.5 (H), Hgb 11.2 (L), Plt 174 (N).","Your blood count results: White blood cells are 19.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 11.2, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 174, which is normal.",Hematology,Lab Result,high
2647,"78 y/o M with PMH of OA, s/p TKR, CKD Stage 3, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Compression stockings when ambulating. D/C on gabapentin 300mg TID, potassium chloride 20mEq daily, sertraline 50mg daily, atorvastatin 40mg QHS. F/U cardiology in 2 weeks.","A 78-year-old man with a history of arthritis [osteoarthritis], prior knee replacement, and moderate kidney disease was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the heart doctor in 2 weeks.",Orthopedics,Discharge Summary,high
2648,"30 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 30-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2649,HbA1c: 11.3% (H). FBS: 330 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.3%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 330, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2650,"Rx: Humalog per SSI. Tab pregabalin 75mg BID. Do not stop abruptly, taper as directed. F/U 2 weeks.",Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) pregabalin 75mg twice daily [nerve pain medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back for a check-up in 2 weeks.,Neurology,Prescription,medium
2651,Procedure: ERCP with sphincterotomy. Pt 73 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 73-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2652,"Rx: prednisone taper. Tab warfarin 5mg daily. Tab carvedilol 12.5mg BID. Tab amlodipine 5mg daily. Tab empagliflozin 10mg daily. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (3) carvedilol 12.5mg twice daily [heart medicine]. (4) amlodipine 5mg once daily [blood pressure medicine]. (5) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
2653,"39 y/o F with PMH of gout, CKD Stage 4, s/p THR, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on entresto 49/51mg BID, losartan 50mg daily, Spiriva 18mcg daily. F/U surgery in 10 days.","A 39-year-old woman with a history of gout, advanced kidney disease, and prior hip replacement was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) losartan 50mg once daily [blood pressure medicine]; (3) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the surgeon in 10 days.",Orthopedics,Discharge Summary,high
2654,CXR PA: Right-sided pneumothorax. Small left pleural effusion. No pneumothorax. Bilateral pleural effusions. Right middle lobe atelectasis.,"Chest X-ray results: The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There is a small amount of fluid around the left lung. There is no collapsed lung. There is fluid collecting around both lungs. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
2655,"75 y/o M with PMH of h/o CVA, osteoporosis, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on escitalopram 10mg daily, amoxicillin 500mg TID x 10 days, amlodipine 10mg daily, gabapentin 300mg TID. F/U nephrology in 1 week.","A 75-year-old man with a history of history of stroke, and weak bones [osteoporosis] was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the kidney doctor in 1 week.",General Surgery,Discharge Summary,high
2656,"CBC: WBC 24.4 (H), Hgb 10.7 (L), Plt 166 (N).","Your blood count results: White blood cells are 24.4 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 10.7, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 166, which is normal.",Hematology,Lab Result,high
2657,HbA1c: 13.2% (H). FBS: 140 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.2%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 140, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
2658,"BMP: Na 144 (N), K 6.8 (H), BUN 10, Cr 3.7 (H), Glucose 98.","Your blood chemistry results: Sodium is normal at 144. Potassium is dangerously high at 6.8 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 3.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 98 (normal).",Nephrology,Lab Result,high
2659,"Rx: Tab pantoprazole 40mg AC breakfast. Tab metformin 1000mg BID. Tab montelukast 10mg QHS. Adv: elevate affected limb, compression stockings Adv: weight bearing exercise, calcium/vit D supplementation. F/U 6 weeks with LFTs.","Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) metformin 1000mg twice daily with meals [blood sugar medicine]. (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 6 weeks for liver function blood tests.",Pulmonology,Prescription,medium
2660,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,high
2661,Procedure: Laparoscopic appendectomy. Pt 85 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 85-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2662,"31 y/o F with PMH of ICD in situ, s/p TKR, HFpEF, obesity (BMI 38), asthma, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on azithromycin 500mg day 1 then 250mg x 4 days, omeprazole 20mg AC breakfast, gabapentin 300mg TID, potassium chloride 20mEq daily, sertraline 50mg daily. F/U orthopedics in 6 weeks with X-ray.","A 31-year-old woman with a history of implanted heart defibrillator, prior knee replacement, heart failure with stiff heart muscle, obesity, and asthma was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
2663,"Rx: Tab empagliflozin 10mg daily. Tab hydroxychloroquine 200mg BID. Tab ASA 81mg daily. Tab omeprazole 20mg AC breakfast. Adv: avoid alcohol, hepatotoxic drugs. F/U INR in 3 days.",Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) baby aspirin 81mg once daily [prevents blood clots]. (4) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
2664,Rx: Tab Eliquis 5mg BID. Tab latanoprost 0.005% OU QHS. Tab gabapentin 300mg TID. Tab rosuvastatin 10mg QHS. Avoid grapefruit juice Adv: wound care with daily dressing changes. F/U 2 weeks.,"Your medicines: (1) Eliquis 5mg twice daily [blood thinner]. (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) rosuvastatin 10mg at bedtime [cholesterol medicine]. Do not drink grapefruit juice as it interferes with this medication Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
2665,"US Abdomen: Ascites moderate amount. Pancreas unremarkable. Simple renal cysts bilaterally. Spleen 11cm, normal. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. The pancreas looks normal. Both kidneys have harmless fluid-filled cysts. The spleen is a normal size. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
2666,"CBC: WBC 7.9 (N), Hgb 12.5 (N), Plt 165 (N).","Your blood count results: White blood cells are 7.9 (normal). Hemoglobin is normal at 12.5. Platelets are 165, which is normal.",Hematology,Lab Result,medium
2667,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,high
2668,"58 y/o M with PMH of SLE, BPH, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on ASA 81mg daily, prednisone taper, Humalog per SSI, metoprolol succinate 50mg daily, Spiriva 18mcg daily. F/U nephrology in 1 week.","A 58-year-old man with a history of lupus, and enlarged prostate was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) Humalog insulin before meals as directed [fast-acting insulin]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (5) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the kidney doctor in 1 week.",Infectious Disease,Discharge Summary,high
2669,"30 y/o F with PMH of HFpEF, h/o TIA, s/p TKR, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on entresto 49/51mg BID, pantoprazole 40mg AC breakfast, tramadol 50mg Q6H PRN pain, atorvastatin 40mg QHS. F/U surgery in 10 days.","A 30-year-old woman with a history of heart failure with stiff heart muscle, history of mini-stroke, and prior knee replacement was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (4) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the surgeon in 10 days.",Pulmonology,Discharge Summary,high
2670,"US Abdomen: CBD 12mm, dilated. CBD 5mm, not dilated. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Left kidney 8cm, cortical thinning consistent with CKD. No focal hepatic lesion.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. The bile duct is normal size [not blocked]. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. Left kidney is small with thin outer layer, consistent with chronic kidney disease. No tumors or masses were found in the liver.",Gastroenterology,Radiology Report,high
2671,"US Abdomen: Pancreas unremarkable. Spleen 11cm, normal. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The pancreas looks normal. The spleen is a normal size. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
2672,"85 y/o M with PMH of HFrEF (EF 30%), CKD Stage 3, h/o CVA, h/o TIA, s/p CABG, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on clopidogrel 75mg daily, metoprolol 25mg BID. F/U nephrology in 5 days.","A 85-year-old man with a history of heart failure with weak pumping (30%), moderate kidney disease, history of stroke, history of mini-stroke, and prior heart bypass surgery was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the kidney doctor in 5 days.",Urology,Discharge Summary,high
2673,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. No compression fracture.,MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. No bones are broken or collapsed.,Orthopedics,Radiology Report,high
2674,"26 y/o F with PMH of CKD Stage 4, seizure disorder on Keppra, obesity (BMI 38), s/p THR, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on levothyroxine 75mcg daily on empty stomach, omeprazole 20mg AC breakfast, clopidogrel 75mg daily, calcium + vitamin D 600/400 daily, methotrexate 15mg weekly. F/U PCP in 2 weeks.","A 26-year-old woman with a history of advanced kidney disease, seizure disorder [on Keppra], obesity, and prior hip replacement was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
2675,"63 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 63-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2676,"Rx: Tab ASA 81mg daily. prednisone taper. Tab acetaminophen 650mg Q6H PRN. Adv: avoid alcohol, hepatotoxic drugs. F/U PCP in 1 week for BP recheck.",Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
2677,Procedure: Laparoscopic cholecystectomy. Pt 61 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 61-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2678,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
2679,"75 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 75-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2680,"Rx: Tab furosemide 40mg daily. Tab metoprolol 25mg BID. Adv: low salt low sugar diet, regular exercise Adv: avoid alcohol, hepatotoxic drugs. F/U PCP in 1 week for BP recheck.","Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
2681,CXR PA: Clear lung fields bilaterally. No pneumothorax. Left lower lobe consolidation.,Chest X-ray results: Both lungs look clear with no problems. There is no collapsed lung. There is an area in the lower left lung that appears infected.,Pulmonology,Radiology Report,high
2682,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Tab amlodipine 10mg daily. Adv: high fiber diet, adequate hydration. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
2683,Rx: Tab metoprolol succinate 50mg daily. Tab ciprofloxacin 500mg BID x 5 days. Tab lisinopril 10mg daily. albuterol MDI 2 puffs Q4-6H PRN. Tab hydroxychloroquine 200mg BID. Avoid NSAIDs. F/U INR in 3 days.,Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (5) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
2684,Rx: Tab calcium + vitamin D 600/400 daily. Tab pregabalin 75mg BID. Adv: low potassium diet Avoid grapefruit juice. F/U 1 week with wound check.,"Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) pregabalin 75mg twice daily [nerve pain medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Do not drink grapefruit juice as it interferes with this medication. Come back in 1 week to have the wound checked.",Neurology,Prescription,medium
2685,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. C5-C6 disc herniation with cord compression.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
2686,"53 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 53-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2687,"Rx: Tab hydroxychloroquine 200mg BID. Tab acetaminophen 650mg Q6H PRN. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 6 weeks with LFTs.","Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 6 weeks for liver function blood tests.",Rheumatology,Prescription,medium
2688,"Rx: Tab lisinopril 10mg daily. Tab levothyroxine 75mcg daily on empty stomach. Tab potassium chloride 20mEq daily. Adv: DASH diet, daily BP monitoring Adv: SMBG BID, diabetic diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
2689,"43 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 43-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2690,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
2691,"73 y/o F with PMH of s/p CABG, PPM in situ, osteoporosis, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on entresto 49/51mg BID, Spiriva 18mcg daily, Xarelto 20mg daily with dinner, pantoprazole 40mg AC breakfast. F/U orthopedics in 6 weeks with X-ray.","A 73-year-old woman with a history of prior heart bypass surgery, implanted pacemaker, and weak bones [osteoporosis] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) Xarelto 20mg once daily with dinner [blood thinner]; (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Orthopedics,Discharge Summary,high
2692,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
2693,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
2694,CXR PA: Bilateral hilar lymphadenopathy. NG tube tip in stomach. Cardiomegaly with CTR >0.5. Osseous structures intact.,"Chest X-ray results: There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The feeding/drainage tube tip is correctly positioned in the stomach. The heart appears larger than normal. The bones look normal with no fractures.",Pulmonology,Radiology Report,high
2695,"48 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 48-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2696,"56 y/o F with PMH of s/p CABG, CHF, CKD Stage 3, CKD Stage 4, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on potassium chloride 20mEq daily, rosuvastatin 10mg QHS, ferrous sulfate 325mg BID, Lantus 20U QHS, losartan 50mg daily. F/U orthopedics in 6 weeks with X-ray.","A 56-year-old woman with a history of prior heart bypass surgery, heart failure, moderate kidney disease, and advanced kidney disease was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) Lantus insulin 20 units at bedtime [long-acting insulin]; (5) losartan 50mg once daily [blood pressure medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Nephrology,Discharge Summary,high
2697,"Rx: Tab gabapentin 300mg TID. Tab omeprazole 20mg AC breakfast. Spiriva 18mcg daily. Tab amlodipine 5mg daily. Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) Spiriva inhaler once daily [long-acting lung medicine]. (4) amlodipine 5mg once daily [blood pressure medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",Pediatrics,Prescription,high
2698,"Rx: Tab entresto 49/51mg BID. albuterol MDI 2 puffs Q4-6H PRN. Tab Eliquis 5mg BID. Adv: wound care with daily dressing changes. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (3) Eliquis 5mg twice daily [blood thinner]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
2699,"85 y/o M with PMH of ESRD on HD, asthma, A-fib, s/p THR, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Humalog per SSI, Dulcolax 10mg QHS PRN. F/U cardiology in 2 weeks.","A 85-year-old man with a history of kidney failure requiring dialysis, asthma, irregular heartbeat [atrial fibrillation], and prior hip replacement was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Humalog insulin before meals as directed [fast-acting insulin]; (2) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the heart doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2700,"48 y/o M with PMH of Parkinson's disease, PPM in situ, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on amlodipine 5mg daily, ferrous sulfate 325mg BID, Spiriva 18mcg daily, furosemide 40mg daily. F/U surgery in 2 weeks for drain removal.","A 48-year-old man with a history of Parkinson's disease, and implanted pacemaker was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) Spiriva inhaler once daily [long-acting lung medicine]; (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Follow-up with the surgeon in 2 weeks to remove the drain.",Gastroenterology,Discharge Summary,high
2701,"54 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 54-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2702,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab metoprolol succinate 50mg daily. Tab warfarin 5mg daily. Avoid grapefruit juice Adv: fall precautions, home safety evaluation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Do not drink grapefruit juice as it interferes with this medication Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
2703,"Rx: Tab warfarin 5mg daily. Tab furosemide 40mg daily. Tab metformin 1000mg BID. Adv: smoking cessation, pulmonary rehab Adv: high fiber diet, adequate hydration. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
2704,"91 y/o M with PMH of Parkinson's disease, h/o CVA, s/p CABG, h/o TIA, s/p THR, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on ASA 81mg daily, furosemide 40mg BID, metformin 1000mg BID, metoprolol succinate 50mg daily. F/U neurology in 2 weeks.","A 91-year-old man with a history of Parkinson's disease, history of stroke, prior heart bypass surgery, history of mini-stroke, and prior hip replacement was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) furosemide (Lasix) 40mg twice daily [water pill]; (3) metformin 1000mg twice daily with meals [blood sugar medicine]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Pulmonology,Discharge Summary,high
2705,"26 y/o F with PMH of Parkinson's disease, CHF, osteoporosis, COPD, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on Lantus 20U QHS, timolol 0.5% OU BID, Dulcolax 10mg QHS PRN. F/U oncology in 1 week.","A 26-year-old woman with a history of Parkinson's disease, heart failure, weak bones [osteoporosis], and chronic lung disease was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (3) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the cancer doctor in 1 week.",General Surgery,Discharge Summary,high
2706,Procedure: PCI with DES to LAD. Pt 77 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 77-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
2707,"28 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 28-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2708,"Rx: Tab potassium chloride 20mEq daily. Tab amoxicillin 500mg TID x 10 days. Tab ciprofloxacin 500mg BID x 5 days. Tab Eliquis 5mg BID. Tab ibuprofen 400mg Q6H PRN with food. Adv: low salt diet, fluid restriction 1.5L/day Adv: fall precautions, home safety evaluation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (4) Eliquis 5mg twice daily [blood thinner]. (5) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Infectious Disease,Prescription,high
2709,Procedure: EGD with biopsy. Pt 62 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 62-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2710,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab atorvastatin 40mg QHS. Adv: wound care with daily dressing changes. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
2711,"68 y/o M with PMH of h/o CVA, PAD, osteoporosis, Parkinson's disease, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on sertraline 50mg daily, Spiriva 18mcg daily, amlodipine 10mg daily, metformin 1000mg BID. F/U PCP in 2 weeks.","A 68-year-old man with a history of history of stroke, poor blood flow in the legs [peripheral artery disease], weak bones [osteoporosis], and Parkinson's disease was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the primary care doctor in 2 weeks.",General Surgery,Discharge Summary,high
2712,"Thyroid panel: TSH 7.84 (H), Free T4 1.6.","Your thyroid test results: TSH is elevated at 7.84 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2713,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
2714,"54 y/o F with PMH of s/p THR, BPH, OA, obesity (BMI 38), hypothyroidism, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on metformin 1000mg BID, Xarelto 20mg daily with dinner, Spiriva 18mcg daily, levothyroxine 75mcg daily on empty stomach, furosemide 40mg daily. F/U endocrine in 1 week.","A 54-year-old woman with a history of prior hip replacement, enlarged prostate, arthritis [osteoarthritis], obesity, and underactive thyroid was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) Spiriva inhaler once daily [long-acting lung medicine]; (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (5) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Follow-up with the hormone/diabetes doctor in 1 week.",Endocrinology,Discharge Summary,high
2715,Procedure: Colonoscopy with polypectomy. Pt 79 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 79-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2716,"90 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 90-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2717,"26 y/o M with PMH of h/o CVA, CKD Stage 3, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on methotrexate 15mg weekly, ibuprofen 400mg Q6H PRN with food. F/U orthopedics in 6 weeks with X-ray.","A 26-year-old man with a history of history of stroke, and moderate kidney disease was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Psychiatry,Discharge Summary,high
2718,"52 y/o F with PMH of depression, GERD, anxiety, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Compression stockings when ambulating. D/C on rosuvastatin 10mg QHS, methotrexate 15mg weekly, amlodipine 10mg daily, atorvastatin 40mg QHS. F/U PCP in 2 weeks.","A 52-year-old woman with a history of depression, acid reflux, and anxiety was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
2719,Rx: prednisone taper. Tab levothyroxine 75mcg daily on empty stomach. Avoid grapefruit juice Adv: low potassium diet. F/U 2 weeks with INR.,"Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Do not drink grapefruit juice as it interferes with this medication Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks for a blood thinner level check [INR].",Endocrinology,Prescription,medium
2720,"64 y/o M with PMH of anemia, SLE, s/p TKR, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on albuterol MDI 2 puffs Q4-6H PRN, latanoprost 0.005% OU QHS, Humalog per SSI, ASA 81mg daily, amlodipine 5mg daily. F/U orthopedics in 6 weeks with X-ray.","A 64-year-old man with a history of low blood count [anemia], lupus, and prior knee replacement was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) Humalog insulin before meals as directed [fast-acting insulin]; (4) baby aspirin 81mg once daily [prevents blood clots]; (5) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Neurology,Discharge Summary,high
2721,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,medium
2722,"82 y/o M with PMH of s/p CABG, OSA on CPAP, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Strict I&O, daily weights. D/C on hydroxychloroquine 200mg BID, Lantus 20U QHS, empagliflozin 10mg daily, ferrous sulfate 325mg BID. F/U wound care in 3 days.","A 82-year-old man with a history of prior heart bypass surgery, and sleep apnea [uses a breathing machine at night] was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
2723,"BMP: Na 123 (L), K 4.9 (N), BUN 58, Cr 1.1 (N), Glucose 95.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.9. Creatinine is normal at 1.1. Blood sugar is 95 (normal).",Nephrology,Lab Result,high
2724,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
2725,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
2726,"40 y/o F with PMH of CKD Stage 4, asthma, anxiety, PPM in situ, ICD in situ, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Compression stockings when ambulating. D/C on metoprolol 25mg BID, atorvastatin 40mg QHS, methotrexate 15mg weekly. F/U PCP in 2 weeks.","A 40-year-old woman with a history of advanced kidney disease, asthma, anxiety, implanted pacemaker, and implanted heart defibrillator was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the primary care doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2727,"BMP: Na 123 (L), K 6.2 (H), BUN 64, Cr 1.4 (H), Glucose 357.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.2 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is mildly elevated at 1.4. Blood sugar is 357 (high).",Nephrology,Lab Result,high
2728,"CBC: WBC 6.8 (N), Hgb 6.0 (L), Plt 482 (H).","Your blood count results: White blood cells are 6.8 (normal). Hemoglobin is low at 6.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 482, which is high — your blood may clot too easily.",Hematology,Lab Result,high
2729,"77 y/o F with PMH of GERD, osteoporosis, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on ASA 81mg daily, metoprolol 25mg BID, ferrous sulfate 325mg BID, Lantus 20U QHS, furosemide 40mg BID. F/U PCP in 2 weeks.","A 77-year-old woman with a history of acid reflux, and weak bones [osteoporosis] was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) Lantus insulin 20 units at bedtime [long-acting insulin]; (5) furosemide (Lasix) 40mg twice daily [water pill]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
2730,"78 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 78-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
2731,CXR PA: Right middle lobe atelectasis. Elevated left hemidiaphragm. Right-sided pneumothorax. Bilateral pleural effusions. Osseous structures intact.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There is fluid collecting around both lungs. The bones look normal with no fractures.",Pulmonology,Radiology Report,high
2732,"BMP: Na 135 (L), K 3.1 (L), BUN 84, Cr 3.6 (H), Glucose 362.","Your blood chemistry results: Sodium is low at 135 (normal 136-145), meaning too much water in your body. Potassium is low at 3.1 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 3.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 362 (high).",Nephrology,Lab Result,high
2733,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
2734,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
2735,"40 y/o F with PMH of seizure disorder on Keppra, COPD, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Low potassium diet. D/C on levothyroxine 75mcg daily on empty stomach, metoprolol succinate 50mg daily, warfarin 5mg daily, Lantus 20U QHS, Dulcolax 10mg QHS PRN. F/U nephrology in 5 days.","A 40-year-old woman with a history of seizure disorder [on Keppra], and chronic lung disease was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (4) Lantus insulin 20 units at bedtime [long-acting insulin]; (5) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the kidney doctor in 5 days.",Gastroenterology,Discharge Summary,high
2736,"37 y/o M with PMH of gout, hypothyroidism, HFrEF (EF 30%), cirrhosis, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on azithromycin 500mg day 1 then 250mg x 4 days, furosemide 40mg daily, ondansetron 4mg Q8H PRN N/V, ferrous sulfate 325mg BID. F/U wound care in 3 days.","A 37-year-old man with a history of gout, underactive thyroid, heart failure with weak pumping (30%), and liver scarring [cirrhosis] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up at the wound care clinic in 3 days.",Psychiatry,Discharge Summary,high
2737,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,low
2738,"Lipid panel: TC 154, LDL 109, HDL 80, TG 226.",Your cholesterol results: Total cholesterol is 154. LDL (bad cholesterol) is high at 109 (goal under 100). HDL (good cholesterol) is good at 80. Triglycerides are high at 226.,Cardiology,Lab Result,high
2739,"US Abdomen: Left kidney 8cm, cortical thinning consistent with CKD. Spleen 16cm, splenomegaly. Right kidney 10.5cm, no hydronephrosis. GB sludge, no stones. Ascites moderate amount.","Abdominal ultrasound results: Left kidney is small with thin outer layer, consistent with chronic kidney disease. The spleen is enlarged [splenomegaly]. Right kidney is normal size with no blockage. The gallbladder contains thickened bile [sludge] but no stones. There is a moderate amount of fluid in the belly [ascites].",Gastroenterology,Radiology Report,high
2740,"24 y/o F with PMH of CAD, DM2, depression, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on pantoprazole 40mg AC breakfast, amoxicillin 500mg TID x 10 days, warfarin 5mg daily, tramadol 50mg Q6H PRN pain. F/U neurology in 2 weeks.","A 24-year-old woman with a history of coronary artery disease [heart artery blockages], type 2 diabetes, and depression was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
2741,"Rx: Tab pregabalin 75mg BID. Tab ferrous sulfate 325mg BID. Tab empagliflozin 10mg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab amlodipine 10mg daily. Adv: SMBG BID, diabetic diet Adv: low potassium diet. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (5) amlodipine 10mg once daily [blood pressure medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",General,Prescription,high
2742,"90 y/o M with PMH of osteoporosis, HFrEF (EF 30%), anemia, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on clopidogrel 75mg daily, Augmentin 875/125 BID x 7 days, furosemide 40mg BID, Lantus 20U QHS, metformin 1000mg BID. F/U cardiology in 2 weeks.","A 90-year-old man with a history of weak bones [osteoporosis], heart failure with weak pumping (30%), and low blood count [anemia] was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) Lantus insulin 20 units at bedtime [long-acting insulin]; (5) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the heart doctor in 2 weeks.",Hematology,Discharge Summary,high
2743,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab montelukast 10mg QHS. Tab losartan 50mg daily. Tab spironolactone 25mg daily. Adv: low salt low sugar diet, regular exercise. F/U 2 weeks.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) losartan 50mg once daily [blood pressure medicine]. (4) spironolactone 25mg once daily [heart-protecting water pill]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
2744,"56 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 56-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2745,"33 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 33-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2746,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. No mass effect. Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain. There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain.",Neurology,Radiology Report,high
2747,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
2748,"28 y/o M with PMH of PAD, DM2, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Low potassium diet. D/C on gabapentin 300mg TID, pregabalin 75mg BID, metoprolol 25mg BID. F/U orthopedics in 6 weeks with X-ray.","A 28-year-old man with a history of poor blood flow in the legs [peripheral artery disease], and type 2 diabetes was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Pulmonology,Discharge Summary,high
2749,"35 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 35-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2750,"BMP: Na 129 (L), K 5.7 (H), BUN 78, Cr 3.9 (H), Glucose 193.","Your blood chemistry results: Sodium is low at 129 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 5.7 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 3.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 193 (high).",Nephrology,Lab Result,high
2751,"34 y/o F with PMH of asthma, OSA on CPAP, s/p TKR, anxiety, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Low potassium diet. D/C on ciprofloxacin 500mg BID x 5 days, warfarin 5mg daily, Xarelto 20mg daily with dinner, metformin 1000mg BID, sertraline 50mg daily. F/U orthopedics in 6 weeks with X-ray.","A 34-year-old woman with a history of asthma, sleep apnea [uses a breathing machine at night], prior knee replacement, and anxiety was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) Xarelto 20mg once daily with dinner [blood thinner]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]; (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
2752,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. No compression fracture. Central canal stenosis at L3-L4.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. No bones are broken or collapsed. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
2753,CT Head without contrast: No mass effect. No midline shift. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There are no tumors or masses pushing on the brain. The brain is centered normally. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
2754,"79 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 79-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2755,Delivery Note: G?P? at 38+2 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2756,"LFTs: AST 308 (H), ALT 41 (H), ALP 35, T.Bili 2.8 (H), Albumin 3.2.","Your liver blood test results: Liver enzymes (AST 308, ALT 41) are mildly elevated (normal is under 40). Bilirubin is high at 2.8 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 3.2 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
2757,Procedure: Port-a-cath placement. Pt 64 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 64-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
2758,"23 y/o F with PMH of PAD, s/p THR, cirrhosis, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Spiriva 18mcg daily, losartan 50mg daily, ASA 81mg daily. F/U endocrine in 1 week.","A 23-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], prior hip replacement, and liver scarring [cirrhosis] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) losartan 50mg once daily [blood pressure medicine]; (3) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the hormone/diabetes doctor in 1 week.",Psychiatry,Discharge Summary,high
2759,"CBC: WBC 14.7 (H), Hgb 15.5 (N), Plt 400 (N).","Your blood count results: White blood cells are 14.7 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 15.5. Platelets are 400, which is normal.",Hematology,Lab Result,high
2760,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
2761,"29 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 29-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2762,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,low
2763,Procedure: Colonoscopy with polypectomy. Pt 78 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 78-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2764,"24 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 24-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2765,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,high
2766,"62 y/o M with PMH of SLE, CHF, h/o TIA, anxiety, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on carvedilol 12.5mg BID, Lantus 20U QHS, montelukast 10mg QHS, metformin 1000mg BID, atorvastatin 40mg QHS. F/U oncology in 1 week.","A 62-year-old man with a history of lupus, heart failure, history of mini-stroke, and anxiety was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]; (5) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the cancer doctor in 1 week.",Gastroenterology,Discharge Summary,high
2767,CT Head without contrast: Acute ischemic infarct in R MCA territory. No acute intracranial hemorrhage. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is no bleeding in the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
2768,"Rx: Tab atorvastatin 80mg QHS. Tab Dulcolax 10mg QHS PRN. Tab potassium chloride 20mEq daily. Tab clopidogrel 75mg daily. Adv: low potassium diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
2769,Rx: Tab atorvastatin 80mg QHS. Tab ciprofloxacin 500mg BID x 5 days. Adv: wound care with daily dressing changes. F/U PCP in 1 week for BP recheck.,"Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
2770,"Rx: Tab montelukast 10mg QHS. Tab timolol 0.5% OU BID. Tab sertraline 50mg daily. Tab ibuprofen 400mg Q6H PRN with food. Tab ondansetron 4mg Q8H PRN N/V. Adv: DASH diet, daily BP monitoring Do not stop abruptly, taper as directed. F/U 6 weeks with LFTs.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (5) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 6 weeks for liver function blood tests.",General,Prescription,high
2771,Delivery Note: G?P? at 37+3 weeks. SVD. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2772,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
2773,"LFTs: AST 449 (H), ALT 294 (H), ALP 290, T.Bili 3.7 (H), Albumin 2.4.","Your liver blood test results: Liver enzymes (AST 449, ALT 294) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 3.7 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.4 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
2774,"Rx: Tab methotrexate 15mg weekly. Tab hydroxychloroquine 200mg BID. Tab metformin 500mg BID. Lantus 20U QHS. Adv: wound care with daily dressing changes Adv: fall precautions, home safety evaluation. F/U 1 week with wound check.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. (4) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week to have the wound checked.",Endocrinology,Prescription,high
2775,CT Head without contrast: No mass effect. Acute ischemic infarct in R MCA territory. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
2776,Procedure: R TKA. Pt 57 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 57-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2777,"73 y/o M with PMH of OA, CHF, DVT/PE on warfarin, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on timolol 0.5% OU BID, rosuvastatin 10mg QHS, albuterol MDI 2 puffs Q4-6H PRN. F/U neurology in 2 weeks.","A 73-year-old man with a history of arthritis [osteoarthritis], heart failure, and blood clots [on blood thinner warfarin] was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
2778,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2779,HbA1c: 8.3% (H). FBS: 115 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.3%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 115, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
2780,"40 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 40-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
2781,"75 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 75-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2782,"US Abdomen: GB sludge, no stones. CBD 5mm, not dilated. Ascites moderate amount. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. The bile duct is normal size [not blocked]. There is a moderate amount of fluid in the belly [ascites]. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
2783,"68 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 68-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
2784,CT Head without contrast: Acute ischemic infarct in R MCA territory. Paranasal sinuses clear. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The sinuses are clear with no infection. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
2785,"63 y/o F with PMH of CAD, OA, HLD, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Strict I&O, daily weights. D/C on warfarin 5mg daily, lisinopril 20mg daily, furosemide 40mg daily, latanoprost 0.005% OU QHS, metformin 1000mg BID. F/U wound care in 3 days.","A 63-year-old woman with a history of coronary artery disease [heart artery blockages], arthritis [osteoarthritis], and high cholesterol was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (5) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up at the wound care clinic in 3 days.",Endocrinology,Discharge Summary,high
2786,"22 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 22-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2787,HbA1c: 9.8% (H). FBS: 248 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.8%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 248, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
2788,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,low
2789,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
2790,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. Chronic lacunar infarcts in bilateral basal ganglia. No midline shift. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides. There are signs of small old strokes in the deep parts of the brain. The brain is centered normally. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
2791,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
2792,"22 y/o M with PMH of HFrEF (EF 30%), h/o CVA, DVT/PE on warfarin, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on metformin 500mg BID, entresto 49/51mg BID, ibuprofen 400mg Q6H PRN with food. F/U PCP in 2 weeks.","A 22-year-old man with a history of heart failure with weak pumping (30%), history of stroke, and blood clots [on blood thinner warfarin] was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
2793,"Rx: Tab carvedilol 12.5mg BID. Tab rosuvastatin 10mg QHS. Adv: smoking cessation, pulmonary rehab Avoid NSAIDs. F/U 2 weeks with INR.",Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,medium
2794,"39 y/o M with PMH of PPM in situ, HFrEF (EF 30%), DVT/PE on warfarin, s/p TKR, cirrhosis, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on glipizide 5mg BID AC, Lantus 20U QHS, ciprofloxacin 500mg BID x 5 days. F/U endocrine in 1 week.","A 39-year-old man with a history of implanted pacemaker, heart failure with weak pumping (30%), blood clots [on blood thinner warfarin], prior knee replacement, and liver scarring [cirrhosis] was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Follow-up with the hormone/diabetes doctor in 1 week.",Urology,Discharge Summary,high
2795,"55 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 55-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2796,"LFTs: AST 140 (H), ALT 272 (H), ALP 65, T.Bili 6.6 (H), Albumin 3.9.","Your liver blood test results: Liver enzymes (AST 140, ALT 272) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.6 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.9.",Gastroenterology,Lab Result,high
2797,CXR PA: Sternotomy wires intact. Port-a-cath in appropriate position. No pneumothorax. Left lower lobe consolidation. Right lower lobe consolidation.,"Chest X-ray results: The wires from prior heart surgery are intact. The implanted medication port is in the correct position. There is no collapsed lung. There is an area in the lower left lung that appears infected. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
2798,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab sertraline 50mg daily. Adv: low salt low sugar diet, regular exercise Adv: high fiber diet, adequate hydration. F/U 1 month with repeat imaging.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 month — a repeat scan will be ordered.",Psychiatry,Prescription,medium
2799,"64 y/o M with PMH of RA on MTX, ESRD on HD, s/p CABG, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on Lantus 20U QHS, Augmentin 875/125 BID x 7 days. F/U cardiology in 2 weeks.","A 64-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], kidney failure requiring dialysis, and prior heart bypass surgery was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the heart doctor in 2 weeks.",Pulmonology,Discharge Summary,high
2800,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,high
2801,Procedure: Laparoscopic appendectomy. Pt 31 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 31-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2802,"Rx: Tab furosemide 40mg daily. Tab gabapentin 300mg TID. Adv: fall precautions, home safety evaluation. F/U 1 week with wound check.","Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
2803,"Thyroid panel: TSH 13.81 (H), Free T4 2.1.","Your thyroid test results: TSH is elevated at 13.81 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2804,"46 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 46-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2805,Procedure: EGD with biopsy. Pt 49 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 49-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
2806,"Lipid panel: TC 170, LDL 123, HDL 34, TG 192.","Your cholesterol results: Total cholesterol is 170. LDL (bad cholesterol) is high at 123 (goal under 100). HDL (good cholesterol) is too low at 34 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are high at 192.",Cardiology,Lab Result,high
2807,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. No mass effect. Acute ischemic infarct in R MCA territory. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
2808,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,high
2809,"58 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 58-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2810,"75 y/o F with PMH of osteoporosis, ESRD on HD, OSA on CPAP, DVT/PE on warfarin, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Strict I&O, daily weights. D/C on acetaminophen 650mg Q6H PRN, prednisone taper, azithromycin 500mg day 1 then 250mg x 4 days. F/U PCP in 1 week.","A 75-year-old woman with a history of weak bones [osteoporosis], kidney failure requiring dialysis, sleep apnea [uses a breathing machine at night], and blood clots [on blood thinner warfarin] was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the primary care doctor in 1 week.",Cardiology,Discharge Summary,high
2811,"BMP: Na 133 (L), K 4.3 (N), BUN 26, Cr 5.8 (H), Glucose 91.","Your blood chemistry results: Sodium is low at 133 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.3. Creatinine is elevated at 5.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 91 (normal).",Nephrology,Lab Result,high
2812,"65 y/o F with PMH of PPM in situ, s/p CABG, HTN, ESRD on HD, HFpEF, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on atorvastatin 40mg QHS, glipizide 5mg BID AC, Augmentin 875/125 BID x 7 days, metoprolol succinate 50mg daily. F/U cardiology in 2 weeks.","A 65-year-old woman with a history of implanted pacemaker, prior heart bypass surgery, high blood pressure, kidney failure requiring dialysis, and heart failure with stiff heart muscle was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the heart doctor in 2 weeks.",General Surgery,Discharge Summary,high
2813,"84 y/o M with PMH of DM2, CKD Stage 4, HLD, s/p CABG, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on amlodipine 10mg daily, spironolactone 25mg daily, furosemide 40mg BID. F/U surgery in 2 weeks for drain removal.","A 84-year-old man with a history of type 2 diabetes, advanced kidney disease, high cholesterol, and prior heart bypass surgery was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) furosemide (Lasix) 40mg twice daily [water pill]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
2814,"59 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 59-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2815,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
2816,CT Head without contrast: Paranasal sinuses clear. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. 4cm right subdural hematoma with 5mm midline shift. No mass effect. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: The sinuses are clear with no infection. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
2817,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab methotrexate 15mg weekly. Tab ondansetron 4mg Q8H PRN N/V. Avoid grapefruit juice. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Do not drink grapefruit juice as it interferes with this medication. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Infectious Disease,Prescription,medium
2818,Rx: Tab amlodipine 5mg daily. Tab entresto 49/51mg BID. Avoid NSAIDs. F/U PCP in 1 week for BP recheck.,Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) Entresto 49/51mg twice daily [heart failure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
2819,"35 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 35-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2820,"CBC: WBC 7.2 (N), Hgb 7.0 (L), Plt 73 (L).","Your blood count results: White blood cells are 7.2 (normal). Hemoglobin is low at 7.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 73, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
2821,"Lipid panel: TC 189, LDL 154, HDL 80, TG 70.",Your cholesterol results: Total cholesterol is 189. LDL (bad cholesterol) is high at 154 (goal under 100). HDL (good cholesterol) is good at 80. Triglycerides are normal at 70.,Cardiology,Lab Result,high
2822,"70 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 70-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2823,"Lipid panel: TC 290, LDL 68, HDL 40, TG 324.",Your cholesterol results: Total cholesterol is 290. LDL (bad cholesterol) is at goal (68). HDL (good cholesterol) is good at 40. Triglycerides are very high at 324 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
2824,Rx: Humalog per SSI. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab metformin 1000mg BID. Avoid grapefruit juice. F/U PCP in 1 week for BP recheck.,"Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. Do not drink grapefruit juice as it interferes with this medication. See your primary care doctor in 1 week to recheck blood pressure.",Endocrinology,Prescription,medium
2825,"55 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 55-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2826,CXR PA: Right lower lobe consolidation. Bilateral pleural effusions. Mild cardiomegaly. Bilateral hilar lymphadenopathy. Port-a-cath in appropriate position.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. There is fluid collecting around both lungs. The heart is slightly larger than normal. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The implanted medication port is in the correct position.",Pulmonology,Radiology Report,high
2827,CT Head without contrast: No midline shift. Paranasal sinuses clear. No acute intracranial hemorrhage.,CT scan of the head results: The brain is centered normally. The sinuses are clear with no infection. There is no bleeding in the brain.,Neurology,Radiology Report,high
2828,"Rx: Humalog per SSI. Tab atorvastatin 40mg QHS. Adv: SMBG BID, diabetic diet. F/U 1 month with repeat imaging.",Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,medium
2829,"51 y/o F with PMH of PAD, HLD, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on metformin 500mg BID, entresto 49/51mg BID. F/U orthopedics in 6 weeks with X-ray.","A 51-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], and high cholesterol was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
2830,"CBC: WBC 20.7 (H), Hgb 8.2 (L), Plt 403 (H).","Your blood count results: White blood cells are 20.7 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 8.2, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 403, which is high — your blood may clot too easily.",Hematology,Lab Result,high
2831,Procedure: ORIF L distal radius. Pt 60 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 60-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2832,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
2833,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab clopidogrel 75mg daily. Adv: fall precautions, home safety evaluation. F/U 1 week with wound check.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
2834,Rx: Tab omeprazole 20mg AC breakfast. Tab lisinopril 20mg daily. Tab pregabalin 75mg BID. Tab spironolactone 25mg daily. Tab lisinopril 10mg daily. Avoid grapefruit juice. F/U 2 weeks.,Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) lisinopril 20mg once daily [blood pressure medicine]. (3) pregabalin 75mg twice daily [nerve pain medicine]. (4) spironolactone 25mg once daily [heart-protecting water pill]. (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Do not drink grapefruit juice as it interferes with this medication. Come back for a check-up in 2 weeks.,Cardiology,Prescription,high
2835,"US Abdomen: Ascites moderate amount. Spleen 11cm, normal. GB wall thickening with stones, positive Murphy's sign. No focal hepatic lesion. GB sludge, no stones.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. The spleen is a normal size. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. No tumors or masses were found in the liver. The gallbladder contains thickened bile [sludge] but no stones.",Gastroenterology,Radiology Report,high
2836,"Rx: Tab timolol 0.5% OU BID. Spiriva 18mcg daily. Do not stop abruptly, taper as directed. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (2) Spiriva inhaler once daily [long-acting lung medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Pulmonology,Prescription,medium
2837,"22 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 22-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2838,"90 y/o F with PMH of COPD, RA on MTX, gout, ESRD on HD, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on calcium + vitamin D 600/400 daily, furosemide 40mg daily. F/U GI in 1 week.","A 90-year-old woman with a history of chronic lung disease, rheumatoid arthritis [on immune-suppressing medicine], gout, and kidney failure requiring dialysis was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) calcium plus vitamin D once daily [bone strengthening]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Follow-up with the stomach doctor in 1 week.",Neurology,Discharge Summary,high
2839,"69 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 69-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2840,"Rx: Tab latanoprost 0.005% OU QHS. Tab clopidogrel 75mg daily. Tab ferrous sulfate 325mg BID. Tab Dulcolax 10mg QHS PRN. Tab lisinopril 10mg daily. Adv: elevate affected limb, compression stockings Avoid NSAIDs. F/U 2 weeks.",Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: keep the affected leg elevated when resting and wear compression stockings Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back for a check-up in 2 weeks.,Cardiology,Prescription,high
2841,"Rx: Humalog per SSI. Tab furosemide 40mg BID. Do not stop abruptly, taper as directed. F/U 6 weeks with LFTs.",Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) furosemide (Lasix) 40mg twice daily [water pill]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,medium
2842,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
2843,"32 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 32-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2844,Procedure: PCI with DES to LAD. Pt 60 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 60-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
2845,"Rx: prednisone taper. Tab levothyroxine 75mcg daily on empty stomach. Tab metoprolol succinate 50mg daily. Tab entresto 49/51mg BID. Tab escitalopram 10mg daily. Adv: fall precautions, home safety evaluation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (4) Entresto 49/51mg twice daily [heart failure medicine]. (5) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
2846,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
2847,CXR PA: Compression fracture T12. Hyperinflated lungs consistent with COPD. No cardiomegaly.,"Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The heart is a normal size.",Pulmonology,Radiology Report,high
2848,"BMP: Na 131 (L), K 6.5 (H), BUN 64, Cr 6.0 (H), Glucose 92.","Your blood chemistry results: Sodium is low at 131 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.5 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 6.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 92 (normal).",Nephrology,Lab Result,high
2849,"51 y/o F with PMH of Parkinson's disease, HFpEF, s/p CABG, HTN, asthma, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Strict I&O, daily weights. D/C on amlodipine 5mg daily, clopidogrel 75mg daily, ibuprofen 400mg Q6H PRN with food, Dulcolax 10mg QHS PRN. F/U neurology in 2 weeks.","A 51-year-old woman with a history of Parkinson's disease, heart failure with stiff heart muscle, prior heart bypass surgery, high blood pressure, and asthma was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the brain/nerve doctor in 2 weeks.",Nephrology,Discharge Summary,high
2850,"US Abdomen: Spleen 16cm, splenomegaly. Right kidney 10.5cm, no hydronephrosis. Spleen 11cm, normal. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: The spleen is enlarged [splenomegaly]. Right kidney is normal size with no blockage. The spleen is a normal size. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
2851,MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. C5-C6 disc herniation with cord compression. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
2852,"39 y/o F with PMH of DVT/PE on warfarin, CHF, s/p THR, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on albuterol MDI 2 puffs Q4-6H PRN, metformin 1000mg BID, ASA 81mg daily, hydroxychloroquine 200mg BID, omeprazole 20mg AC breakfast. F/U surgery in 10 days.","A 39-year-old woman with a history of blood clots [on blood thinner warfarin], heart failure, and prior hip replacement was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) baby aspirin 81mg once daily [prevents blood clots]; (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (5) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the surgeon in 10 days.",Orthopedics,Discharge Summary,high
2853,"Rx: Tab lisinopril 20mg daily. Tab methotrexate 15mg weekly. Tab sertraline 50mg daily. Adv: fall precautions, home safety evaluation Adv: avoid alcohol, hepatotoxic drugs. F/U 1 week with wound check.","Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
2854,CXR PA: Right lower lobe consolidation. Hyperinflated lungs consistent with COPD. Patchy bilateral infiltrates.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There are scattered cloudy patches in both lungs suggesting infection or inflammation.",Pulmonology,Radiology Report,high
2855,"Rx: Tab latanoprost 0.005% OU QHS. Tab potassium chloride 20mEq daily. Tab empagliflozin 10mg daily. Tab hydroxychloroquine 200mg BID. Adv: low salt low sugar diet, regular exercise. F/U 1 month with repeat imaging.","Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 month — a repeat scan will be ordered.",Endocrinology,Prescription,high
2856,"22 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 22-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
2857,"LFTs: AST 115 (H), ALT 571 (H), ALP 270, T.Bili 3.7 (H), Albumin 4.1.","Your liver blood test results: Liver enzymes (AST 115, ALT 571) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 3.7 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.1.",Gastroenterology,Lab Result,high
2858,"LFTs: AST 500 (H), ALT 341 (H), ALP 134, T.Bili 2.8 (H), Albumin 4.6.","Your liver blood test results: Liver enzymes (AST 500, ALT 341) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 2.8 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.6.",Gastroenterology,Lab Result,high
2859,"Thyroid panel: TSH 3.74 (N), Free T4 0.7.",Your thyroid test results: TSH is normal at 3.74. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
2860,"Rx: Tab escitalopram 10mg daily. Tab Augmentin 875/125 BID x 7 days. Tab sertraline 50mg daily. Do not stop abruptly, taper as directed Adv: high fiber diet, adequate hydration. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Psychiatry,Prescription,medium
2861,Procedure: PCI with DES to LAD. Pt 54 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 54-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
2862,"45 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 45-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2863,"Thyroid panel: TSH 3.88 (N), Free T4 1.0.",Your thyroid test results: TSH is normal at 3.88. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
2864,"91 y/o F with PMH of s/p TKR, HLD, anemia, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on albuterol MDI 2 puffs Q4-6H PRN, ibuprofen 400mg Q6H PRN with food, levothyroxine 75mcg daily on empty stomach, prednisone taper, empagliflozin 10mg daily. F/U INR check in 3 days.","A 91-year-old woman with a history of prior knee replacement, high cholesterol, and low blood count [anemia] was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (5) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
2865,"LFTs: AST 253 (H), ALT 470 (H), ALP 37, T.Bili 6.7 (H), Albumin 1.8.","Your liver blood test results: Liver enzymes (AST 253, ALT 470) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.7 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 1.8 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
2866,"63 y/o M with PMH of h/o TIA, CKD Stage 4, s/p THR, OA, SLE, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on losartan 50mg daily, azithromycin 500mg day 1 then 250mg x 4 days, hydroxychloroquine 200mg BID, methotrexate 15mg weekly, amlodipine 5mg daily. F/U hematology in 2 weeks.","A 63-year-old man with a history of history of mini-stroke, advanced kidney disease, prior hip replacement, arthritis [osteoarthritis], and lupus was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (5) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Endocrinology,Discharge Summary,high
2867,"Rx: Tab furosemide 40mg BID. Spiriva 18mcg daily. Tab Eliquis 5mg BID. Tab atorvastatin 40mg QHS. Adv: smoking cessation, pulmonary rehab Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with CBC, CMP.","Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) Eliquis 5mg twice daily [blood thinner]. (4) atorvastatin 40mg at bedtime [cholesterol medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
2868,"78 y/o F with PMH of depression, OA, s/p THR, HLD, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on amlodipine 5mg daily, acetaminophen 650mg Q6H PRN. F/U oncology in 1 week.","A 78-year-old woman with a history of depression, arthritis [osteoarthritis], prior hip replacement, and high cholesterol was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the cancer doctor in 1 week.",Pulmonology,Discharge Summary,high
2869,"40 y/o F with PMH of asthma, anemia, COPD, HLD, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on ondansetron 4mg Q8H PRN N/V, Augmentin 875/125 BID x 7 days, amoxicillin 500mg TID x 10 days. F/U nephrology in 1 week.","A 40-year-old woman with a history of asthma, low blood count [anemia], chronic lung disease, and high cholesterol was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the kidney doctor in 1 week.",Infectious Disease,Discharge Summary,high
2870,"47 y/o M with PMH of GERD, asthma, SLE, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on azithromycin 500mg day 1 then 250mg x 4 days, metformin 500mg BID. F/U PCP in 2 weeks.","A 47-year-old man with a history of acid reflux, asthma, and lupus was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the primary care doctor in 2 weeks.",Neurology,Discharge Summary,high
2871,CXR PA: Small left pleural effusion. Pacemaker leads in appropriate position. ET tube 3cm above carina. Patchy bilateral infiltrates.,Chest X-ray results: There is a small amount of fluid around the left lung. The pacemaker wires are in the correct position. The breathing tube is in good position. There are scattered cloudy patches in both lungs suggesting infection or inflammation.,Pulmonology,Radiology Report,high
2872,CT Head without contrast: Acute ischemic infarct in R MCA territory. Paranasal sinuses clear. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The sinuses are clear with no infection. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
2873,HbA1c: 6.2% (H). FBS: 116 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.2%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 116, which is high (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,high
2874,"LFTs: AST 417 (H), ALT 553 (H), ALP 284, T.Bili 1.8 (H), Albumin 4.2.","Your liver blood test results: Liver enzymes (AST 417, ALT 553) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.8. Albumin is normal at 4.2.",Gastroenterology,Lab Result,high
2875,"CBC: WBC 4.7 (N), Hgb 11.0 (L), Plt 282 (N).","Your blood count results: White blood cells are 4.7 (normal). Hemoglobin is low at 11.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 282, which is normal.",Hematology,Lab Result,high
2876,Procedure: Port-a-cath placement. Pt 28 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 28-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
2877,"58 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 58-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
2878,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab entresto 49/51mg BID. Tab Dulcolax 10mg QHS PRN. Adv: DASH diet, daily BP monitoring. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",General,Prescription,medium
2879,"52 y/o M with PMH of s/p TKR, HTN, SLE, CHF, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on pregabalin 75mg BID, atorvastatin 40mg QHS. F/U surgery in 2 weeks for drain removal.","A 52-year-old man with a history of prior knee replacement, high blood pressure, lupus, and heart failure was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Nephrology,Discharge Summary,high
2880,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
2881,"LFTs: AST 55 (H), ALT 330 (H), ALP 288, T.Bili 4.4 (H), Albumin 1.6.","Your liver blood test results: Liver enzymes (AST 55, ALT 330) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 4.4 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 1.6 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
2882,CT Head without contrast: No mass effect. No acute intracranial hemorrhage. Chronic lacunar infarcts in bilateral basal ganglia.,CT scan of the head results: There are no tumors or masses pushing on the brain. There is no bleeding in the brain. There are signs of small old strokes in the deep parts of the brain.,Neurology,Radiology Report,high
2883,"38 y/o F with PMH of HFrEF (EF 30%), anemia, CKD Stage 3, COPD, A-fib, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on atorvastatin 80mg QHS, rosuvastatin 10mg QHS. F/U oncology in 1 week.","A 38-year-old woman with a history of heart failure with weak pumping (30%), low blood count [anemia], moderate kidney disease, chronic lung disease, and irregular heartbeat [atrial fibrillation] was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the cancer doctor in 1 week.",General Surgery,Discharge Summary,high
2884,"US Abdomen: CBD 12mm, dilated. No focal hepatic lesion. Ascites moderate amount. Pancreas unremarkable. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. No tumors or masses were found in the liver. There is a moderate amount of fluid in the belly [ascites]. The pancreas looks normal. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
2885,"48 y/o M with PMH of PPM in situ, OSA on CPAP, HTN, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on timolol 0.5% OU BID, entresto 49/51mg BID, atorvastatin 40mg QHS, lisinopril 10mg daily, atorvastatin 80mg QHS. F/U nephrology in 5 days.","A 48-year-old man with a history of implanted pacemaker, sleep apnea [uses a breathing machine at night], and high blood pressure was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]; (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (5) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the kidney doctor in 5 days.",Hematology,Discharge Summary,high
2886,"88 y/o F with PMH of anxiety, depression, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on metoprolol succinate 50mg daily, amoxicillin 500mg TID x 10 days, Spiriva 18mcg daily, Humalog per SSI. F/U nephrology in 1 week.","A 88-year-old woman with a history of anxiety, and depression was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) Spiriva inhaler once daily [long-acting lung medicine]; (4) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the kidney doctor in 1 week.",Cardiology,Discharge Summary,high
2887,Rx: Tab calcium + vitamin D 600/400 daily. Tab lisinopril 10mg daily. Adv: wound care with daily dressing changes. F/U 1 week with wound check.,"Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
2888,"BMP: Na 144 (N), K 3.1 (L), BUN 5, Cr 0.8 (N), Glucose 258.",Your blood chemistry results: Sodium is normal at 144. Potassium is low at 3.1 — may cause muscle weakness and heart rhythm issues. Creatinine is normal at 0.8. Blood sugar is 258 (high).,Nephrology,Lab Result,high
2889,"Rx: Tab spironolactone 25mg daily. Tab entresto 49/51mg BID. Tab ASA 81mg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab metformin 1000mg BID. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks with INR.",Your medicines: (1) spironolactone 25mg once daily [heart-protecting water pill]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) baby aspirin 81mg once daily [prevents blood clots]. (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (5) metformin 1000mg twice daily with meals [blood sugar medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
2890,"BMP: Na 139 (N), K 4.5 (N), BUN 57, Cr 1.4 (H), Glucose 317.",Your blood chemistry results: Sodium is normal at 139. Potassium is normal at 4.5. Creatinine is mildly elevated at 1.4. Blood sugar is 317 (high).,Nephrology,Lab Result,high
2891,"85 y/o F with PMH of anemia, DM2, OSA on CPAP, osteoporosis, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on tramadol 50mg Q6H PRN pain, losartan 50mg daily, Eliquis 5mg BID, amlodipine 5mg daily. F/U endocrine in 1 week.","A 85-year-old woman with a history of low blood count [anemia], type 2 diabetes, sleep apnea [uses a breathing machine at night], and weak bones [osteoporosis] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) losartan 50mg once daily [blood pressure medicine]; (3) Eliquis 5mg twice daily [blood thinner]; (4) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Nephrology,Discharge Summary,high
2892,"Rx: Lantus 20U QHS. Humalog per SSI. Tab rosuvastatin 10mg QHS. Tab furosemide 40mg BID. Adv: elevate affected limb, compression stockings. F/U 2 weeks with INR.",Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) furosemide (Lasix) 40mg twice daily [water pill]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
2893,"49 y/o M with PMH of DM1, gout, CHF, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on glipizide 5mg BID AC, latanoprost 0.005% OU QHS, azithromycin 500mg day 1 then 250mg x 4 days, rosuvastatin 10mg QHS, Augmentin 875/125 BID x 7 days. F/U pulmonology in 2 weeks.","A 49-year-old man with a history of type 1 diabetes, gout, and heart failure was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]; (5) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the lung doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
2894,HbA1c: 6.9% (H). FBS: 380 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.9%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 380, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
2895,HbA1c: 6.8% (H). FBS: 149 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.8%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 149, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
2896,"34 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 34-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2897,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
2898,"Rx: Tab losartan 50mg daily. Tab ASA 81mg daily. Adv: low salt diet, fluid restriction 1.5L/day. F/U INR in 3 days.",Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,medium
2899,"42 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 42-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2900,"US Abdomen: No focal hepatic lesion. Left kidney 8cm, cortical thinning consistent with CKD. Spleen 16cm, splenomegaly. Moderate right hydronephrosis.","Abdominal ultrasound results: No tumors or masses were found in the liver. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The spleen is enlarged [splenomegaly]. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage.",Gastroenterology,Radiology Report,high
2901,"75 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 75-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
2902,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab montelukast 10mg QHS. Tab timolol 0.5% OU BID. Tab carvedilol 12.5mg BID. Adv: low salt diet, fluid restriction 1.5L/day Adv: low salt low sugar diet, regular exercise. F/U PCP in 1 week for BP recheck.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (4) carvedilol 12.5mg twice daily [heart medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: eat less salt and sugar, and exercise at least 30 minutes most days. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
2903,"Thyroid panel: TSH 11.39 (H), Free T4 2.9.","Your thyroid test results: TSH is elevated at 11.39 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2904,"49 y/o M with PMH of ESRD on HD, s/p CABG, HTN, A-fib, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on escitalopram 10mg daily, ferrous sulfate 325mg BID, levothyroxine 75mcg daily on empty stomach. F/U oncology in 1 week.","A 49-year-old man with a history of kidney failure requiring dialysis, prior heart bypass surgery, high blood pressure, and irregular heartbeat [atrial fibrillation] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the cancer doctor in 1 week.",Orthopedics,Discharge Summary,high
2905,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
2906,"55 y/o M with PMH of COPD, s/p CABG, depression, CKD Stage 4, OA, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on losartan 50mg daily, lisinopril 20mg daily, metformin 500mg BID. F/U endocrine in 1 week.","A 55-year-old man with a history of chronic lung disease, prior heart bypass surgery, depression, advanced kidney disease, and arthritis [osteoarthritis] was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
2907,"Lipid panel: TC 156, LDL 63, HDL 61, TG 253.",Your cholesterol results: Total cholesterol is 156. LDL (bad cholesterol) is at goal (63). HDL (good cholesterol) is good at 61. Triglycerides are high at 253.,Cardiology,Lab Result,high
2908,"Thyroid panel: TSH 8.33 (H), Free T4 1.4.","Your thyroid test results: TSH is elevated at 8.33 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
2909,"Thyroid panel: TSH 3.89 (N), Free T4 1.7.",Your thyroid test results: TSH is normal at 3.89. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
2910,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
2911,"45 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 45-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2912,"CBC: WBC 6.3 (N), Hgb 11.0 (L), Plt 60 (L).","Your blood count results: White blood cells are 6.3 (normal). Hemoglobin is low at 11.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 60, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
2913,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,high
2914,"Rx: Tab Eliquis 5mg BID. Tab atorvastatin 80mg QHS. Tab clopidogrel 75mg daily. Tab amoxicillin 500mg TID x 10 days. Do not stop abruptly, taper as directed Adv: weight bearing exercise, calcium/vit D supplementation. F/U INR in 3 days.","Your medicines: (1) Eliquis 5mg twice daily [blood thinner]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
2915,"LFTs: AST 210 (H), ALT 545 (H), ALP 83, T.Bili 0.8 (N), Albumin 4.0.","Your liver blood test results: Liver enzymes (AST 210, ALT 545) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is normal at 0.8. Albumin is normal at 4.0.",Gastroenterology,Lab Result,high
2916,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
2917,"Lipid panel: TC 209, LDL 68, HDL 44, TG 68.",Your cholesterol results: Total cholesterol is 209. LDL (bad cholesterol) is at goal (68). HDL (good cholesterol) is good at 44. Triglycerides are normal at 68.,Cardiology,Lab Result,medium
2918,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
2919,"22 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 22-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
2920,"CBC: WBC 5.7 (N), Hgb 12.3 (N), Plt 163 (N).","Your blood count results: White blood cells are 5.7 (normal). Hemoglobin is normal at 12.3. Platelets are 163, which is normal.",Hematology,Lab Result,medium
2921,CXR PA: Clear lung fields bilaterally. Right-sided pneumothorax. Pacemaker leads in appropriate position. Port-a-cath in appropriate position.,Chest X-ray results: Both lungs look clear with no problems. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The pacemaker wires are in the correct position. The implanted medication port is in the correct position.,Pulmonology,Radiology Report,high
2922,CT Head without contrast: No mass effect. No acute intracranial hemorrhage. Acute ischemic infarct in R MCA territory. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is no bleeding in the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
2923,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab furosemide 40mg BID. Adv: SMBG BID, diabetic diet. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) furosemide (Lasix) 40mg twice daily [water pill]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
2924,"CBC: WBC 12.5 (H), Hgb 17.0 (N), Plt 265 (N).","Your blood count results: White blood cells are 12.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 17.0. Platelets are 265, which is normal.",Hematology,Lab Result,high
2925,Procedure: ORIF L distal radius. Pt 81 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 81-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
2926,Procedure: TURP for BPH. Pt 73 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 73-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
2927,"73 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 73-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
2928,CXR PA: Bilateral pleural effusions. Sternotomy wires intact. Patchy bilateral infiltrates.,Chest X-ray results: There is fluid collecting around both lungs. The wires from prior heart surgery are intact. There are scattered cloudy patches in both lungs suggesting infection or inflammation.,Pulmonology,Radiology Report,high
2929,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
2930,"85 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 85-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
2931,"Rx: Tab empagliflozin 10mg daily. Tab metoprolol succinate 50mg daily. Tab ciprofloxacin 500mg BID x 5 days. Tab levothyroxine 75mcg daily on empty stomach. Adv: fall precautions, home safety evaluation Adv: DASH diet, daily BP monitoring. F/U 1 month with repeat imaging.","Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 month — a repeat scan will be ordered.",Endocrinology,Prescription,high
2932,"Rx: Tab metformin 500mg BID. Tab metoprolol 25mg BID. Adv: low salt diet, fluid restriction 1.5L/day. F/U 1 week with wound check.",Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 1 week to have the wound checked.,Cardiology,Prescription,medium
2933,"69 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 69-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2934,CXR PA: Elevated left hemidiaphragm. Pacemaker leads in appropriate position. Clear lung fields bilaterally. Osseous structures intact. No cardiomegaly.,Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. The pacemaker wires are in the correct position. Both lungs look clear with no problems. The bones look normal with no fractures. The heart is a normal size.,Pulmonology,Radiology Report,high
2935,Rx: Tab calcium + vitamin D 600/400 daily. Tab tramadol 50mg Q6H PRN pain. Tab hydroxychloroquine 200mg BID. Avoid grapefruit juice. F/U 1 week with wound check.,Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Do not drink grapefruit juice as it interferes with this medication. Come back in 1 week to have the wound checked.,General,Prescription,medium
2936,"Rx: Tab Dulcolax 10mg QHS PRN. Tab glipizide 5mg BID AC. Tab Xarelto 20mg daily with dinner. Adv: fall precautions, home safety evaluation. F/U 1 week with CBC, CMP.","Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) glipizide 5mg twice daily before meals [helps release insulin]. (3) Xarelto 20mg once daily with dinner [blood thinner]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,medium
2937,CXR PA: Port-a-cath in appropriate position. No pneumothorax. Bilateral pleural effusions.,Chest X-ray results: The implanted medication port is in the correct position. There is no collapsed lung. There is fluid collecting around both lungs.,Pulmonology,Radiology Report,high
2938,"59 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 59-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
2939,Delivery Note: G?P? at 40+0 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2940,Procedure: TURP for BPH. Pt 38 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 38-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
2941,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
2942,"86 y/o M with PMH of gout, RA on MTX, obesity (BMI 38), admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on warfarin 5mg daily, amlodipine 5mg daily, levothyroxine 75mcg daily on empty stomach. F/U PCP in 1 week.","A 86-year-old man with a history of gout, rheumatoid arthritis [on immune-suppressing medicine], and obesity was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) amlodipine 5mg once daily [blood pressure medicine]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the primary care doctor in 1 week.",Pulmonology,Discharge Summary,high
2943,MRI Lumbar Spine: No compression fracture. L5-S1 disc desiccation with mild bulge.,"MRI of the lower back results: No bones are broken or collapsed. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
2944,"35 y/o M with PMH of HFpEF, HFrEF (EF 30%), SLE, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on Augmentin 875/125 BID x 7 days, amlodipine 10mg daily, metformin 1000mg BID. F/U INR check in 3 days.","A 35-year-old man with a history of heart failure with stiff heart muscle, heart failure with weak pumping (30%), and lupus was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
2945,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,high
2946,"Rx: Tab montelukast 10mg QHS. Tab amlodipine 5mg daily. Do not stop abruptly, taper as directed Adv: DASH diet, daily BP monitoring. F/U PCP in 1 week for BP recheck.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
2947,"Rx: Lantus 20U QHS. Tab calcium + vitamin D 600/400 daily. Tab ferrous sulfate 325mg BID. Tab atorvastatin 80mg QHS. Tab metformin 500mg BID. Adv: fall precautions, home safety evaluation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) calcium plus vitamin D once daily [bone strengthening]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (5) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Endocrinology,Prescription,high
2948,"US Abdomen: Right kidney 10.5cm, no hydronephrosis. CBD 5mm, not dilated. Spleen 16cm, splenomegaly. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: Right kidney is normal size with no blockage. The bile duct is normal size [not blocked]. The spleen is enlarged [splenomegaly]. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
2949,"MRI Lumbar Spine: Conus medullaris at L1, normal. Multilevel degenerative disc disease. C5-C6 disc herniation with cord compression.","MRI of the lower back results: The spinal cord ends at a normal level. Multiple discs in the spine are showing wear and aging. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
2950,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. No midline shift. Paranasal sinuses clear. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. The brain is centered normally. The sinuses are clear with no infection. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
2951,"Lipid panel: TC 120, LDL 93, HDL 68, TG 161.",Your cholesterol results: Total cholesterol is 120. LDL (bad cholesterol) is at goal (93). HDL (good cholesterol) is good at 68. Triglycerides are high at 161.,Cardiology,Lab Result,high
2952,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
2953,"41 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 41-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
2954,Procedure: Laparoscopic appendectomy. Pt 73 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 73-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2955,"46 y/o F with PMH of SLE, DM1, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Compression stockings when ambulating. D/C on methotrexate 15mg weekly, gabapentin 300mg TID. F/U wound care in 3 days.","A 46-year-old woman with a history of lupus, and type 1 diabetes was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up at the wound care clinic in 3 days.",Orthopedics,Discharge Summary,high
2956,"72 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 72-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2957,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Lantus 20U QHS. Tab amlodipine 10mg daily. Tab metformin 1000mg BID. Tab ASA 81mg daily. Adv: SMBG BID, diabetic diet. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) Lantus insulin 20 units at bedtime [long-acting insulin]. (3) amlodipine 10mg once daily [blood pressure medicine]. (4) metformin 1000mg twice daily with meals [blood sugar medicine]. (5) baby aspirin 81mg once daily [prevents blood clots]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Endocrinology,Prescription,high
2958,"CBC: WBC 18.4 (H), Hgb 10.4 (L), Plt 399 (N).","Your blood count results: White blood cells are 18.4 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 10.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 399, which is normal.",Hematology,Lab Result,high
2959,"US Abdomen: Ascites moderate amount. No focal hepatic lesion. Simple renal cysts bilaterally. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Left kidney 8cm, cortical thinning consistent with CKD.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. No tumors or masses were found in the liver. Both kidneys have harmless fluid-filled cysts. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. Left kidney is small with thin outer layer, consistent with chronic kidney disease.",Gastroenterology,Radiology Report,high
2960,"55 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 55-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
2961,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab Xarelto 20mg daily with dinner. prednisone taper. Tab tramadol 50mg Q6H PRN pain. Adv: SMBG BID, diabetic diet. F/U INR in 3 days.",Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 3 days for a blood thinner level check [INR].,Infectious Disease,Prescription,high
2962,"60 y/o M with PMH of BPH, ICD in situ, h/o TIA, GERD, s/p CABG, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Low potassium diet. D/C on rosuvastatin 10mg QHS, metoprolol 25mg BID, pantoprazole 40mg AC breakfast. F/U cardiology in 2 weeks.","A 60-year-old man with a history of enlarged prostate, implanted heart defibrillator, history of mini-stroke, acid reflux, and prior heart bypass surgery was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the heart doctor in 2 weeks.",General Surgery,Discharge Summary,high
2963,"42 y/o M with PMH of depression, hypothyroidism, OA, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on escitalopram 10mg daily, metoprolol succinate 50mg daily, methotrexate 15mg weekly, ibuprofen 400mg Q6H PRN with food, metoprolol 25mg BID. F/U INR check in 3 days.","A 42-year-old man with a history of depression, underactive thyroid, and arthritis [osteoarthritis] was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (5) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up for a blood thinner level check in 3 days.",Infectious Disease,Discharge Summary,high
2964,Procedure: Port-a-cath placement. Pt 91 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 91-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
2965,MRI Lumbar Spine: Central canal stenosis at L3-L4. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
2966,"65 y/o F with PMH of depression, CKD Stage 3, CKD Stage 4, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Compression stockings when ambulating. D/C on hydroxychloroquine 200mg BID, amlodipine 10mg daily, escitalopram 10mg daily, methotrexate 15mg weekly. F/U PCP in 1 week.","A 65-year-old woman with a history of depression, moderate kidney disease, and advanced kidney disease was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the primary care doctor in 1 week.",Cardiology,Discharge Summary,high
2967,CXR PA: ET tube 3cm above carina. Clear lung fields bilaterally. Left lower lobe consolidation.,Chest X-ray results: The breathing tube is in good position. Both lungs look clear with no problems. There is an area in the lower left lung that appears infected.,Pulmonology,Radiology Report,high
2968,"Rx: Tab losartan 50mg daily. Tab tramadol 50mg Q6H PRN pain. Humalog per SSI. Tab atorvastatin 80mg QHS. Tab sertraline 50mg daily. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks with INR.",Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) Humalog insulin before meals as directed [fast-acting insulin]. (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
2969,"36 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 36-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
2970,"52 y/o F with PMH of osteoporosis, DM2, CHF, RA on MTX, depression, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on carvedilol 12.5mg BID, acetaminophen 650mg Q6H PRN, amoxicillin 500mg TID x 10 days. F/U oncology in 1 week.","A 52-year-old woman with a history of weak bones [osteoporosis], type 2 diabetes, heart failure, rheumatoid arthritis [on immune-suppressing medicine], and depression was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the cancer doctor in 1 week.",Endocrinology,Discharge Summary,high
2971,Procedure: TURP for BPH. Pt 76 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 76-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
2972,"CBC: WBC 7.9 (N), Hgb 7.9 (L), Plt 252 (N).","Your blood count results: White blood cells are 7.9 (normal). Hemoglobin is low at 7.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 252, which is normal.",Hematology,Lab Result,high
2973,HbA1c: 7.3% (H). FBS: 316 mg/dL (H).,"Your diabetes blood test results: HbA1c is 7.3%, which is above the target of 7.0%. Your blood sugar has been somewhat poorly controlled over the past 3 months. Fasting blood sugar was 316, which is high (normal is 70-100). Your diabetes medicines may need adjustment. Discuss with your doctor.",Endocrinology,Lab Result,high
2974,"45 y/o M with PMH of PAD, DM1, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on lisinopril 10mg daily, hydroxychloroquine 200mg BID, glipizide 5mg BID AC. F/U PCP in 1 week.","A 45-year-old man with a history of poor blood flow in the legs [peripheral artery disease], and type 1 diabetes was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the primary care doctor in 1 week.",Gastroenterology,Discharge Summary,high
2975,"89 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 89-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
2976,Procedure: Laparoscopic appendectomy. Pt 62 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 62-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
2977,"25 y/o M with PMH of asthma, DVT/PE on warfarin, h/o CVA, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on pantoprazole 40mg AC breakfast, metformin 1000mg BID, sertraline 50mg daily, potassium chloride 20mEq daily. F/U nephrology in 1 week.","A 25-year-old man with a history of asthma, blood clots [on blood thinner warfarin], and history of stroke was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the kidney doctor in 1 week.",Pulmonology,Discharge Summary,high
2978,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
2979,Procedure: Port-a-cath placement. Pt 49 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 49-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
2980,"76 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 76-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2981,"42 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 42-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
2982,"Rx: Tab pregabalin 75mg BID. Lantus 20U QHS. Tab warfarin 5mg daily. Tab Dulcolax 10mg QHS PRN. Tab calcium + vitamin D 600/400 daily. Adv: SMBG BID, diabetic diet. F/U 1 month with repeat imaging.",Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) Lantus insulin 20 units at bedtime [long-acting insulin]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. (5) calcium plus vitamin D once daily [bone strengthening]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 month — a repeat scan will be ordered.,General,Prescription,high
2983,"Rx: Tab atorvastatin 40mg QHS. Tab calcium + vitamin D 600/400 daily. Tab spironolactone 25mg daily. Adv: high fiber diet, adequate hydration. F/U PCP in 1 week for BP recheck.","Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) calcium plus vitamin D once daily [bone strengthening]. (3) spironolactone 25mg once daily [heart-protecting water pill]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
2984,CXR PA: Pacemaker leads in appropriate position. Cardiomegaly with CTR >0.5. ET tube 3cm above carina.,Chest X-ray results: The pacemaker wires are in the correct position. The heart appears larger than normal. The breathing tube is in good position.,Pulmonology,Radiology Report,high
2985,"CBC: WBC 18.6 (H), Hgb 14.4 (N), Plt 131 (L).","Your blood count results: White blood cells are 18.6 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 14.4. Platelets are 131, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
2986,"CBC: WBC 7.9 (N), Hgb 5.9 (L), Plt 479 (H).","Your blood count results: White blood cells are 7.9 (normal). Hemoglobin is low at 5.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 479, which is high — your blood may clot too easily.",Hematology,Lab Result,high
2987,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
2988,"71 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 71-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2989,"Rx: Tab entresto 49/51mg BID. Tab pregabalin 75mg BID. Tab ferrous sulfate 325mg BID. Adv: DASH diet, daily BP monitoring Do not stop abruptly, taper as directed. F/U 1 week with CBC, CMP.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,medium
2990,"Rx: Tab atorvastatin 80mg QHS. Tab rosuvastatin 10mg QHS. Adv: DASH diet, daily BP monitoring. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
2991,"Rx: Tab metoprolol succinate 50mg daily. Tab gabapentin 300mg TID. Tab entresto 49/51mg BID. Tab carvedilol 12.5mg BID. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with CBC, CMP.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (3) Entresto 49/51mg twice daily [heart failure medicine]. (4) carvedilol 12.5mg twice daily [heart medicine]. (5) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
2992,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
2993,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
2994,"42 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 42-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
2995,"28 y/o F with PMH of COPD, A-fib, s/p TKR, DM1, HFrEF (EF 30%), admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on azithromycin 500mg day 1 then 250mg x 4 days, atorvastatin 40mg QHS, Lantus 20U QHS. F/U oncology in 1 week.","A 28-year-old woman with a history of chronic lung disease, irregular heartbeat [atrial fibrillation], prior knee replacement, type 1 diabetes, and heart failure with weak pumping (30%) was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the cancer doctor in 1 week.",Pulmonology,Discharge Summary,high
2996,Delivery Note: G?P? at 39+1 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
2997,"LFTs: AST 483 (H), ALT 346 (H), ALP 80, T.Bili 6.4 (H), Albumin 4.3.","Your liver blood test results: Liver enzymes (AST 483, ALT 346) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.4 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.3.",Gastroenterology,Lab Result,high
2998,"Rx: Tab entresto 49/51mg BID. Tab carvedilol 12.5mg BID. Adv: high fiber diet, adequate hydration Adv: weight bearing exercise, calcium/vit D supplementation. F/U 6 weeks with LFTs.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) carvedilol 12.5mg twice daily [heart medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
2999,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Tab timolol 0.5% OU BID. Adv: fall precautions, home safety evaluation Adv: DASH diet, daily BP monitoring. F/U 1 week with CBC, CMP.","Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,medium
3000,"Rx: Tab montelukast 10mg QHS. Tab losartan 50mg daily. Humalog per SSI. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) losartan 50mg once daily [blood pressure medicine]. (3) Humalog insulin before meals as directed [fast-acting insulin]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
3001,"73 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 73-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3002,"25 y/o M with PMH of HFpEF, anemia, s/p TKR, COPD, asthma, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on ferrous sulfate 325mg BID, gabapentin 300mg TID, Lantus 20U QHS, ciprofloxacin 500mg BID x 5 days. F/U endocrine in 1 week.","A 25-year-old man with a history of heart failure with stiff heart muscle, low blood count [anemia], prior knee replacement, chronic lung disease, and asthma was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) Lantus insulin 20 units at bedtime [long-acting insulin]; (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Follow-up with the hormone/diabetes doctor in 1 week.",General Surgery,Discharge Summary,high
3003,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3004,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. L5-S1 disc desiccation with mild bulge. Multilevel degenerative disc disease. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. Multiple discs in the spine are showing wear and aging. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
3005,"84 y/o M with PMH of s/p CABG, s/p TKR, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on metoprolol succinate 50mg daily, montelukast 10mg QHS. F/U pulmonology in 2 weeks.","A 84-year-old man with a history of prior heart bypass surgery, and prior knee replacement was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the lung doctor in 2 weeks.",Endocrinology,Discharge Summary,high
3006,"BMP: Na 127 (L), K 5.9 (H), BUN 86, Cr 2.1 (H), Glucose 132.","Your blood chemistry results: Sodium is low at 127 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 5.9 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 2.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 132 (high).",Nephrology,Lab Result,high
3007,HbA1c: 9.0% (H). FBS: 238 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.0%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 238, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
3008,"69 y/o F with PMH of osteoporosis, anemia, seizure disorder on Keppra, OSA on CPAP, h/o TIA, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Strict I&O, daily weights. D/C on Xarelto 20mg daily with dinner, timolol 0.5% OU BID, montelukast 10mg QHS, furosemide 40mg BID, amlodipine 5mg daily. F/U orthopedics in 6 weeks with X-ray.","A 69-year-old woman with a history of weak bones [osteoporosis], low blood count [anemia], seizure disorder [on Keppra], sleep apnea [uses a breathing machine at night], and history of mini-stroke was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]; (4) furosemide (Lasix) 40mg twice daily [water pill]; (5) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Urology,Discharge Summary,high
3009,"30 y/o F with PMH of anxiety, HLD, CHF, gout, COPD, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Strict I&O, daily weights. D/C on carvedilol 12.5mg BID, acetaminophen 650mg Q6H PRN. F/U GI in 1 week.","A 30-year-old woman with a history of anxiety, high cholesterol, heart failure, gout, and chronic lung disease was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the stomach doctor in 1 week.",Neurology,Discharge Summary,high
3010,"US Abdomen: No focal hepatic lesion. Left kidney 8cm, cortical thinning consistent with CKD. Right kidney 10.5cm, no hydronephrosis. Simple renal cysts bilaterally.","Abdominal ultrasound results: No tumors or masses were found in the liver. Left kidney is small with thin outer layer, consistent with chronic kidney disease. Right kidney is normal size with no blockage. Both kidneys have harmless fluid-filled cysts.",Gastroenterology,Radiology Report,high
3011,HbA1c: 10.4% (H). FBS: 126 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.4%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 126, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3012,"63 y/o M with PMH of cirrhosis, OA, CAD, s/p THR, BPH, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on metformin 1000mg BID, Humalog per SSI. F/U PCP in 1 week.","A 63-year-old man with a history of liver scarring [cirrhosis], arthritis [osteoarthritis], coronary artery disease [heart artery blockages], prior hip replacement, and enlarged prostate was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the primary care doctor in 1 week.",Pulmonology,Discharge Summary,high
3013,"38 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 38-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3014,"CBC: WBC 7.1 (N), Hgb 7.7 (L), Plt 375 (N).","Your blood count results: White blood cells are 7.1 (normal). Hemoglobin is low at 7.7, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 375, which is normal.",Hematology,Lab Result,high
3015,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
3016,CXR PA: Clear lung fields bilaterally. Right-sided pneumothorax. Bilateral hilar lymphadenopathy.,"Chest X-ray results: Both lungs look clear with no problems. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
3017,"Rx: Tab lisinopril 10mg daily. Tab ASA 81mg daily. Do not stop abruptly, taper as directed. F/U 1 week with CBC, CMP.",Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) baby aspirin 81mg once daily [prevents blood clots]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,medium
3018,Procedure: EGD with biopsy. Pt 34 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 34-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3019,"66 y/o F with PMH of COPD, depression, osteoporosis, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on amlodipine 10mg daily, Lantus 20U QHS, escitalopram 10mg daily. F/U hematology in 2 weeks.","A 66-year-old woman with a history of chronic lung disease, depression, and weak bones [osteoporosis] was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Follow-up with the blood disorder doctor in 2 weeks.",General Surgery,Discharge Summary,high
3020,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,medium
3021,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3022,"Thyroid panel: TSH 2.9 (N), Free T4 1.2.",Your thyroid test results: TSH is normal at 2.9. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
3023,CXR PA: Right middle lobe atelectasis. Osseous structures intact. Right lower lobe consolidation. Small left pleural effusion.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The bones look normal with no fractures. There is an area in the lower right lung that appears infected, suggesting pneumonia. There is a small amount of fluid around the left lung.",Pulmonology,Radiology Report,high
3024,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3025,"Rx: Tab sertraline 50mg daily. Tab amoxicillin 500mg TID x 10 days. Tab omeprazole 20mg AC breakfast. Tab losartan 50mg daily. Tab metformin 500mg BID. Adv: DASH diet, daily BP monitoring. F/U 2 weeks.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) omeprazole 20mg before breakfast [acid-reducing medicine]. (4) losartan 50mg once daily [blood pressure medicine]. (5) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
3026,"62 y/o M with PMH of HFpEF, CAD, HFrEF (EF 30%), admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Compression stockings when ambulating. D/C on albuterol MDI 2 puffs Q4-6H PRN, clopidogrel 75mg daily, amlodipine 5mg daily, Eliquis 5mg BID, Humalog per SSI. F/U nephrology in 5 days.","A 62-year-old man with a history of heart failure with stiff heart muscle, coronary artery disease [heart artery blockages], and heart failure with weak pumping (30%) was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) Eliquis 5mg twice daily [blood thinner]; (5) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the kidney doctor in 5 days.",Infectious Disease,Discharge Summary,high
3027,Rx: Tab sertraline 50mg daily. Tab rosuvastatin 10mg QHS. Adv: wound care with daily dressing changes. F/U INR in 3 days.,"Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
3028,CXR PA: Elevated left hemidiaphragm. Compression fracture T12. Right middle lobe atelectasis. Bilateral pleural effusions.,"Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. There is a compression fracture [collapsed bone] in the lower spine at T12. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is fluid collecting around both lungs.",Pulmonology,Radiology Report,high
3029,CXR PA: Clear lung fields bilaterally. Increased interstitial markings suggesting pulmonary edema. Sternotomy wires intact.,"Chest X-ray results: Both lungs look clear with no problems. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. The wires from prior heart surgery are intact.",Pulmonology,Radiology Report,high
3030,Procedure: R TKA. Pt 22 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 22-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
3031,"25 y/o M with PMH of Parkinson's disease, anxiety, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on metoprolol succinate 50mg daily, metformin 1000mg BID, furosemide 40mg daily, lisinopril 20mg daily. F/U surgery in 2 weeks for drain removal.","A 25-year-old man with a history of Parkinson's disease, and anxiety was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
3032,"59 y/o F with PMH of A-fib, CKD Stage 4, BPH, seizure disorder on Keppra, CKD Stage 3, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Low potassium diet. D/C on gabapentin 300mg TID, pantoprazole 40mg AC breakfast, methotrexate 15mg weekly. F/U cardiology in 2 weeks.","A 59-year-old woman with a history of irregular heartbeat [atrial fibrillation], advanced kidney disease, enlarged prostate, seizure disorder [on Keppra], and moderate kidney disease was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the heart doctor in 2 weeks.",Pulmonology,Discharge Summary,high
3033,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3034,"25 y/o M with PMH of anemia, SLE, PAD, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on Xarelto 20mg daily with dinner, carvedilol 12.5mg BID, calcium + vitamin D 600/400 daily. F/U neurology in 2 weeks.","A 25-year-old man with a history of low blood count [anemia], lupus, and poor blood flow in the legs [peripheral artery disease] was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the brain/nerve doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
3035,"Lipid panel: TC 184, LDL 70, HDL 45, TG 458.",Your cholesterol results: Total cholesterol is 184. LDL (bad cholesterol) is at goal (70). HDL (good cholesterol) is good at 45. Triglycerides are very high at 458 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
3036,Procedure: PCI with DES to LAD. Pt 47 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 47-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
3037,MRI Lumbar Spine: Central canal stenosis at L3-L4. No compression fracture. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. No bones are broken or collapsed. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
3038,CXR PA: Moderate right pleural effusion. Small left pleural effusion. Right lower lobe consolidation. ET tube 3cm above carina.,"Chest X-ray results: There is a moderate amount of fluid around the right lung. There is a small amount of fluid around the left lung. There is an area in the lower right lung that appears infected, suggesting pneumonia. The breathing tube is in good position.",Pulmonology,Radiology Report,high
3039,CXR PA: No cardiomegaly. NG tube tip in stomach. Moderate right pleural effusion. Cardiomegaly with CTR >0.5.,Chest X-ray results: The heart is a normal size. The feeding/drainage tube tip is correctly positioned in the stomach. There is a moderate amount of fluid around the right lung. The heart appears larger than normal.,Pulmonology,Radiology Report,high
3040,"Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab acetaminophen 650mg Q6H PRN. Tab Dulcolax 10mg QHS PRN. Tab escitalopram 10mg daily. Adv: DASH diet, daily BP monitoring Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",General,Prescription,high
3041,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3042,"Rx: Tab warfarin 5mg daily. Tab pantoprazole 40mg AC breakfast. Lantus 20U QHS. Spiriva 18mcg daily. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) Lantus insulin 20 units at bedtime [long-acting insulin]. (4) Spiriva inhaler once daily [long-acting lung medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Pulmonology,Prescription,high
3043,"31 y/o F with PMH of osteoporosis, DM1, HLD, BPH, RA on MTX, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on ciprofloxacin 500mg BID x 5 days, Augmentin 875/125 BID x 7 days. F/U hematology in 2 weeks.","A 31-year-old woman with a history of weak bones [osteoporosis], type 1 diabetes, high cholesterol, enlarged prostate, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
3044,Procedure: Port-a-cath placement. Pt 37 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 37-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
3045,"Thyroid panel: TSH 1.45 (N), Free T4 2.7.",Your thyroid test results: TSH is normal at 1.45. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
3046,CXR PA: Bilateral hilar lymphadenopathy. Right middle lobe atelectasis. Mild cardiomegaly. No cardiomegaly.,"Chest X-ray results: There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The heart is slightly larger than normal. The heart is a normal size.",Pulmonology,Radiology Report,high
3047,"70 y/o F with PMH of osteoporosis, depression, cirrhosis, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on amoxicillin 500mg TID x 10 days, azithromycin 500mg day 1 then 250mg x 4 days, timolol 0.5% OU BID. F/U hematology in 2 weeks.","A 70-year-old woman with a history of weak bones [osteoporosis], depression, and liver scarring [cirrhosis] was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
3048,"Rx: Humalog per SSI. prednisone taper. Tab Eliquis 5mg BID. Tab Dulcolax 10mg QHS PRN. Tab pantoprazole 40mg AC breakfast. Adv: high fiber diet, adequate hydration. F/U 2 weeks.","Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) Eliquis 5mg twice daily [blood thinner]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. (5) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back for a check-up in 2 weeks.",Gastroenterology,Prescription,high
3049,"US Abdomen: Spleen 11cm, normal. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Moderate right hydronephrosis. Right kidney 10.5cm, no hydronephrosis. GB wall thickening with stones, positive Murphy's sign. Simple renal cysts bilaterally.","Abdominal ultrasound results: The spleen is a normal size. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. Right kidney is normal size with no blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Both kidneys have harmless fluid-filled cysts.",Gastroenterology,Radiology Report,high
3050,"60 y/o F with PMH of cirrhosis, CAD, hypothyroidism, SLE, OA, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on tramadol 50mg Q6H PRN pain, metformin 500mg BID, furosemide 40mg daily, ibuprofen 400mg Q6H PRN with food. F/U nephrology in 1 week.","A 60-year-old woman with a history of liver scarring [cirrhosis], coronary artery disease [heart artery blockages], underactive thyroid, lupus, and arthritis [osteoarthritis] was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) metformin 500mg twice daily with meals [blood sugar medicine]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the kidney doctor in 1 week.",Cardiology,Discharge Summary,high
3051,"Rx: Lantus 20U QHS. Tab omeprazole 20mg AC breakfast. Tab furosemide 40mg daily. Tab latanoprost 0.005% OU QHS. Adv: wound care with daily dressing changes Adv: high fiber diet, adequate hydration. F/U 1 month with repeat imaging.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
3052,"BMP: Na 147 (H), K 4.6 (N), BUN 45, Cr 7.5 (H), Glucose 151.","Your blood chemistry results: Sodium is high at 147, meaning you may be dehydrated. Potassium is normal at 4.6. Creatinine is elevated at 7.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 151 (high).",Nephrology,Lab Result,high
3053,CT Head without contrast: No mass effect. Acute ischemic infarct in R MCA territory. No midline shift.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The brain is centered normally.",Neurology,Radiology Report,high
3054,"Rx: Tab montelukast 10mg QHS. Tab lisinopril 20mg daily. Adv: low salt diet, fluid restriction 1.5L/day Adv: weight bearing exercise, calcium/vit D supplementation. F/U 6 weeks with LFTs.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) lisinopril 20mg once daily [blood pressure medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
3055,"Rx: Tab calcium + vitamin D 600/400 daily. Tab metoprolol succinate 50mg daily. Adv: low salt low sugar diet, regular exercise Avoid NSAIDs. F/U 1 week with wound check.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 week to have the wound checked.",Cardiology,Prescription,low
3056,"CBC: WBC 9.6 (N), Hgb 5.3 (L), Plt 145 (L).","Your blood count results: White blood cells are 9.6 (normal). Hemoglobin is low at 5.3, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 145, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
3057,"Rx: Tab pregabalin 75mg BID. Tab montelukast 10mg QHS. Tab methotrexate 15mg weekly. Tab potassium chloride 20mEq daily. Do not stop abruptly, taper as directed Adv: low salt diet, fluid restriction 1.5L/day. F/U 6 weeks with LFTs.",Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 6 weeks for liver function blood tests.,Pulmonology,Prescription,high
3058,Procedure: Port-a-cath placement. Pt 57 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 57-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
3059,"Rx: Tab gabapentin 300mg TID. Tab levothyroxine 75mcg daily on empty stomach. Adv: avoid alcohol, hepatotoxic drugs. F/U 6 weeks with LFTs.",Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 6 weeks for liver function blood tests.,Neurology,Prescription,medium
3060,HbA1c: 9.1% (H). FBS: 164 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.1%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 164, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
3061,"Rx: Tab atorvastatin 80mg QHS. Tab empagliflozin 10mg daily. Tab Augmentin 875/125 BID x 7 days. Adv: weight bearing exercise, calcium/vit D supplementation Avoid NSAIDs. F/U INR in 3 days.","Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
3062,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. 4cm right subdural hematoma with 5mm midline shift. No acute intracranial hemorrhage. Paranasal sinuses clear.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is no bleeding in the brain. The sinuses are clear with no infection.",Neurology,Radiology Report,high
3063,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3064,CT Head without contrast: Acute ischemic infarct in R MCA territory. No mass effect. No midline shift.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are no tumors or masses pushing on the brain. The brain is centered normally.",Neurology,Radiology Report,high
3065,CT Head without contrast: No acute intracranial hemorrhage. Paranasal sinuses clear. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is no bleeding in the brain. The sinuses are clear with no infection. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
3066,"22 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 22-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3067,"MRI Lumbar Spine: No compression fracture. Facet joint hypertrophy at L4-L5. C5-C6 disc herniation with cord compression. Conus medullaris at L1, normal.","MRI of the lower back results: No bones are broken or collapsed. The small joints in the spine at L4-L5 are enlarged from arthritis. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
3068,HbA1c: 11.9% (H). FBS: 176 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.9%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 176, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3069,CT Head without contrast: No midline shift. Paranasal sinuses clear. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: The brain is centered normally. The sinuses are clear with no infection. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
3070,"71 y/o M with PMH of OA, seizure disorder on Keppra, DVT/PE on warfarin, ICD in situ, s/p THR, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Compression stockings when ambulating. D/C on tramadol 50mg Q6H PRN pain, Xarelto 20mg daily with dinner, potassium chloride 20mEq daily, empagliflozin 10mg daily. F/U PCP in 1 week.","A 71-year-old man with a history of arthritis [osteoarthritis], seizure disorder [on Keppra], blood clots [on blood thinner warfarin], implanted heart defibrillator, and prior hip replacement was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the primary care doctor in 1 week.",Cardiology,Discharge Summary,high
3071,"BMP: Na 142 (N), K 2.5 (L), BUN 50, Cr 4.6 (H), Glucose 142.","Your blood chemistry results: Sodium is normal at 142. Potassium is low at 2.5 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 4.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 142 (high).",Nephrology,Lab Result,high
3072,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,low
3073,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3074,Procedure: ORIF L distal radius. Pt 46 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 46-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
3075,Delivery Note: G?P? at 38+2 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3076,"Rx: Tab atorvastatin 40mg QHS. Tab lisinopril 10mg daily. Tab omeprazole 20mg AC breakfast. Tab sertraline 50mg daily. Tab metformin 500mg BID. Adv: SMBG BID, diabetic diet Adv: wound care with daily dressing changes. F/U 1 month with repeat imaging.","Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) omeprazole 20mg before breakfast [acid-reducing medicine]. (4) sertraline 50mg once daily [antidepressant/anxiety medicine]. (5) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
3077,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3078,"84 y/o F with PMH of s/p TKR, ESRD on HD, HFrEF (EF 30%), HLD, obesity (BMI 38), admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on amoxicillin 500mg TID x 10 days, ASA 81mg daily, ciprofloxacin 500mg BID x 5 days, ibuprofen 400mg Q6H PRN with food, Eliquis 5mg BID. F/U endocrine in 1 week.","A 84-year-old woman with a history of prior knee replacement, kidney failure requiring dialysis, heart failure with weak pumping (30%), high cholesterol, and obesity was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (5) Eliquis 5mg twice daily [blood thinner]. Follow-up with the hormone/diabetes doctor in 1 week.",Gastroenterology,Discharge Summary,high
3079,"Rx: Tab metoprolol succinate 50mg daily. Tab lisinopril 10mg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab metoprolol 25mg BID. Avoid NSAIDs. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
3080,"CBC: WBC 5.0 (N), Hgb 5.7 (L), Plt 211 (N).","Your blood count results: White blood cells are 5.0 (normal). Hemoglobin is low at 5.7, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 211, which is normal.",Hematology,Lab Result,high
3081,"31 y/o F with PMH of COPD, anemia, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on glipizide 5mg BID AC, ondansetron 4mg Q8H PRN N/V, omeprazole 20mg AC breakfast. F/U pulmonology in 2 weeks.","A 31-year-old woman with a history of chronic lung disease, and low blood count [anemia] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the lung doctor in 2 weeks.",Orthopedics,Discharge Summary,high
3082,CXR PA: No pneumothorax. Cardiomegaly with CTR >0.5. Left lower lobe consolidation. Bilateral pleural effusions. Compression fracture T12.,Chest X-ray results: There is no collapsed lung. The heart appears larger than normal. There is an area in the lower left lung that appears infected. There is fluid collecting around both lungs. There is a compression fracture [collapsed bone] in the lower spine at T12.,Pulmonology,Radiology Report,high
3083,CXR PA: Pacemaker leads in appropriate position. Small left pleural effusion. ET tube 3cm above carina. Osseous structures intact. Widened mediastinum.,"Chest X-ray results: The pacemaker wires are in the correct position. There is a small amount of fluid around the left lung. The breathing tube is in good position. The bones look normal with no fractures. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
3084,"87 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 87-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3085,"22 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 22-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3086,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,medium
3087,"Rx: Tab amlodipine 5mg daily. Tab metoprolol 25mg BID. Tab amlodipine 10mg daily. Tab ferrous sulfate 325mg BID. Adv: high fiber diet, adequate hydration Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks.","Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) amlodipine 10mg once daily [blood pressure medicine]. (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
3088,"22 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 22-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3089,"53 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 53-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3090,Procedure: ERCP with sphincterotomy. Pt 71 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 71-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3091,"63 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 63-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
3092,"40 y/o F with PMH of DVT/PE on warfarin, ESRD on HD, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on prednisone taper, ASA 81mg daily, ibuprofen 400mg Q6H PRN with food. F/U neurology in 2 weeks.","A 40-year-old woman with a history of blood clots [on blood thinner warfarin], and kidney failure requiring dialysis was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
3093,"31 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 31-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3094,"BMP: Na 131 (L), K 5.2 (H), BUN 81, Cr 3.8 (H), Glucose 147.","Your blood chemistry results: Sodium is low at 131 (normal 136-145), meaning too much water in your body. Potassium is high at 5.2 — needs monitoring. Creatinine is elevated at 3.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 147 (high).",Nephrology,Lab Result,high
3095,CXR PA: Widened mediastinum. Patchy bilateral infiltrates. Hyperinflated lungs consistent with COPD. NG tube tip in stomach. Bilateral hilar lymphadenopathy.,"Chest X-ray results: The space between the lungs appears wider than normal, which needs further evaluation. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The feeding/drainage tube tip is correctly positioned in the stomach. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
3096,"64 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 64-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3097,Delivery Note: G?P? at 38+2 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3098,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3099,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3100,"Rx: Tab furosemide 40mg BID. Tab empagliflozin 10mg daily. Tab ferrous sulfate 325mg BID. Tab spironolactone 25mg daily. Humalog per SSI. Adv: weight bearing exercise, calcium/vit D supplementation Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (4) spironolactone 25mg once daily [heart-protecting water pill]. (5) Humalog insulin before meals as directed [fast-acting insulin]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
3101,"Rx: Tab metoprolol succinate 50mg daily. Tab sertraline 50mg daily. Adv: avoid alcohol, hepatotoxic drugs. F/U INR in 3 days.",Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,medium
3102,"28 y/o F with PMH of DVT/PE on warfarin, HTN, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on clopidogrel 75mg daily, escitalopram 10mg daily, glipizide 5mg BID AC, entresto 49/51mg BID. F/U hematology in 2 weeks.","A 28-year-old woman with a history of blood clots [on blood thinner warfarin], and high blood pressure was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
3103,"82 y/o F with PMH of HFrEF (EF 30%), ESRD on HD, CHF, OA, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on Xarelto 20mg daily with dinner, azithromycin 500mg day 1 then 250mg x 4 days, acetaminophen 650mg Q6H PRN, empagliflozin 10mg daily, rosuvastatin 10mg QHS. F/U orthopedics in 6 weeks with X-ray.","A 82-year-old woman with a history of heart failure with weak pumping (30%), kidney failure requiring dialysis, heart failure, and arthritis [osteoarthritis] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (5) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
3104,"CBC: WBC 3.6 (L), Hgb 17.6 (H), Plt 317 (N).","Your blood count results: White blood cells are 3.6 (low, meaning your immune system may be weakened). Hemoglobin is elevated at 17.6. Platelets are 317, which is normal.",Hematology,Lab Result,high
3105,"64 y/o M with PMH of Parkinson's disease, depression, DVT/PE on warfarin, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on Xarelto 20mg daily with dinner, furosemide 40mg daily, amoxicillin 500mg TID x 10 days, spironolactone 25mg daily. F/U wound care in 3 days.","A 64-year-old man with a history of Parkinson's disease, depression, and blood clots [on blood thinner warfarin] was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (4) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up at the wound care clinic in 3 days.",Endocrinology,Discharge Summary,high
3106,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
3107,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
3108,Procedure: ORIF L distal radius. Pt 62 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 62-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
3109,"59 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 59-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3110,"BMP: Na 129 (L), K 6.3 (H), BUN 82, Cr 2.0 (H), Glucose 230.","Your blood chemistry results: Sodium is low at 129 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.3 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 2.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 230 (high).",Nephrology,Lab Result,high
3111,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
3112,"Lipid panel: TC 318, LDL 111, HDL 67, TG 258.",Your cholesterol results: Total cholesterol is 318. LDL (bad cholesterol) is high at 111 (goal under 100). HDL (good cholesterol) is good at 67. Triglycerides are high at 258.,Cardiology,Lab Result,high
3113,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab omeprazole 20mg AC breakfast. Tab losartan 50mg daily. Tab Augmentin 875/125 BID x 7 days. Tab spironolactone 25mg daily. Avoid grapefruit juice Adv: DASH diet, daily BP monitoring. F/U 1 month with repeat imaging.","Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) losartan 50mg once daily [blood pressure medicine]. (4) Augmentin 875mg twice daily for 7 days [antibiotic]. (5) spironolactone 25mg once daily [heart-protecting water pill]. Do not drink grapefruit juice as it interferes with this medication Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
3114,"43 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 43-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3115,"85 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 85-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3116,"Rx: Tab atorvastatin 40mg QHS. Tab spironolactone 25mg daily. Tab rosuvastatin 10mg QHS. Tab furosemide 40mg BID. Tab metformin 1000mg BID. Avoid NSAIDs Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks.",Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) metformin 1000mg twice daily with meals [blood sugar medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back for a check-up in 2 weeks.,Cardiology,Prescription,high
3117,"35 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 35-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3118,Procedure: ERCP with sphincterotomy. Pt 70 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 70-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3119,HbA1c: 8.5% (H). FBS: 258 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.5%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 258, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
3120,Delivery Note: G?P? at 37+3 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3121,Rx: Tab entresto 49/51mg BID. Tab montelukast 10mg QHS. Tab levothyroxine 75mcg daily on empty stomach. Avoid NSAIDs Adv: wound care with daily dressing changes. F/U INR in 3 days.,"Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
3122,"23 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 23-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3123,"Rx: Tab carvedilol 12.5mg BID. Tab amlodipine 10mg daily. Tab calcium + vitamin D 600/400 daily. Tab amlodipine 5mg daily. Adv: low potassium diet Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks.","Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) calcium plus vitamin D once daily [bone strengthening]. (4) amlodipine 5mg once daily [blood pressure medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
3124,"Rx: Lantus 20U QHS. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: smoking cessation, pulmonary rehab Adv: low salt low sugar diet, regular exercise. F/U 2 weeks with INR.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 2 weeks for a blood thinner level check [INR].",Endocrinology,Prescription,medium
3125,"55 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 55-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3126,"58 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 58-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3127,"Lipid panel: TC 148, LDL 166, HDL 27, TG 341.","Your cholesterol results: Total cholesterol is 148. LDL (bad cholesterol) is very high at 166 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is too low at 27 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 341 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
3128,"42 y/o M with PMH of BPH, CKD Stage 4, CHF, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on metoprolol 25mg BID, prednisone taper. F/U orthopedics in 6 weeks with X-ray.","A 42-year-old man with a history of enlarged prostate, advanced kidney disease, and heart failure was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Nephrology,Discharge Summary,high
3129,"78 y/o F with PMH of CAD, DVT/PE on warfarin, DM1, COPD, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on tramadol 50mg Q6H PRN pain, amlodipine 10mg daily, ibuprofen 400mg Q6H PRN with food, timolol 0.5% OU BID. F/U GI in 1 week.","A 78-year-old woman with a history of coronary artery disease [heart artery blockages], blood clots [on blood thinner warfarin], type 1 diabetes, and chronic lung disease was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
3130,"45 y/o F with PMH of CHF, SLE, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on entresto 49/51mg BID, amoxicillin 500mg TID x 10 days, calcium + vitamin D 600/400 daily, pregabalin 75mg BID. F/U wound care in 3 days.","A 45-year-old woman with a history of heart failure, and lupus was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) calcium plus vitamin D once daily [bone strengthening]; (4) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up at the wound care clinic in 3 days.",Psychiatry,Discharge Summary,high
3131,Procedure: PCI with DES to LAD. Pt 87 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 87-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
3132,"Rx: Tab pantoprazole 40mg AC breakfast. Tab atorvastatin 40mg QHS. albuterol MDI 2 puffs Q4-6H PRN. Adv: SMBG BID, diabetic diet Adv: DASH diet, daily BP monitoring. F/U 1 month with repeat imaging.","Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
3133,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab lisinopril 10mg daily. Tab Xarelto 20mg daily with dinner. Tab metformin 500mg BID. Tab clopidogrel 75mg daily. Adv: low potassium diet. F/U 1 week with CBC, CMP.","Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) Xarelto 20mg once daily with dinner [blood thinner]. (4) metformin 500mg twice daily with meals [blood sugar medicine]. (5) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
3134,"72 y/o M with PMH of anemia, h/o CVA, PPM in situ, OSA on CPAP, s/p THR, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on atorvastatin 80mg QHS, potassium chloride 20mEq daily, entresto 49/51mg BID, amoxicillin 500mg TID x 10 days. F/U oncology in 1 week.","A 72-year-old man with a history of low blood count [anemia], history of stroke, implanted pacemaker, sleep apnea [uses a breathing machine at night], and prior hip replacement was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) Entresto 49/51mg twice daily [heart failure medicine]; (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the cancer doctor in 1 week.",Urology,Discharge Summary,high
3135,"68 y/o M with PMH of HTN, DVT/PE on warfarin, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on ondansetron 4mg Q8H PRN N/V, furosemide 40mg BID, amlodipine 10mg daily, atorvastatin 80mg QHS. F/U PCP in 2 weeks.","A 68-year-old man with a history of high blood pressure, and blood clots [on blood thinner warfarin] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) furosemide (Lasix) 40mg twice daily [water pill]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the primary care doctor in 2 weeks.",Neurology,Discharge Summary,high
3136,CXR PA: Cardiomegaly with CTR >0.5. Moderate right pleural effusion. Patchy bilateral infiltrates. Right lower lobe consolidation.,"Chest X-ray results: The heart appears larger than normal. There is a moderate amount of fluid around the right lung. There are scattered cloudy patches in both lungs suggesting infection or inflammation. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
3137,"Lipid panel: TC 190, LDL 150, HDL 31, TG 125.","Your cholesterol results: Total cholesterol is 190. LDL (bad cholesterol) is high at 150 (goal under 100). HDL (good cholesterol) is too low at 31 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are normal at 125.",Cardiology,Lab Result,high
3138,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3139,CT Head without contrast: No midline shift. No mass effect. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: The brain is centered normally. There are no tumors or masses pushing on the brain. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
3140,"Rx: Tab losartan 50mg daily. Tab clopidogrel 75mg daily. Tab ibuprofen 400mg Q6H PRN with food. Adv: low salt diet, fluid restriction 1.5L/day Do not stop abruptly, taper as directed. F/U 2 weeks.",Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
3141,CXR PA: Right middle lobe atelectasis. Compression fracture T12. Right lower lobe consolidation. Pacemaker leads in appropriate position.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is a compression fracture [collapsed bone] in the lower spine at T12. There is an area in the lower right lung that appears infected, suggesting pneumonia. The pacemaker wires are in the correct position.",Pulmonology,Radiology Report,high
3142,CT Head without contrast: No acute intracranial hemorrhage. 4cm right subdural hematoma with 5mm midline shift. Mild generalized cerebral atrophy appropriate for age. No midline shift.,"CT scan of the head results: There is no bleeding in the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is mild brain shrinkage, which is normal for your age. The brain is centered normally.",Neurology,Radiology Report,high
3143,"BMP: Na 137 (N), K 3.4 (L), BUN 90, Cr 6.5 (H), Glucose 228.","Your blood chemistry results: Sodium is normal at 137. Potassium is low at 3.4 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 6.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 228 (high).",Nephrology,Lab Result,high
3144,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,high
3145,"Rx: Tab empagliflozin 10mg daily. Tab pantoprazole 40mg AC breakfast. Adv: high fiber diet, adequate hydration. F/U 2 weeks.","Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back for a check-up in 2 weeks.",Gastroenterology,Prescription,medium
3146,CT Head without contrast: Acute ischemic infarct in R MCA territory. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
3147,HbA1c: 13.9% (H). FBS: 159 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.9%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 159, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3148,"79 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 79-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3149,"63 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 63-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3150,Procedure: Colonoscopy with polypectomy. Pt 91 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 91-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3151,Procedure: PCI with DES to LAD. Pt 77 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 77-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
3152,"CBC: WBC 9.0 (N), Hgb 12.1 (N), Plt 410 (H).","Your blood count results: White blood cells are 9.0 (normal). Hemoglobin is normal at 12.1. Platelets are 410, which is high — your blood may clot too easily.",Hematology,Lab Result,high
3153,"75 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 75-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3154,"57 y/o M with PMH of asthma, CAD, DM2, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on latanoprost 0.005% OU QHS, amoxicillin 500mg TID x 10 days. F/U hematology in 2 weeks.","A 57-year-old man with a history of asthma, coronary artery disease [heart artery blockages], and type 2 diabetes was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
3155,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab ferrous sulfate 325mg BID. Tab metformin 1000mg BID. Tab levothyroxine 75mcg daily on empty stomach. Tab spironolactone 25mg daily. Adv: smoking cessation, pulmonary rehab. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (5) spironolactone 25mg once daily [heart-protecting water pill]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Endocrinology,Prescription,high
3156,"US Abdomen: Left kidney 8cm, cortical thinning consistent with CKD. GB sludge, no stones. Moderate right hydronephrosis. CBD 5mm, not dilated.","Abdominal ultrasound results: Left kidney is small with thin outer layer, consistent with chronic kidney disease. The gallbladder contains thickened bile [sludge] but no stones. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The bile duct is normal size [not blocked].",Gastroenterology,Radiology Report,high
3157,"33 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 33-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3158,"81 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 81-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3159,MRI Lumbar Spine: No compression fracture. Central canal stenosis at L3-L4. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: No bones are broken or collapsed. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
3160,"74 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 74-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3161,"42 y/o M with PMH of PPM in situ, SLE, cirrhosis, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on Dulcolax 10mg QHS PRN, atorvastatin 80mg QHS, furosemide 40mg daily, metformin 1000mg BID, ibuprofen 400mg Q6H PRN with food. F/U neurology in 2 weeks.","A 42-year-old man with a history of implanted pacemaker, lupus, and liver scarring [cirrhosis] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]; (5) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the brain/nerve doctor in 2 weeks.",Neurology,Discharge Summary,high
3162,"Lipid panel: TC 258, LDL 126, HDL 39, TG 328.","Your cholesterol results: Total cholesterol is 258. LDL (bad cholesterol) is high at 126 (goal under 100). HDL (good cholesterol) is too low at 39 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 328 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
3163,"50 y/o F with PMH of HFrEF (EF 30%), RA on MTX, HLD, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on ASA 81mg daily, pantoprazole 40mg AC breakfast, hydroxychloroquine 200mg BID, ibuprofen 400mg Q6H PRN with food, entresto 49/51mg BID. F/U PCP in 1 week.","A 50-year-old woman with a history of heart failure with weak pumping (30%), rheumatoid arthritis [on immune-suppressing medicine], and high cholesterol was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (5) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the primary care doctor in 1 week.",Orthopedics,Discharge Summary,high
3164,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3165,Procedure: R TKA. Pt 51 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 51-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
3166,"81 y/o M with PMH of BPH, HFrEF (EF 30%), HTN, anxiety, ESRD on HD, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on gabapentin 300mg TID, metformin 500mg BID, metformin 1000mg BID. F/U surgery in 2 weeks for drain removal.","A 81-year-old man with a history of enlarged prostate, heart failure with weak pumping (30%), high blood pressure, anxiety, and kidney failure requiring dialysis was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) metformin 500mg twice daily with meals [blood sugar medicine]; (3) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",General Surgery,Discharge Summary,high
3167,"BMP: Na 135 (L), K 4.9 (N), BUN 30, Cr 0.6 (N), Glucose 344.","Your blood chemistry results: Sodium is low at 135 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.9. Creatinine is normal at 0.6. Blood sugar is 344 (high).",Nephrology,Lab Result,high
3168,"64 y/o F with PMH of h/o TIA, s/p CABG, DM1, CAD, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on Humalog per SSI, Dulcolax 10mg QHS PRN, amlodipine 5mg daily, omeprazole 20mg AC breakfast. F/U surgery in 10 days.","A 64-year-old woman with a history of history of mini-stroke, prior heart bypass surgery, type 1 diabetes, and coronary artery disease [heart artery blockages] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Humalog insulin before meals as directed [fast-acting insulin]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the surgeon in 10 days.",Nephrology,Discharge Summary,high
3169,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab atorvastatin 40mg QHS. Tab losartan 50mg daily. Tab furosemide 40mg daily. albuterol MDI 2 puffs Q4-6H PRN. Adv: smoking cessation, pulmonary rehab. F/U 1 week with wound check.",Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) losartan 50mg once daily [blood pressure medicine]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (5) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week to have the wound checked.,Cardiology,Prescription,high
3170,Rx: Tab ferrous sulfate 325mg BID. Tab spironolactone 25mg daily. Tab calcium + vitamin D 600/400 daily. Tab levothyroxine 75mcg daily on empty stomach. Avoid NSAIDs. F/U INR in 3 days.,Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) calcium plus vitamin D once daily [bone strengthening]. (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 3 days for a blood thinner level check [INR].,General,Prescription,high
3171,CT Head without contrast: No midline shift. No mass effect. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,CT scan of the head results: The brain is centered normally. There are no tumors or masses pushing on the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.,Neurology,Radiology Report,high
3172,"Rx: Humalog per SSI. Tab rosuvastatin 10mg QHS. Tab spironolactone 25mg daily. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: fall precautions, home safety evaluation. F/U INR in 3 days.","Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) spironolactone 25mg once daily [heart-protecting water pill]. (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
3173,Procedure: ORIF L distal radius. Pt 60 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 60-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
3174,"Rx: Tab metformin 500mg BID. Tab tramadol 50mg Q6H PRN pain. Tab methotrexate 15mg weekly. Tab potassium chloride 20mEq daily. Adv: smoking cessation, pulmonary rehab. F/U PCP in 1 week for BP recheck.",Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. See your primary care doctor in 1 week to recheck blood pressure.,General,Prescription,high
3175,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3176,"53 y/o M with PMH of seizure disorder on Keppra, s/p TKR, gout, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on timolol 0.5% OU BID, clopidogrel 75mg daily, azithromycin 500mg day 1 then 250mg x 4 days. F/U GI in 1 week.","A 53-year-old man with a history of seizure disorder [on Keppra], prior knee replacement, and gout was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the stomach doctor in 1 week.",Neurology,Discharge Summary,high
3177,MRI Lumbar Spine: Central canal stenosis at L3-L4. C5-C6 disc herniation with cord compression. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Multilevel degenerative disc disease.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
3178,"Rx: Lantus 20U QHS. Tab amlodipine 5mg daily. Tab warfarin 5mg daily. Tab empagliflozin 10mg daily. Tab ciprofloxacin 500mg BID x 5 days. Adv: low salt low sugar diet, regular exercise. F/U INR in 3 days.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (5) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 3 days for a blood thinner level check [INR].",Endocrinology,Prescription,high
3179,"Lipid panel: TC 195, LDL 73, HDL 31, TG 234.","Your cholesterol results: Total cholesterol is 195. LDL (bad cholesterol) is at goal (73). HDL (good cholesterol) is too low at 31 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are high at 234.",Cardiology,Lab Result,high
3180,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3181,"Rx: Tab omeprazole 20mg AC breakfast. Tab potassium chloride 20mEq daily. Adv: fall precautions, home safety evaluation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Gastroenterology,Prescription,medium
3182,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3183,"Rx: Tab ferrous sulfate 325mg BID. prednisone taper. Tab rosuvastatin 10mg QHS. Tab glipizide 5mg BID AC. Adv: high fiber diet, adequate hydration. F/U INR in 3 days.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) glipizide 5mg twice daily before meals [helps release insulin]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
3184,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
3185,"66 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 66-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
3186,Rx: Tab omeprazole 20mg AC breakfast. Spiriva 18mcg daily. Tab gabapentin 300mg TID. Adv: wound care with daily dressing changes Avoid NSAIDs. F/U INR in 3 days.,"Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 3 days for a blood thinner level check [INR].",Pulmonology,Prescription,medium
3187,"Lipid panel: TC 148, LDL 186, HDL 22, TG 301.","Your cholesterol results: Total cholesterol is 148. LDL (bad cholesterol) is very high at 186 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is too low at 22 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 301 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
3188,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3189,Procedure: ERCP with sphincterotomy. Pt 29 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 29-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3190,"54 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 54-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3191,"55 y/o F with PMH of anemia, DM1, ICD in situ, s/p THR, GERD, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on ibuprofen 400mg Q6H PRN with food, albuterol MDI 2 puffs Q4-6H PRN, azithromycin 500mg day 1 then 250mg x 4 days. F/U INR check in 3 days.","A 55-year-old woman with a history of low blood count [anemia], type 1 diabetes, implanted heart defibrillator, prior hip replacement, and acid reflux was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up for a blood thinner level check in 3 days.",Gastroenterology,Discharge Summary,high
3192,CT Head without contrast: No mass effect. 4cm right subdural hematoma with 5mm midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No midline shift.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The brain is centered normally.",Neurology,Radiology Report,high
3193,"Rx: Tab empagliflozin 10mg daily. Tab acetaminophen 650mg Q6H PRN. Tab sertraline 50mg daily. Tab potassium chloride 20mEq daily. Adv: fall precautions, home safety evaluation Adv: low salt diet, fluid restriction 1.5L/day. F/U 1 week with CBC, CMP.","Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",General,Prescription,high
3194,"Rx: Tab omeprazole 20mg AC breakfast. Tab methotrexate 15mg weekly. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: smoking cessation, pulmonary rehab. F/U PCP in 1 week for BP recheck.","Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. See your primary care doctor in 1 week to recheck blood pressure.",Gastroenterology,Prescription,medium
3195,"Lipid panel: TC 250, LDL 99, HDL 48, TG 470.",Your cholesterol results: Total cholesterol is 250. LDL (bad cholesterol) is at goal (99). HDL (good cholesterol) is good at 48. Triglycerides are very high at 470 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
3196,"44 y/o F with PMH of PAD, DVT/PE on warfarin, RA on MTX, anemia, s/p TKR, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on losartan 50mg daily, warfarin 5mg daily, atorvastatin 80mg QHS, ferrous sulfate 325mg BID, levothyroxine 75mcg daily on empty stomach. F/U nephrology in 5 days.","A 44-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], blood clots [on blood thinner warfarin], rheumatoid arthritis [on immune-suppressing medicine], low blood count [anemia], and prior knee replacement was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (5) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the kidney doctor in 5 days.",Cardiology,Discharge Summary,high
3197,Procedure: PCI with DES to LAD. Pt 48 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 48-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
3198,CXR PA: No pneumothorax. Widened mediastinum. Sternotomy wires intact. Osseous structures intact.,"Chest X-ray results: There is no collapsed lung. The space between the lungs appears wider than normal, which needs further evaluation. The wires from prior heart surgery are intact. The bones look normal with no fractures.",Pulmonology,Radiology Report,high
3199,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. 4cm right subdural hematoma with 5mm midline shift. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
3200,"BMP: Na 146 (H), K 4.6 (N), BUN 85, Cr 3.1 (H), Glucose 264.","Your blood chemistry results: Sodium is high at 146, meaning you may be dehydrated. Potassium is normal at 4.6. Creatinine is elevated at 3.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 264 (high).",Nephrology,Lab Result,high
3201,"Rx: Tab pregabalin 75mg BID. Tab pantoprazole 40mg AC breakfast. Adv: fall precautions, home safety evaluation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Neurology,Prescription,medium
3202,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,low
3203,"Rx: Tab lisinopril 10mg daily. Tab metformin 500mg BID. Tab spironolactone 25mg daily. Tab carvedilol 12.5mg BID. Tab metoprolol succinate 50mg daily. Adv: elevate affected limb, compression stockings. F/U 2 weeks with INR.",Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) spironolactone 25mg once daily [heart-protecting water pill]. (4) carvedilol 12.5mg twice daily [heart medicine]. (5) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
3204,"CBC: WBC 18.0 (H), Hgb 7.3 (L), Plt 182 (N).","Your blood count results: White blood cells are 18.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 7.3, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 182, which is normal.",Hematology,Lab Result,high
3205,Procedure: ERCP with sphincterotomy. Pt 78 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 78-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3206,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
3207,"44 y/o F with PMH of GERD, OSA on CPAP, anemia, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Low potassium diet. D/C on lisinopril 10mg daily, latanoprost 0.005% OU QHS, carvedilol 12.5mg BID, amoxicillin 500mg TID x 10 days, sertraline 50mg daily. F/U wound care in 3 days.","A 44-year-old woman with a history of acid reflux, sleep apnea [uses a breathing machine at night], and low blood count [anemia] was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up at the wound care clinic in 3 days.",Gastroenterology,Discharge Summary,high
3208,Delivery Note: G?P? at 37+3 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3209,Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab spironolactone 25mg daily. Humalog per SSI. Tab montelukast 10mg QHS. Tab amlodipine 10mg daily. Adv: wound care with daily dressing changes. F/U PCP in 1 week for BP recheck.,"Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) Humalog insulin before meals as directed [fast-acting insulin]. (4) montelukast 10mg at bedtime [asthma/allergy medicine]. (5) amlodipine 10mg once daily [blood pressure medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
3210,"65 y/o M with PMH of PPM in situ, ESRD on HD, s/p THR, s/p TKR, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on amlodipine 5mg daily, pantoprazole 40mg AC breakfast, montelukast 10mg QHS. F/U INR check in 3 days.","A 65-year-old man with a history of implanted pacemaker, kidney failure requiring dialysis, prior hip replacement, and prior knee replacement was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
3211,CXR PA: Cardiomegaly with CTR >0.5. Left lower lobe consolidation. Right-sided pneumothorax.,Chest X-ray results: The heart appears larger than normal. There is an area in the lower left lung that appears infected. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax].,Pulmonology,Radiology Report,high
3212,Rx: Tab furosemide 40mg BID. Tab amlodipine 5mg daily. Tab gabapentin 300mg TID. Tab acetaminophen 650mg Q6H PRN. Avoid NSAIDs. F/U 1 week with wound check.,Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 week to have the wound checked.,Cardiology,Prescription,high
3213,"69 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 69-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3214,"US Abdomen: No focal hepatic lesion. Ascites moderate amount. CBD 12mm, dilated. GB wall thickening with stones, positive Murphy's sign. GB sludge, no stones. Spleen 16cm, splenomegaly.","Abdominal ultrasound results: No tumors or masses were found in the liver. There is a moderate amount of fluid in the belly [ascites]. The bile duct is wider than normal [dilated], which may indicate a blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The gallbladder contains thickened bile [sludge] but no stones. The spleen is enlarged [splenomegaly].",Gastroenterology,Radiology Report,high
3215,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Acute ischemic infarct in R MCA territory. No mass effect.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
3216,"BMP: Na 129 (L), K 5.3 (H), BUN 80, Cr 4.7 (H), Glucose 143.","Your blood chemistry results: Sodium is low at 129 (normal 136-145), meaning too much water in your body. Potassium is high at 5.3 — needs monitoring. Creatinine is elevated at 4.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 143 (high).",Nephrology,Lab Result,high
3217,CXR PA: Hyperinflated lungs consistent with COPD. Compression fracture T12. Small left pleural effusion. Moderate right pleural effusion. No cardiomegaly.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There is a compression fracture [collapsed bone] in the lower spine at T12. There is a small amount of fluid around the left lung. There is a moderate amount of fluid around the right lung. The heart is a normal size.",Pulmonology,Radiology Report,high
3218,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3219,Procedure: Laparoscopic appendectomy. Pt 71 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 71-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
3220,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3221,"40 y/o F with PMH of h/o TIA, PAD, CKD Stage 4, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on rosuvastatin 10mg QHS, Dulcolax 10mg QHS PRN, acetaminophen 650mg Q6H PRN, timolol 0.5% OU BID. F/U PCP in 1 week.","A 40-year-old woman with a history of history of mini-stroke, poor blood flow in the legs [peripheral artery disease], and advanced kidney disease was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up with the primary care doctor in 1 week.",Cardiology,Discharge Summary,high
3222,"58 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 58-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3223,"81 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 81-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3224,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3225,"90 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 90-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3226,"55 y/o F with PMH of PAD, A-fib, h/o CVA, cirrhosis, hypothyroidism, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on pantoprazole 40mg AC breakfast, lisinopril 10mg daily, prednisone taper, Humalog per SSI. F/U surgery in 2 weeks for drain removal.","A 55-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], irregular heartbeat [atrial fibrillation], history of stroke, liver scarring [cirrhosis], and underactive thyroid was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (4) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the surgeon in 2 weeks to remove the drain.",Gastroenterology,Discharge Summary,high
3227,"Rx: Tab atorvastatin 80mg QHS. Tab warfarin 5mg daily. Tab metformin 1000mg BID. Tab amlodipine 10mg daily. Tab carvedilol 12.5mg BID. Adv: SMBG BID, diabetic diet Adv: wound care with daily dressing changes. F/U 6 weeks with LFTs.","Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) amlodipine 10mg once daily [blood pressure medicine]. (5) carvedilol 12.5mg twice daily [heart medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
3228,"Rx: Tab escitalopram 10mg daily. Tab lisinopril 20mg daily. Adv: smoking cessation, pulmonary rehab. F/U 1 week with CBC, CMP.",Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) lisinopril 20mg once daily [blood pressure medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,medium
3229,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3230,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3231,"52 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 52-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3232,"BMP: Na 139 (N), K 6.6 (H), BUN 7, Cr 6.8 (H), Glucose 151.","Your blood chemistry results: Sodium is normal at 139. Potassium is dangerously high at 6.6 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 6.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 151 (high).",Nephrology,Lab Result,high
3233,"39 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 39-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3234,Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab atorvastatin 80mg QHS. Tab lisinopril 10mg daily. Adv: wound care with daily dressing changes. F/U 2 weeks with INR.,"Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
3235,"60 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 60-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3236,"Rx: Tab amlodipine 5mg daily. Tab ibuprofen 400mg Q6H PRN with food. Tab ondansetron 4mg Q8H PRN N/V. Tab ferrous sulfate 325mg BID. Tab gabapentin 300mg TID. Adv: wound care with daily dressing changes. F/U 1 week with CBC, CMP.","Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (5) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",General,Prescription,high
3237,HbA1c: 7.8% (H). FBS: 161 mg/dL (H).,"Your diabetes blood test results: HbA1c is 7.8%, which is above the target of 7.0%. Your blood sugar has been somewhat poorly controlled over the past 3 months. Fasting blood sugar was 161, which is high (normal is 70-100). Your diabetes medicines may need adjustment. Discuss with your doctor.",Endocrinology,Lab Result,high
3238,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
3239,"Lipid panel: TC 162, LDL 91, HDL 67, TG 422.",Your cholesterol results: Total cholesterol is 162. LDL (bad cholesterol) is at goal (91). HDL (good cholesterol) is good at 67. Triglycerides are very high at 422 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
3240,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3241,Procedure: Laparoscopic cholecystectomy. Pt 38 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 38-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
3242,"78 y/o M with PMH of HTN, CKD Stage 4, SLE, CAD, h/o CVA, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on warfarin 5mg daily, ciprofloxacin 500mg BID x 5 days, potassium chloride 20mEq daily, clopidogrel 75mg daily. F/U PCP in 2 weeks.","A 78-year-old man with a history of high blood pressure, advanced kidney disease, lupus, coronary artery disease [heart artery blockages], and history of stroke was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Follow-up with the primary care doctor in 2 weeks.",General Surgery,Discharge Summary,high
3243,"Rx: Tab potassium chloride 20mEq daily. Tab furosemide 40mg BID. Tab empagliflozin 10mg daily. Tab atorvastatin 40mg QHS. Tab acetaminophen 650mg Q6H PRN. Do not stop abruptly, taper as directed. F/U 2 weeks.",Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (4) atorvastatin 40mg at bedtime [cholesterol medicine]. (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back for a check-up in 2 weeks.,Cardiology,Prescription,high
3244,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Mild generalized cerebral atrophy appropriate for age. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is mild brain shrinkage, which is normal for your age. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
3245,"US Abdomen: No focal hepatic lesion. Ascites moderate amount. Simple renal cysts bilaterally. Spleen 11cm, normal.",Abdominal ultrasound results: No tumors or masses were found in the liver. There is a moderate amount of fluid in the belly [ascites]. Both kidneys have harmless fluid-filled cysts. The spleen is a normal size.,Gastroenterology,Radiology Report,high
3246,Procedure: Laparoscopic appendectomy. Pt 63 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 63-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
3247,HbA1c: 11.5% (H). FBS: 110 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.5%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 110, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3248,HbA1c: 12.4% (H). FBS: 387 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.4%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 387, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3249,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,low
3250,"70 y/o F with PMH of CKD Stage 3, ICD in situ, PAD, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Compression stockings when ambulating. D/C on entresto 49/51mg BID, rosuvastatin 10mg QHS, ondansetron 4mg Q8H PRN N/V. F/U orthopedics in 6 weeks with X-ray.","A 70-year-old woman with a history of moderate kidney disease, implanted heart defibrillator, and poor blood flow in the legs [peripheral artery disease] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Pulmonology,Discharge Summary,high
3251,"BMP: Na 150 (H), K 4.8 (N), BUN 77, Cr 6.3 (H), Glucose 117.","Your blood chemistry results: Sodium is high at 150, meaning you may be dehydrated. Potassium is normal at 4.8. Creatinine is elevated at 6.3 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 117 (high).",Nephrology,Lab Result,high
3252,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
3253,"73 y/o M with PMH of OSA on CPAP, GERD, OA, obesity (BMI 38), admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on metformin 500mg BID, hydroxychloroquine 200mg BID, Lantus 20U QHS, calcium + vitamin D 600/400 daily. F/U INR check in 3 days.","A 73-year-old man with a history of sleep apnea [uses a breathing machine at night], acid reflux, arthritis [osteoarthritis], and obesity was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) Lantus insulin 20 units at bedtime [long-acting insulin]; (4) calcium plus vitamin D once daily [bone strengthening]. Follow-up for a blood thinner level check in 3 days.",Pulmonology,Discharge Summary,high
3254,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3255,Procedure: Colonoscopy with polypectomy. Pt 82 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 82-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3256,"70 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 70-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3257,"MRI Lumbar Spine: Conus medullaris at L1, normal. L4-L5 disc herniation with moderate bilateral foraminal stenosis. No compression fracture.","MRI of the lower back results: The spinal cord ends at a normal level. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
3258,"78 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 78-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3259,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,low
3260,"CBC: WBC 9.8 (N), Hgb 13.8 (N), Plt 261 (N).","Your blood count results: White blood cells are 9.8 (normal). Hemoglobin is normal at 13.8. Platelets are 261, which is normal.",Hematology,Lab Result,medium
3261,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Paranasal sinuses clear. No midline shift.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. The sinuses are clear with no infection. The brain is centered normally.",Neurology,Radiology Report,high
3262,"Rx: Tab metformin 500mg BID. Tab carvedilol 12.5mg BID. Adv: low salt low sugar diet, regular exercise Adv: low salt diet, fluid restriction 1.5L/day. F/U PCP in 1 week for BP recheck.","Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) carvedilol 12.5mg twice daily [heart medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: eat less salt and limit your total fluid intake to about 6 cups per day. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
3263,"78 y/o M with PMH of CHF, CKD Stage 4, HTN, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on warfarin 5mg daily, pantoprazole 40mg AC breakfast, carvedilol 12.5mg BID. F/U INR check in 3 days.","A 78-year-old man with a history of heart failure, advanced kidney disease, and high blood pressure was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) carvedilol 12.5mg twice daily [heart medicine]. Follow-up for a blood thinner level check in 3 days.",Neurology,Discharge Summary,high
3264,"BMP: Na 135 (L), K 3.7 (N), BUN 28, Cr 3.5 (H), Glucose 384.","Your blood chemistry results: Sodium is low at 135 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.7. Creatinine is elevated at 3.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 384 (high).",Nephrology,Lab Result,high
3265,"76 y/o F with PMH of DVT/PE on warfarin, GERD, anemia, h/o CVA, A-fib, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on prednisone taper, Eliquis 5mg BID, spironolactone 25mg daily, potassium chloride 20mEq daily, metoprolol succinate 50mg daily. F/U hematology in 2 weeks.","A 76-year-old woman with a history of blood clots [on blood thinner warfarin], acid reflux, low blood count [anemia], history of stroke, and irregular heartbeat [atrial fibrillation] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) Eliquis 5mg twice daily [blood thinner]; (3) spironolactone 25mg once daily [heart-protecting water pill]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (5) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Nephrology,Discharge Summary,high
3266,CXR PA: Osseous structures intact. ET tube 3cm above carina. Left lower lobe consolidation. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: The bones look normal with no fractures. The breathing tube is in good position. There is an area in the lower left lung that appears infected. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
3267,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. Paranasal sinuses clear. No midline shift. No acute intracranial hemorrhage. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. The sinuses are clear with no infection. The brain is centered normally. There is no bleeding in the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
3268,Procedure: EGD with biopsy. Pt 90 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 90-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3269,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Multilevel degenerative disc disease. Central canal stenosis at L3-L4.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. Multiple discs in the spine are showing wear and aging. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
3270,"82 y/o F with PMH of CAD, h/o TIA, cirrhosis, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on furosemide 40mg BID, lisinopril 20mg daily, escitalopram 10mg daily, Humalog per SSI. F/U hematology in 2 weeks.","A 82-year-old woman with a history of coronary artery disease [heart artery blockages], history of mini-stroke, and liver scarring [cirrhosis] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (4) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the blood disorder doctor in 2 weeks.",Nephrology,Discharge Summary,high
3271,"Rx: Tab pantoprazole 40mg AC breakfast. Tab empagliflozin 10mg daily. Lantus 20U QHS. Tab entresto 49/51mg BID. Do not stop abruptly, taper as directed. F/U 1 week with wound check.",Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) Lantus insulin 20 units at bedtime [long-acting insulin]. (4) Entresto 49/51mg twice daily [heart failure medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week to have the wound checked.,Endocrinology,Prescription,high
3272,"CBC: WBC 6.7 (N), Hgb 8.9 (L), Plt 60 (L).","Your blood count results: White blood cells are 6.7 (normal). Hemoglobin is low at 8.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 60, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
3273,"36 y/o M with PMH of anxiety, depression, CKD Stage 3, A-fib, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on amoxicillin 500mg TID x 10 days, omeprazole 20mg AC breakfast. F/U PCP in 1 week.","A 36-year-old man with a history of anxiety, depression, moderate kidney disease, and irregular heartbeat [atrial fibrillation] was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the primary care doctor in 1 week.",Infectious Disease,Discharge Summary,high
3274,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab clopidogrel 75mg daily. prednisone taper. Adv: SMBG BID, diabetic diet. F/U 6 weeks with LFTs.",Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,medium
3275,"LFTs: AST 305 (H), ALT 58 (H), ALP 219, T.Bili 2.7 (H), Albumin 3.5.","Your liver blood test results: Liver enzymes (AST 305, ALT 58) are mildly elevated (normal is under 40). Bilirubin is high at 2.7 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.5.",Gastroenterology,Lab Result,high
3276,CXR PA: No cardiomegaly. Patchy bilateral infiltrates. Port-a-cath in appropriate position. Cardiomegaly with CTR >0.5. Sternotomy wires intact.,Chest X-ray results: The heart is a normal size. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The implanted medication port is in the correct position. The heart appears larger than normal. The wires from prior heart surgery are intact.,Pulmonology,Radiology Report,high
3277,CXR PA: Moderate right pleural effusion. No pneumothorax. Clear lung fields bilaterally. Osseous structures intact.,Chest X-ray results: There is a moderate amount of fluid around the right lung. There is no collapsed lung. Both lungs look clear with no problems. The bones look normal with no fractures.,Pulmonology,Radiology Report,high
3278,"Rx: Tab methotrexate 15mg weekly. Tab ASA 81mg daily. Tab lisinopril 10mg daily. Adv: SMBG BID, diabetic diet Adv: high fiber diet, adequate hydration. F/U 1 week with wound check.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
3279,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,medium
3280,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3281,"Rx: Lantus 20U QHS. Tab amlodipine 10mg daily. Tab metoprolol succinate 50mg daily. Adv: smoking cessation, pulmonary rehab Adv: SMBG BID, diabetic diet. F/U INR in 3 days.",Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,medium
3282,"78 y/o M with PMH of DM1, depression, GERD, BPH, CKD Stage 4, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Low potassium diet. D/C on atorvastatin 40mg QHS, Dulcolax 10mg QHS PRN. F/U PCP in 1 week.","A 78-year-old man with a history of type 1 diabetes, depression, acid reflux, enlarged prostate, and advanced kidney disease was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the primary care doctor in 1 week.",General Surgery,Discharge Summary,high
3283,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,high
3284,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3285,"34 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 34-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3286,"Rx: Tab carvedilol 12.5mg BID. Tab ASA 81mg daily. Tab ibuprofen 400mg Q6H PRN with food. Tab latanoprost 0.005% OU QHS. Adv: low salt diet, fluid restriction 1.5L/day Adv: avoid alcohol, hepatotoxic drugs. F/U 6 weeks with LFTs.",Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,high
3287,CT Head without contrast: Acute ischemic infarct in R MCA territory. Subarachnoid hemorrhage in bilateral sylvian fissures. No midline shift.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is bleeding around the brain surface, particularly in the grooves on both sides. The brain is centered normally.",Neurology,Radiology Report,high
3288,"37 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 37-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3289,"52 y/o F with PMH of COPD, gout, CKD Stage 4, DM2, OSA on CPAP, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on metformin 500mg BID, escitalopram 10mg daily, Dulcolax 10mg QHS PRN. F/U nephrology in 5 days.","A 52-year-old woman with a history of chronic lung disease, gout, advanced kidney disease, type 2 diabetes, and sleep apnea [uses a breathing machine at night] was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the kidney doctor in 5 days.",Pulmonology,Discharge Summary,high
3290,"Lipid panel: TC 266, LDL 175, HDL 46, TG 213.","Your cholesterol results: Total cholesterol is 266. LDL (bad cholesterol) is very high at 175 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 46. Triglycerides are high at 213.",Cardiology,Lab Result,high
3291,"62 y/o F with PMH of SLE, RA on MTX, COPD, obesity (BMI 38), DM2, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Strict I&O, daily weights. D/C on timolol 0.5% OU BID, ciprofloxacin 500mg BID x 5 days, pregabalin 75mg BID. F/U oncology in 1 week.","A 62-year-old woman with a history of lupus, rheumatoid arthritis [on immune-suppressing medicine], chronic lung disease, obesity, and type 2 diabetes was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the cancer doctor in 1 week.",Gastroenterology,Discharge Summary,high
3292,"64 y/o F with PMH of RA on MTX, hypothyroidism, HFpEF, h/o CVA, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on atorvastatin 40mg QHS, acetaminophen 650mg Q6H PRN. F/U oncology in 1 week.","A 64-year-old woman with a history of rheumatoid arthritis [on immune-suppressing medicine], underactive thyroid, heart failure with stiff heart muscle, and history of stroke was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the cancer doctor in 1 week.",Hematology,Discharge Summary,high
3293,"27 y/o M with PMH of HFrEF (EF 30%), A-fib, RA on MTX, DVT/PE on warfarin, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on spironolactone 25mg daily, ondansetron 4mg Q8H PRN N/V. F/U wound care in 3 days.","A 27-year-old man with a history of heart failure with weak pumping (30%), irregular heartbeat [atrial fibrillation], rheumatoid arthritis [on immune-suppressing medicine], and blood clots [on blood thinner warfarin] was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
3294,CXR PA: Clear lung fields bilaterally. Left lower lobe consolidation. Sternotomy wires intact.,Chest X-ray results: Both lungs look clear with no problems. There is an area in the lower left lung that appears infected. The wires from prior heart surgery are intact.,Pulmonology,Radiology Report,high
3295,"73 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 73-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3296,"Rx: Tab metformin 500mg BID. Tab clopidogrel 75mg daily. Tab ibuprofen 400mg Q6H PRN with food. Adv: smoking cessation, pulmonary rehab. F/U 1 week with CBC, CMP.",Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,medium
3297,"48 y/o F with PMH of h/o CVA, PAD, DM1, cirrhosis, A-fib, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on Dulcolax 10mg QHS PRN, furosemide 40mg daily, amoxicillin 500mg TID x 10 days, albuterol MDI 2 puffs Q4-6H PRN. F/U GI in 1 week.","A 48-year-old woman with a history of history of stroke, poor blood flow in the legs [peripheral artery disease], type 1 diabetes, liver scarring [cirrhosis], and irregular heartbeat [atrial fibrillation] was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the stomach doctor in 1 week.",Urology,Discharge Summary,high
3298,"32 y/o M with PMH of Parkinson's disease, DVT/PE on warfarin, seizure disorder on Keppra, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Strict I&O, daily weights. D/C on montelukast 10mg QHS, levothyroxine 75mcg daily on empty stomach, Eliquis 5mg BID. F/U INR check in 3 days.","A 32-year-old man with a history of Parkinson's disease, blood clots [on blood thinner warfarin], and seizure disorder [on Keppra] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) Eliquis 5mg twice daily [blood thinner]. Follow-up for a blood thinner level check in 3 days.",Neurology,Discharge Summary,high
3299,"US Abdomen: Right kidney 10.5cm, no hydronephrosis. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Left kidney 8cm, cortical thinning consistent with CKD. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: Right kidney is normal size with no blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
3300,CXR PA: Sternotomy wires intact. Cardiomegaly with CTR >0.5. No cardiomegaly. Bilateral pleural effusions.,Chest X-ray results: The wires from prior heart surgery are intact. The heart appears larger than normal. The heart is a normal size. There is fluid collecting around both lungs.,Pulmonology,Radiology Report,high
3301,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
3302,HbA1c: 6.9% (H). FBS: 373 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.9%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 373, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
3303,"BMP: Na 135 (L), K 4.2 (N), BUN 88, Cr 0.8 (N), Glucose 382.","Your blood chemistry results: Sodium is low at 135 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.2. Creatinine is normal at 0.8. Blood sugar is 382 (high).",Nephrology,Lab Result,high
3304,CXR PA: ET tube 3cm above carina. Clear lung fields bilaterally. Elevated left hemidiaphragm. Right-sided pneumothorax.,Chest X-ray results: The breathing tube is in good position. Both lungs look clear with no problems. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax].,Pulmonology,Radiology Report,high
3305,"22 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 22-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3306,"BMP: Na 148 (H), K 6.7 (H), BUN 71, Cr 1.3 (H), Glucose 394.","Your blood chemistry results: Sodium is high at 148, meaning you may be dehydrated. Potassium is dangerously high at 6.7 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is mildly elevated at 1.3. Blood sugar is 394 (high).",Nephrology,Lab Result,high
3307,"Rx: Tab Dulcolax 10mg QHS PRN. Tab lisinopril 10mg daily. Tab calcium + vitamin D 600/400 daily. Adv: high fiber diet, adequate hydration. F/U 2 weeks with INR.","Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) calcium plus vitamin D once daily [bone strengthening]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks for a blood thinner level check [INR].",General,Prescription,medium
3308,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
3309,CXR PA: ET tube 3cm above carina. Hyperinflated lungs consistent with COPD. Widened mediastinum. Cardiomegaly with CTR >0.5. Small left pleural effusion.,"Chest X-ray results: The breathing tube is in good position. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The space between the lungs appears wider than normal, which needs further evaluation. The heart appears larger than normal. There is a small amount of fluid around the left lung.",Pulmonology,Radiology Report,high
3310,Procedure: Laparoscopic appendectomy. Pt 28 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 28-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
3311,"US Abdomen: CBD 5mm, not dilated. Simple renal cysts bilaterally. Moderate right hydronephrosis. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The bile duct is normal size [not blocked]. Both kidneys have harmless fluid-filled cysts. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
3312,Procedure: Port-a-cath placement. Pt 33 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 33-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
3313,"MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. C5-C6 disc herniation with cord compression. Facet joint hypertrophy at L4-L5. Conus medullaris at L1, normal.","MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
3314,"US Abdomen: No focal hepatic lesion. Simple renal cysts bilaterally. Ascites moderate amount. Spleen 16cm, splenomegaly. Pancreas unremarkable. GB sludge, no stones.",Abdominal ultrasound results: No tumors or masses were found in the liver. Both kidneys have harmless fluid-filled cysts. There is a moderate amount of fluid in the belly [ascites]. The spleen is enlarged [splenomegaly]. The pancreas looks normal. The gallbladder contains thickened bile [sludge] but no stones.,Gastroenterology,Radiology Report,high
3315,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3316,CXR PA: Patchy bilateral infiltrates. Bilateral hilar lymphadenopathy. Right lower lobe consolidation. No cardiomegaly.,"Chest X-ray results: There are scattered cloudy patches in both lungs suggesting infection or inflammation. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There is an area in the lower right lung that appears infected, suggesting pneumonia. The heart is a normal size.",Pulmonology,Radiology Report,high
3317,CXR PA: Right middle lobe atelectasis. Bilateral hilar lymphadenopathy. Mild cardiomegaly. Sternotomy wires intact.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The heart is slightly larger than normal. The wires from prior heart surgery are intact.",Pulmonology,Radiology Report,high
3318,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Chronic lacunar infarcts in bilateral basal ganglia. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There are signs of small old strokes in the deep parts of the brain. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
3319,Procedure: TURP for BPH. Pt 89 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 89-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
3320,"CBC: WBC 15.1 (H), Hgb 8.6 (L), Plt 405 (H).","Your blood count results: White blood cells are 15.1 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 8.6, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 405, which is high — your blood may clot too easily.",Hematology,Lab Result,high
3321,"Rx: Tab pantoprazole 40mg AC breakfast. Tab ASA 81mg daily. Tab acetaminophen 650mg Q6H PRN. Tab montelukast 10mg QHS. Adv: smoking cessation, pulmonary rehab Adv: elevate affected limb, compression stockings. F/U 2 weeks with INR.",Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (4) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
3322,HbA1c: 6.7% (H). FBS: 373 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.7%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 373, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
3323,HbA1c: 13.2% (H). FBS: 395 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.2%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 395, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3324,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
3325,"LFTs: AST 224 (H), ALT 33 (N), ALP 125, T.Bili 4.5 (H), Albumin 2.9.","Your liver blood test results: Liver enzymes (AST 224, ALT 33) are normal (normal is under 40). Bilirubin is high at 4.5 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.9 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
3326,"52 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 52-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3327,"Rx: Tab rosuvastatin 10mg QHS. Tab Dulcolax 10mg QHS PRN. Tab timolol 0.5% OU BID. Tab potassium chloride 20mEq daily. Adv: SMBG BID, diabetic diet. F/U PCP in 1 week for BP recheck.",Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. See your primary care doctor in 1 week to recheck blood pressure.,Pediatrics,Prescription,high
3328,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
3329,CXR PA: Left lower lobe consolidation. Port-a-cath in appropriate position. Mild cardiomegaly.,Chest X-ray results: There is an area in the lower left lung that appears infected. The implanted medication port is in the correct position. The heart is slightly larger than normal.,Pulmonology,Radiology Report,high
3330,"77 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 77-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
3331,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3332,"34 y/o F with PMH of Parkinson's disease, SLE, HLD, anxiety, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on tramadol 50mg Q6H PRN pain, carvedilol 12.5mg BID, amoxicillin 500mg TID x 10 days. F/U PCP in 2 weeks.","A 34-year-old woman with a history of Parkinson's disease, lupus, high cholesterol, and anxiety was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the primary care doctor in 2 weeks.",Nephrology,Discharge Summary,high
3333,"22 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 22-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3334,Procedure: EGD with biopsy. Pt 30 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 30-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3335,"US Abdomen: Moderate right hydronephrosis. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Left kidney 8cm, cortical thinning consistent with CKD. CBD 12mm, dilated. Right kidney 10.5cm, no hydronephrosis. No focal hepatic lesion.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The bile duct is wider than normal [dilated], which may indicate a blockage. Right kidney is normal size with no blockage. No tumors or masses were found in the liver.",Gastroenterology,Radiology Report,high
3336,"65 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 65-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3337,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. Left kidney 8cm, cortical thinning consistent with CKD. Ascites moderate amount. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Left kidney is small with thin outer layer, consistent with chronic kidney disease. There is a moderate amount of fluid in the belly [ascites]. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
3338,"Lipid panel: TC 120, LDL 45, HDL 57, TG 488.",Your cholesterol results: Total cholesterol is 120. LDL (bad cholesterol) is at goal (45). HDL (good cholesterol) is good at 57. Triglycerides are very high at 488 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
3339,"60 y/o F with PMH of BPH, seizure disorder on Keppra, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on pantoprazole 40mg AC breakfast, amoxicillin 500mg TID x 10 days. F/U endocrine in 1 week.","A 60-year-old woman with a history of enlarged prostate, and seizure disorder [on Keppra] was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the hormone/diabetes doctor in 1 week.",Infectious Disease,Discharge Summary,high
3340,"79 y/o M with PMH of OSA on CPAP, OA, PAD, anxiety, CAD, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Strict I&O, daily weights. D/C on lisinopril 20mg daily, tramadol 50mg Q6H PRN pain. F/U cardiology in 2 weeks.","A 79-year-old man with a history of sleep apnea [uses a breathing machine at night], arthritis [osteoarthritis], poor blood flow in the legs [peripheral artery disease], anxiety, and coronary artery disease [heart artery blockages] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the heart doctor in 2 weeks.",Neurology,Discharge Summary,high
3341,"72 y/o M with PMH of depression, HFrEF (EF 30%), RA on MTX, OA, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on carvedilol 12.5mg BID, hydroxychloroquine 200mg BID, pantoprazole 40mg AC breakfast, ibuprofen 400mg Q6H PRN with food. F/U nephrology in 1 week.","A 72-year-old man with a history of depression, heart failure with weak pumping (30%), rheumatoid arthritis [on immune-suppressing medicine], and arthritis [osteoarthritis] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]; (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the kidney doctor in 1 week.",Psychiatry,Discharge Summary,high
3342,"32 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 32-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3343,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3344,"44 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 44-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3345,"49 y/o F with PMH of OA, HTN, gout, anxiety, cirrhosis, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on amoxicillin 500mg TID x 10 days, rosuvastatin 10mg QHS, prednisone taper. F/U cardiology in 2 weeks.","A 49-year-old woman with a history of arthritis [osteoarthritis], high blood pressure, gout, anxiety, and liver scarring [cirrhosis] was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the heart doctor in 2 weeks.",Endocrinology,Discharge Summary,high
3346,CXR PA: No cardiomegaly. Right middle lobe atelectasis. Right-sided pneumothorax. Small left pleural effusion. No pneumothorax.,"Chest X-ray results: The heart is a normal size. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There is a small amount of fluid around the left lung. There is no collapsed lung.",Pulmonology,Radiology Report,high
3347,"Rx: Tab rosuvastatin 10mg QHS. Tab ibuprofen 400mg Q6H PRN with food. Spiriva 18mcg daily. Adv: low salt diet, fluid restriction 1.5L/day Adv: smoking cessation, pulmonary rehab. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (3) Spiriva inhaler once daily [long-acting lung medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
3348,"54 y/o M with PMH of CHF, osteoporosis, BPH, s/p CABG, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on lisinopril 20mg daily, furosemide 40mg BID, ASA 81mg daily. F/U PCP in 1 week.","A 54-year-old man with a history of heart failure, weak bones [osteoporosis], enlarged prostate, and prior heart bypass surgery was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) furosemide (Lasix) 40mg twice daily [water pill]; (3) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the primary care doctor in 1 week.",General Surgery,Discharge Summary,high
3349,"Rx: Tab ASA 81mg daily. Tab levothyroxine 75mcg daily on empty stomach. Tab metformin 500mg BID. Tab methotrexate 15mg weekly. Tab metoprolol succinate 50mg daily. Do not stop abruptly, taper as directed Adv: smoking cessation, pulmonary rehab. F/U PCP in 1 week for BP recheck.",Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (5) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,high
3350,"Rx: Tab methotrexate 15mg weekly. Tab potassium chloride 20mEq daily. Spiriva 18mcg daily. Tab pantoprazole 40mg AC breakfast. Adv: low salt diet, fluid restriction 1.5L/day Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with INR.",Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) Spiriva inhaler once daily [long-acting lung medicine]. (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks for a blood thinner level check [INR].,Pulmonology,Prescription,high
3351,"72 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 72-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3352,"81 y/o M with PMH of CHF, CKD Stage 4, HLD, OA, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on losartan 50mg daily, albuterol MDI 2 puffs Q4-6H PRN, levothyroxine 75mcg daily on empty stomach, metformin 1000mg BID, glipizide 5mg BID AC. F/U pulmonology in 2 weeks.","A 81-year-old man with a history of heart failure, advanced kidney disease, high cholesterol, and arthritis [osteoarthritis] was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]; (5) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the lung doctor in 2 weeks.",General Surgery,Discharge Summary,high
3353,"68 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 68-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3354,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
3355,"50 y/o M with PMH of DM1, s/p THR, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Low potassium diet. D/C on losartan 50mg daily, albuterol MDI 2 puffs Q4-6H PRN, amlodipine 10mg daily. F/U pulmonology in 2 weeks.","A 50-year-old man with a history of type 1 diabetes, and prior hip replacement was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (3) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the lung doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
3356,"Rx: Tab Dulcolax 10mg QHS PRN. Tab rosuvastatin 10mg QHS. Lantus 20U QHS. Avoid grapefruit juice Adv: low salt low sugar diet, regular exercise. F/U 1 week with wound check.","Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) Lantus insulin 20 units at bedtime [long-acting insulin]. Do not drink grapefruit juice as it interferes with this medication Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
3357,"Rx: Tab lisinopril 10mg daily. Tab methotrexate 15mg weekly. Tab acetaminophen 650mg Q6H PRN. Tab ASA 81mg daily. Tab potassium chloride 20mEq daily. Adv: high fiber diet, adequate hydration Adv: avoid alcohol, hepatotoxic drugs. F/U PCP in 1 week for BP recheck.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (4) baby aspirin 81mg once daily [prevents blood clots]. (5) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
3358,CXR PA: Sternotomy wires intact. Increased interstitial markings suggesting pulmonary edema. No cardiomegaly. Left lower lobe consolidation.,"Chest X-ray results: The wires from prior heart surgery are intact. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. The heart is a normal size. There is an area in the lower left lung that appears infected.",Pulmonology,Radiology Report,high
3359,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. Simple renal cysts bilaterally. Pancreas unremarkable. Right kidney 10.5cm, no hydronephrosis. Ascites moderate amount.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Both kidneys have harmless fluid-filled cysts. The pancreas looks normal. Right kidney is normal size with no blockage. There is a moderate amount of fluid in the belly [ascites].",Gastroenterology,Radiology Report,high
3360,"58 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 58-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3361,CXR PA: Bilateral pleural effusions. Right-sided pneumothorax. Right lower lobe consolidation. Right middle lobe atelectasis. Port-a-cath in appropriate position.,"Chest X-ray results: There is fluid collecting around both lungs. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There is an area in the lower right lung that appears infected, suggesting pneumonia. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The implanted medication port is in the correct position.",Pulmonology,Radiology Report,high
3362,"MRI Lumbar Spine: Conus medullaris at L1, normal. Central canal stenosis at L3-L4.","MRI of the lower back results: The spinal cord ends at a normal level. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
3363,"Rx: Tab carvedilol 12.5mg BID. Tab escitalopram 10mg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab atorvastatin 40mg QHS. Adv: DASH diet, daily BP monitoring. F/U 6 weeks with LFTs.","Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) atorvastatin 40mg at bedtime [cholesterol medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
3364,"33 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 33-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3365,HbA1c: 7.3% (H). FBS: 185 mg/dL (H).,"Your diabetes blood test results: HbA1c is 7.3%, which is above the target of 7.0%. Your blood sugar has been somewhat poorly controlled over the past 3 months. Fasting blood sugar was 185, which is high (normal is 70-100). Your diabetes medicines may need adjustment. Discuss with your doctor.",Endocrinology,Lab Result,high
3366,CXR PA: Elevated left hemidiaphragm. Port-a-cath in appropriate position. Pacemaker leads in appropriate position. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. The implanted medication port is in the correct position. The pacemaker wires are in the correct position. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
3367,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3368,Procedure: Laparoscopic appendectomy. Pt 40 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 40-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
3369,"Rx: Tab timolol 0.5% OU BID. Tab glipizide 5mg BID AC. Adv: low salt low sugar diet, regular exercise. F/U 1 week with CBC, CMP.","Your medicines: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (2) glipizide 5mg twice daily before meals [helps release insulin]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,medium
3370,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3371,"36 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 36-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3372,CT Head without contrast: No acute intracranial hemorrhage. Mild generalized cerebral atrophy appropriate for age. No mass effect. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is no bleeding in the brain. There is mild brain shrinkage, which is normal for your age. There are no tumors or masses pushing on the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
3373,HbA1c: 10.9% (H). FBS: 182 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.9%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 182, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3374,"MRI Lumbar Spine: Central canal stenosis at L3-L4. Facet joint hypertrophy at L4-L5. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Conus medullaris at L1, normal.","MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. The small joints in the spine at L4-L5 are enlarged from arthritis. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
3375,"Lipid panel: TC 302, LDL 42, HDL 30, TG 83.","Your cholesterol results: Total cholesterol is 302. LDL (bad cholesterol) is at goal (42). HDL (good cholesterol) is too low at 30 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are normal at 83.",Cardiology,Lab Result,high
3376,"32 y/o F with PMH of ESRD on HD, HFrEF (EF 30%), admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on sertraline 50mg daily, montelukast 10mg QHS, pregabalin 75mg BID, metformin 1000mg BID. F/U neurology in 2 weeks.","A 32-year-old woman with a history of kidney failure requiring dialysis, and heart failure with weak pumping (30%) was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]; (3) pregabalin 75mg twice daily [nerve pain medicine]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Endocrinology,Discharge Summary,high
3377,"Rx: Tab Xarelto 20mg daily with dinner. Tab pregabalin 75mg BID. Tab lisinopril 20mg daily. Tab tramadol 50mg Q6H PRN pain. Adv: weight bearing exercise, calcium/vit D supplementation. F/U INR in 3 days.","Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) lisinopril 20mg once daily [blood pressure medicine]. (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
3378,"US Abdomen: No focal hepatic lesion. CBD 12mm, dilated. Ascites moderate amount.","Abdominal ultrasound results: No tumors or masses were found in the liver. The bile duct is wider than normal [dilated], which may indicate a blockage. There is a moderate amount of fluid in the belly [ascites].",Gastroenterology,Radiology Report,high
3379,"80 y/o F with PMH of ICD in situ, CKD Stage 4, SLE, A-fib, h/o TIA, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on furosemide 40mg BID, lisinopril 10mg daily, potassium chloride 20mEq daily, Xarelto 20mg daily with dinner, Lantus 20U QHS. F/U wound care in 3 days.","A 80-year-old woman with a history of implanted heart defibrillator, advanced kidney disease, lupus, irregular heartbeat [atrial fibrillation], and history of mini-stroke was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) Xarelto 20mg once daily with dinner [blood thinner]; (5) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
3380,"28 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 28-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3381,"Rx: Tab hydroxychloroquine 200mg BID. Tab methotrexate 15mg weekly. Tab furosemide 40mg BID. Adv: low potassium diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) furosemide (Lasix) 40mg twice daily [water pill]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Rheumatology,Prescription,medium
3382,"57 y/o F with PMH of CHF, Parkinson's disease, s/p TKR, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on pregabalin 75mg BID, Dulcolax 10mg QHS PRN, timolol 0.5% OU BID, sertraline 50mg daily. F/U orthopedics in 6 weeks with X-ray.","A 57-year-old woman with a history of heart failure, Parkinson's disease, and prior knee replacement was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (4) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Infectious Disease,Discharge Summary,high
3383,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
3384,CXR PA: Pacemaker leads in appropriate position. Port-a-cath in appropriate position. Right-sided pneumothorax. Right middle lobe atelectasis.,"Chest X-ray results: The pacemaker wires are in the correct position. The implanted medication port is in the correct position. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
3385,"40 y/o M with PMH of s/p TKR, BPH, CHF, obesity (BMI 38), HTN, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on pregabalin 75mg BID, Xarelto 20mg daily with dinner. F/U pulmonology in 2 weeks.","A 40-year-old man with a history of prior knee replacement, enlarged prostate, heart failure, obesity, and high blood pressure was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the lung doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
3386,"Rx: Tab amlodipine 5mg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab Xarelto 20mg daily with dinner. Adv: low potassium diet Adv: low salt low sugar diet, regular exercise. F/U 6 weeks with LFTs.","Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (3) Xarelto 20mg once daily with dinner [blood thinner]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
3387,Procedure: EGD with biopsy. Pt 58 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 58-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3388,"MRI Lumbar Spine: Conus medullaris at L1, normal. Facet joint hypertrophy at L4-L5.",MRI of the lower back results: The spinal cord ends at a normal level. The small joints in the spine at L4-L5 are enlarged from arthritis.,Orthopedics,Radiology Report,high
3389,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,medium
3390,HbA1c: 6.0% (H). FBS: 281 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.0%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 281, which is high (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,high
3391,"45 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 45-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3392,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
3393,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. Multilevel degenerative disc disease.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
3394,"LFTs: AST 305 (H), ALT 21 (N), ALP 41, T.Bili 6.0 (H), Albumin 3.7.","Your liver blood test results: Liver enzymes (AST 305, ALT 21) are normal (normal is under 40). Bilirubin is high at 6.0 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.7.",Gastroenterology,Lab Result,high
3395,"Rx: Tab Augmentin 875/125 BID x 7 days. Lantus 20U QHS. Adv: elevate affected limb, compression stockings. F/U INR in 3 days.",Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 3 days for a blood thinner level check [INR].,Endocrinology,Prescription,medium
3396,"Rx: Spiriva 18mcg daily. Tab montelukast 10mg QHS. Tab latanoprost 0.005% OU QHS. Tab spironolactone 25mg daily. Adv: SMBG BID, diabetic diet. F/U 1 week with CBC, CMP.",Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (4) spironolactone 25mg once daily [heart-protecting water pill]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Pulmonology,Prescription,high
3397,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,medium
3398,"Rx: Tab losartan 50mg daily. Tab entresto 49/51mg BID. Humalog per SSI. Tab acetaminophen 650mg Q6H PRN. Adv: high fiber diet, adequate hydration. F/U INR in 3 days.","Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) Humalog insulin before meals as directed [fast-acting insulin]. (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
3399,"36 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 36-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3400,Delivery Note: G?P? at 38+2 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3401,"71 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 71-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
3402,"84 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 84-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3403,CXR PA: Hyperinflated lungs consistent with COPD. Patchy bilateral infiltrates. No cardiomegaly. Widened mediastinum.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The heart is a normal size. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
3404,CT Head without contrast: Mild generalized cerebral atrophy appropriate for age. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Acute ischemic infarct in R MCA territory. No acute intracranial hemorrhage. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: There is mild brain shrinkage, which is normal for your age. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is no bleeding in the brain. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
3405,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3406,"LFTs: AST 326 (H), ALT 71 (H), ALP 33, T.Bili 5.1 (H), Albumin 3.4.","Your liver blood test results: Liver enzymes (AST 326, ALT 71) are mildly elevated (normal is under 40). Bilirubin is high at 5.1 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 3.4 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
3407,"Rx: Tab glipizide 5mg BID AC. Tab metformin 1000mg BID. Tab spironolactone 25mg daily. Tab furosemide 40mg daily. Adv: avoid alcohol, hepatotoxic drugs Adv: low salt low sugar diet, regular exercise. F/U 2 weeks.","Your medicines: (1) glipizide 5mg twice daily before meals [helps release insulin]. (2) metformin 1000mg twice daily with meals [blood sugar medicine]. (3) spironolactone 25mg once daily [heart-protecting water pill]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
3408,HbA1c: 5.1% (N). FBS: 142 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.1%, which is normal — you do not have diabetes. Fasting blood sugar was 142, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
3409,CXR PA: Elevated left hemidiaphragm. Sternotomy wires intact. Bilateral pleural effusions. Hyperinflated lungs consistent with COPD. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. The wires from prior heart surgery are intact. There is fluid collecting around both lungs. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
3410,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab ibuprofen 400mg Q6H PRN with food. Tab ferrous sulfate 325mg BID. Avoid NSAIDs Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks with INR.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 2 weeks for a blood thinner level check [INR].",General,Prescription,medium
3411,CT Head without contrast: No acute intracranial hemorrhage. Paranasal sinuses clear. No midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is no bleeding in the brain. The sinuses are clear with no infection. The brain is centered normally. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
3412,"28 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 28-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3413,"68 y/o F with PMH of cirrhosis, Parkinson's disease, PPM in situ, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on methotrexate 15mg weekly, carvedilol 12.5mg BID. F/U GI in 1 week.","A 68-year-old woman with a history of liver scarring [cirrhosis], Parkinson's disease, and implanted pacemaker was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the stomach doctor in 1 week.",Infectious Disease,Discharge Summary,high
3414,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab potassium chloride 20mEq daily. Tab losartan 50mg daily. Adv: wound care with daily dressing changes Avoid NSAIDs. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) losartan 50mg once daily [blood pressure medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",General,Prescription,medium
3415,Procedure: ERCP with sphincterotomy. Pt 50 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 50-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3416,"76 y/o M with PMH of s/p THR, A-fib, CKD Stage 4, PAD, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Dulcolax 10mg QHS PRN, atorvastatin 40mg QHS. F/U nephrology in 1 week.","A 76-year-old man with a history of prior hip replacement, irregular heartbeat [atrial fibrillation], advanced kidney disease, and poor blood flow in the legs [peripheral artery disease] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the kidney doctor in 1 week.",Psychiatry,Discharge Summary,high
3417,"Rx: prednisone taper. Tab clopidogrel 75mg daily. Tab amoxicillin 500mg TID x 10 days. Tab metoprolol succinate 50mg daily. Adv: DASH diet, daily BP monitoring. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) Plavix (clopidogrel) 75mg once daily [blood thinner]. (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
3418,Delivery Note: G?P? at 37+3 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3419,"Rx: Tab warfarin 5mg daily. Tab entresto 49/51mg BID. Tab atorvastatin 40mg QHS. Tab amlodipine 5mg daily. Adv: fall precautions, home safety evaluation Adv: DASH diet, daily BP monitoring. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) atorvastatin 40mg at bedtime [cholesterol medicine]. (4) amlodipine 5mg once daily [blood pressure medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
3420,"US Abdomen: Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Spleen 16cm, splenomegaly. Moderate right hydronephrosis. Ascites moderate amount. Right kidney 10.5cm, no hydronephrosis.","Abdominal ultrasound results: The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The spleen is enlarged [splenomegaly]. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. There is a moderate amount of fluid in the belly [ascites]. Right kidney is normal size with no blockage.",Gastroenterology,Radiology Report,high
3421,Procedure: Port-a-cath placement. Pt 56 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 56-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
3422,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3423,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3424,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3425,"22 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 22-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3426,"75 y/o M with PMH of DM2, CKD Stage 4, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on latanoprost 0.005% OU QHS, montelukast 10mg QHS, Dulcolax 10mg QHS PRN, Augmentin 875/125 BID x 7 days. F/U neurology in 2 weeks.","A 75-year-old man with a history of type 2 diabetes, and advanced kidney disease was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]; (3) Dulcolax 10mg at bedtime as needed [for constipation]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the brain/nerve doctor in 2 weeks.",General Surgery,Discharge Summary,high
3427,"24 y/o M with PMH of DM1, CKD Stage 3, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on furosemide 40mg BID, rosuvastatin 10mg QHS. F/U cardiology in 2 weeks.","A 24-year-old man with a history of type 1 diabetes, and moderate kidney disease was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the heart doctor in 2 weeks.",Nephrology,Discharge Summary,high
3428,"Rx: Tab losartan 50mg daily. Tab rosuvastatin 10mg QHS. Tab pantoprazole 40mg AC breakfast. Adv: fall precautions, home safety evaluation. F/U 2 weeks with INR.","Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
3429,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Humalog per SSI. Adv: weight bearing exercise, calcium/vit D supplementation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) Humalog insulin before meals as directed [fast-acting insulin]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. See your primary care doctor in 1 week to recheck blood pressure.",Endocrinology,Prescription,medium
3430,"31 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 31-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3431,"90 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 90-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3432,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage. Mild generalized cerebral atrophy appropriate for age. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain. There is mild brain shrinkage, which is normal for your age. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
3433,"71 y/o F with PMH of BPH, CKD Stage 3, HFpEF, PPM in situ, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on amlodipine 10mg daily, clopidogrel 75mg daily, metoprolol 25mg BID. F/U wound care in 3 days.","A 71-year-old woman with a history of enlarged prostate, moderate kidney disease, heart failure with stiff heart muscle, and implanted pacemaker was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
3434,"CBC: WBC 5.9 (N), Hgb 5.4 (L), Plt 158 (N).","Your blood count results: White blood cells are 5.9 (normal). Hemoglobin is low at 5.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 158, which is normal.",Hematology,Lab Result,high
3435,CXR PA: Increased interstitial markings suggesting pulmonary edema. ET tube 3cm above carina. Port-a-cath in appropriate position.,"Chest X-ray results: There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. The breathing tube is in good position. The implanted medication port is in the correct position.",Pulmonology,Radiology Report,high
3436,"Rx: Tab timolol 0.5% OU BID. Tab ciprofloxacin 500mg BID x 5 days. Tab pregabalin 75mg BID. Tab Eliquis 5mg BID. Adv: avoid alcohol, hepatotoxic drugs Adv: low potassium diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (3) pregabalin 75mg twice daily [nerve pain medicine]. (4) Eliquis 5mg twice daily [blood thinner]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Neurology,Prescription,high
3437,"76 y/o M with PMH of anemia, PPM in situ, PAD, HFpEF, asthma, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on ibuprofen 400mg Q6H PRN with food, calcium + vitamin D 600/400 daily. F/U surgery in 10 days.","A 76-year-old man with a history of low blood count [anemia], implanted pacemaker, poor blood flow in the legs [peripheral artery disease], heart failure with stiff heart muscle, and asthma was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the surgeon in 10 days.",Hematology,Discharge Summary,high
3438,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3439,"78 y/o M with PMH of ICD in situ, seizure disorder on Keppra, PPM in situ, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on atorvastatin 80mg QHS, spironolactone 25mg daily, calcium + vitamin D 600/400 daily, ferrous sulfate 325mg BID, ASA 81mg daily. F/U orthopedics in 6 weeks with X-ray.","A 78-year-old man with a history of implanted heart defibrillator, seizure disorder [on Keppra], and implanted pacemaker was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) calcium plus vitamin D once daily [bone strengthening]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (5) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
3440,HbA1c: 5.9% (H). FBS: 93 mg/dL (N).,"Your diabetes blood test results: HbA1c is 5.9%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 93, which is normal (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,medium
3441,"CBC: WBC 10.0 (N), Hgb 8.7 (L), Plt 356 (N).","Your blood count results: White blood cells are 10.0 (normal). Hemoglobin is low at 8.7, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 356, which is normal.",Hematology,Lab Result,high
3442,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab ibuprofen 400mg Q6H PRN with food. albuterol MDI 2 puffs Q4-6H PRN. Tab latanoprost 0.005% OU QHS. Adv: high fiber diet, adequate hydration. F/U 1 week with CBC, CMP.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Pulmonology,Prescription,high
3443,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
3444,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3445,Procedure: PCI with DES to LAD. Pt 49 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 49-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
3446,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3447,"Rx: Tab furosemide 40mg daily. Tab ondansetron 4mg Q8H PRN N/V. Spiriva 18mcg daily. Tab ferrous sulfate 325mg BID. Tab levothyroxine 75mcg daily on empty stomach. Adv: SMBG BID, diabetic diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (3) Spiriva inhaler once daily [long-acting lung medicine]. (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (5) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",General,Prescription,high
3448,Procedure: TURP for BPH. Pt 89 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 89-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
3449,HbA1c: 13.1% (H). FBS: 347 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.1%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 347, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3450,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3451,"27 y/o F with PMH of PPM in situ, asthma, DM2, CHF, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on ondansetron 4mg Q8H PRN N/V, ibuprofen 400mg Q6H PRN with food. F/U pulmonology in 2 weeks.","A 27-year-old woman with a history of implanted pacemaker, asthma, type 2 diabetes, and heart failure was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the lung doctor in 2 weeks.",Nephrology,Discharge Summary,high
3452,Procedure: TURP for BPH. Pt 83 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 83-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
3453,"37 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 37-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3454,"29 y/o F with PMH of DM2, DM1, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on amlodipine 10mg daily, escitalopram 10mg daily, pantoprazole 40mg AC breakfast, rosuvastatin 10mg QHS. F/U cardiology in 2 weeks.","A 29-year-old woman with a history of type 2 diabetes, and type 1 diabetes was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the heart doctor in 2 weeks.",Pulmonology,Discharge Summary,high
3455,Procedure: ORIF L distal radius. Pt 22 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 22-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
3456,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,medium
3457,"MRI Lumbar Spine: Conus medullaris at L1, normal. No compression fracture. L4-L5 disc herniation with moderate bilateral foraminal stenosis.","MRI of the lower back results: The spinal cord ends at a normal level. No bones are broken or collapsed. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
3458,"25 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 25-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
3459,HbA1c: 9.7% (H). FBS: 197 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.7%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 197, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
3460,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,medium
3461,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,medium
3462,"37 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 37-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3463,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,high
3464,"MRI Lumbar Spine: C5-C6 disc herniation with cord compression. Conus medullaris at L1, normal. Facet joint hypertrophy at L4-L5.","MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal cord ends at a normal level. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
3465,"49 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 49-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3466,"Rx: Tab amlodipine 5mg daily. Tab hydroxychloroquine 200mg BID. Adv: SMBG BID, diabetic diet. F/U 1 month with repeat imaging.",Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,medium
3467,"MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. Multilevel degenerative disc disease. Conus medullaris at L1, normal. L4-L5 disc herniation with moderate bilateral foraminal stenosis.","MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. Multiple discs in the spine are showing wear and aging. The spinal cord ends at a normal level. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
3468,"Rx: Tab pantoprazole 40mg AC breakfast. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab gabapentin 300mg TID. Tab Dulcolax 10mg QHS PRN. Tab omeprazole 20mg AC breakfast. Avoid NSAIDs Adv: smoking cessation, pulmonary rehab. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. (5) omeprazole 20mg before breakfast [acid-reducing medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Gastroenterology,Prescription,high
3469,"33 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 33-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3470,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,medium
3471,"MRI Lumbar Spine: Conus medullaris at L1, normal. C5-C6 disc herniation with cord compression.","MRI of the lower back results: The spinal cord ends at a normal level. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
3472,"90 y/o F with PMH of hypothyroidism, h/o TIA, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on Xarelto 20mg daily with dinner, losartan 50mg daily. F/U surgery in 10 days.","A 90-year-old woman with a history of underactive thyroid, and history of mini-stroke was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) losartan 50mg once daily [blood pressure medicine]. Follow-up with the surgeon in 10 days.",Endocrinology,Discharge Summary,high
3473,"80 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 80-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3474,"66 y/o F with PMH of HLD, anemia, gout, anxiety, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on lisinopril 10mg daily, latanoprost 0.005% OU QHS, Xarelto 20mg daily with dinner, azithromycin 500mg day 1 then 250mg x 4 days, ferrous sulfate 325mg BID. F/U cardiology in 2 weeks.","A 66-year-old woman with a history of high cholesterol, low blood count [anemia], gout, and anxiety was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) Xarelto 20mg once daily with dinner [blood thinner]; (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (5) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the heart doctor in 2 weeks.",Nephrology,Discharge Summary,high
3475,"US Abdomen: GB sludge, no stones. Simple renal cysts bilaterally. Pancreas unremarkable. Left kidney 8cm, cortical thinning consistent with CKD. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. Both kidneys have harmless fluid-filled cysts. The pancreas looks normal. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
3476,CXR PA: No pneumothorax. Cardiomegaly with CTR >0.5. Sternotomy wires intact. Small left pleural effusion. Pacemaker leads in appropriate position.,Chest X-ray results: There is no collapsed lung. The heart appears larger than normal. The wires from prior heart surgery are intact. There is a small amount of fluid around the left lung. The pacemaker wires are in the correct position.,Pulmonology,Radiology Report,high
3477,"CBC: WBC 14.5 (H), Hgb 9.8 (L), Plt 473 (H).","Your blood count results: White blood cells are 14.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 9.8, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 473, which is high — your blood may clot too easily.",Hematology,Lab Result,high
3478,"US Abdomen: Pancreas unremarkable. Simple renal cysts bilaterally. GB wall thickening with stones, positive Murphy's sign. CBD 12mm, dilated. Left kidney 8cm, cortical thinning consistent with CKD. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The pancreas looks normal. Both kidneys have harmless fluid-filled cysts. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The bile duct is wider than normal [dilated], which may indicate a blockage. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
3479,"76 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 76-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
3480,Rx: Tab sertraline 50mg daily. Tab calcium + vitamin D 600/400 daily. Tab clopidogrel 75mg daily. Tab lisinopril 20mg daily. Avoid NSAIDs Avoid grapefruit juice. F/U INR in 3 days.,Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) calcium plus vitamin D once daily [bone strengthening]. (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. (4) lisinopril 20mg once daily [blood pressure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Do not drink grapefruit juice as it interferes with this medication. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
3481,"BMP: Na 145 (N), K 2.7 (L), BUN 19, Cr 5.2 (H), Glucose 164.","Your blood chemistry results: Sodium is normal at 145. Potassium is low at 2.7 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 5.2 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 164 (high).",Nephrology,Lab Result,high
3482,"Rx: Tab pregabalin 75mg BID. Tab rosuvastatin 10mg QHS. Tab amlodipine 10mg daily. Adv: fall precautions, home safety evaluation Adv: wound care with daily dressing changes. F/U 6 weeks with LFTs.","Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) amlodipine 10mg once daily [blood pressure medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
3483,"50 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 50-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3484,"Rx: Tab furosemide 40mg BID. Tab pregabalin 75mg BID. Tab glipizide 5mg BID AC. Tab amlodipine 10mg daily. Adv: elevate affected limb, compression stockings Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks.","Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) glipizide 5mg twice daily before meals [helps release insulin]. (4) amlodipine 10mg once daily [blood pressure medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back for a check-up in 2 weeks.",Pediatrics,Prescription,high
3485,"75 y/o F with PMH of ESRD on HD, OSA on CPAP, BPH, CKD Stage 3, GERD, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on escitalopram 10mg daily, atorvastatin 40mg QHS, gabapentin 300mg TID. F/U nephrology in 5 days.","A 75-year-old woman with a history of kidney failure requiring dialysis, sleep apnea [uses a breathing machine at night], enlarged prostate, moderate kidney disease, and acid reflux was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the kidney doctor in 5 days.",Neurology,Discharge Summary,high
3486,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
3487,"41 y/o M with PMH of s/p THR, DM1, DM2, CHF, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on tramadol 50mg Q6H PRN pain, Lantus 20U QHS, methotrexate 15mg weekly, prednisone taper. F/U orthopedics in 6 weeks with X-ray.","A 41-year-old man with a history of prior hip replacement, type 1 diabetes, type 2 diabetes, and heart failure was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
3488,"88 y/o F with PMH of h/o CVA, seizure disorder on Keppra, PPM in situ, gout, BPH, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on entresto 49/51mg BID, latanoprost 0.005% OU QHS, empagliflozin 10mg daily, Xarelto 20mg daily with dinner. F/U hematology in 2 weeks.","A 88-year-old woman with a history of history of stroke, seizure disorder [on Keppra], implanted pacemaker, gout, and enlarged prostate was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (4) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the blood disorder doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
3489,Procedure: R TKA. Pt 33 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 33-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
3490,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,medium
3491,"Lipid panel: TC 174, LDL 190, HDL 37, TG 436.","Your cholesterol results: Total cholesterol is 174. LDL (bad cholesterol) is very high at 190 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is too low at 37 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 436 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
3492,"34 y/o M with PMH of DM1, GERD, CKD Stage 4, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on atorvastatin 80mg QHS, Augmentin 875/125 BID x 7 days, Spiriva 18mcg daily. F/U nephrology in 5 days.","A 34-year-old man with a history of type 1 diabetes, acid reflux, and advanced kidney disease was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the kidney doctor in 5 days.",Gastroenterology,Discharge Summary,high
3493,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab potassium chloride 20mEq daily. Tab metformin 500mg BID. Adv: avoid alcohol, hepatotoxic drugs Adv: fall precautions, home safety evaluation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Pulmonology,Prescription,medium
3494,HbA1c: 10.3% (H). FBS: 160 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.3%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 160, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3495,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
3496,Procedure: EGD with biopsy. Pt 57 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 57-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3497,"23 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 23-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3498,"90 y/o M with PMH of Parkinson's disease, s/p THR, anemia, HTN, s/p TKR, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on losartan 50mg daily, calcium + vitamin D 600/400 daily, acetaminophen 650mg Q6H PRN. F/U surgery in 2 weeks for drain removal.","A 90-year-old man with a history of Parkinson's disease, prior hip replacement, low blood count [anemia], high blood pressure, and prior knee replacement was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the surgeon in 2 weeks to remove the drain.",General Surgery,Discharge Summary,high
3499,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
3500,Procedure: Port-a-cath placement. Pt 68 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 68-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
3501,"66 y/o F with PMH of hypothyroidism, PAD, DVT/PE on warfarin, HFpEF, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on amoxicillin 500mg TID x 10 days, amlodipine 10mg daily, metoprolol 25mg BID, escitalopram 10mg daily, acetaminophen 650mg Q6H PRN. F/U oncology in 1 week.","A 66-year-old woman with a history of underactive thyroid, poor blood flow in the legs [peripheral artery disease], blood clots [on blood thinner warfarin], and heart failure with stiff heart muscle was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the cancer doctor in 1 week.",Cardiology,Discharge Summary,high
3502,"Thyroid panel: TSH 6.45 (H), Free T4 2.4.","Your thyroid test results: TSH is elevated at 6.45 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
3503,"51 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 51-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3504,"CBC: WBC 20.5 (H), Hgb 6.2 (L), Plt 359 (N).","Your blood count results: White blood cells are 20.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 6.2, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 359, which is normal.",Hematology,Lab Result,high
3505,"38 y/o F with PMH of COPD, SLE, osteoporosis, DM1, CAD, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Compression stockings when ambulating. D/C on metoprolol 25mg BID, ferrous sulfate 325mg BID, ibuprofen 400mg Q6H PRN with food, montelukast 10mg QHS. F/U nephrology in 1 week.","A 38-year-old woman with a history of chronic lung disease, lupus, weak bones [osteoporosis], type 1 diabetes, and coronary artery disease [heart artery blockages] was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
3506,"Rx: Tab potassium chloride 20mEq daily. Tab spironolactone 25mg daily. Tab lisinopril 10mg daily. Avoid grapefruit juice Adv: low potassium diet. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Do not drink grapefruit juice as it interferes with this medication Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
3507,"40 y/o M with PMH of GERD, HTN, BPH, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on ibuprofen 400mg Q6H PRN with food, hydroxychloroquine 200mg BID. F/U surgery in 2 weeks for drain removal.","A 40-year-old man with a history of acid reflux, high blood pressure, and enlarged prostate was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the surgeon in 2 weeks to remove the drain.",General Surgery,Discharge Summary,high
3508,"65 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 65-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3509,Procedure: Colonoscopy with polypectomy. Pt 39 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 39-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3510,"38 y/o F with PMH of OA, CHF, BPH, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Xarelto 20mg daily with dinner, acetaminophen 650mg Q6H PRN. F/U GI in 1 week.","A 38-year-old woman with a history of arthritis [osteoarthritis], heart failure, and enlarged prostate was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the stomach doctor in 1 week.",Gastroenterology,Discharge Summary,high
3511,HbA1c: 6.8% (H). FBS: 350 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.8%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 350, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
3512,HbA1c: 9.5% (H). FBS: 211 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.5%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 211, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
3513,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3514,"72 y/o F with PMH of BPH, ICD in situ, HFpEF, osteoporosis, SLE, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Compression stockings when ambulating. D/C on metoprolol succinate 50mg daily, atorvastatin 80mg QHS, calcium + vitamin D 600/400 daily. F/U nephrology in 1 week.","A 72-year-old woman with a history of enlarged prostate, implanted heart defibrillator, heart failure with stiff heart muscle, weak bones [osteoporosis], and lupus was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the kidney doctor in 1 week.",Infectious Disease,Discharge Summary,high
3515,"Rx: Tab clopidogrel 75mg daily. Tab rosuvastatin 10mg QHS. Tab levothyroxine 75mcg daily on empty stomach. Adv: DASH diet, daily BP monitoring. F/U 2 weeks.","Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
3516,"27 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 27-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3517,"Rx: Tab latanoprost 0.005% OU QHS. Tab atorvastatin 40mg QHS. albuterol MDI 2 puffs Q4-6H PRN. Tab Dulcolax 10mg QHS PRN. Adv: SMBG BID, diabetic diet Adv: low salt low sugar diet, regular exercise. F/U 1 week with wound check.","Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
3518,"69 y/o M with PMH of h/o TIA, A-fib, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on montelukast 10mg QHS, acetaminophen 650mg Q6H PRN, ibuprofen 400mg Q6H PRN with food, amlodipine 5mg daily, atorvastatin 40mg QHS. F/U surgery in 2 weeks for drain removal.","A 69-year-old man with a history of history of mini-stroke, and irregular heartbeat [atrial fibrillation] was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) amlodipine 5mg once daily [blood pressure medicine]; (5) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Endocrinology,Discharge Summary,high
3519,HbA1c: 11.9% (H). FBS: 240 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.9%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 240, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3520,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
3521,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3522,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3523,"83 y/o F with PMH of RA on MTX, COPD, s/p THR, s/p CABG, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on latanoprost 0.005% OU QHS, Eliquis 5mg BID, methotrexate 15mg weekly, timolol 0.5% OU BID, rosuvastatin 10mg QHS. F/U endocrine in 1 week.","A 83-year-old woman with a history of rheumatoid arthritis [on immune-suppressing medicine], chronic lung disease, prior hip replacement, and prior heart bypass surgery was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) Eliquis 5mg twice daily [blood thinner]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (5) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Endocrinology,Discharge Summary,high
3524,CXR PA: Patchy bilateral infiltrates. Bilateral hilar lymphadenopathy. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: There are scattered cloudy patches in both lungs suggesting infection or inflammation. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
3525,"55 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 55-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3526,"73 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 73-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
3527,"37 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 37-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3528,HbA1c: 12.0% (H). FBS: 180 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.0%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 180, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3529,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3530,Procedure: EGD with biopsy. Pt 25 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 25-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3531,"58 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 58-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3532,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,high
3533,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
3534,"Rx: Tab omeprazole 20mg AC breakfast. Tab ferrous sulfate 325mg BID. Tab ondansetron 4mg Q8H PRN N/V. Tab atorvastatin 80mg QHS. Tab clopidogrel 75mg daily. Adv: elevate affected limb, compression stockings. F/U 2 weeks.",Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (5) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back for a check-up in 2 weeks.,Cardiology,Prescription,high
3535,"91 y/o F with PMH of CKD Stage 4, DM2, anemia, ICD in situ, HFpEF, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on metformin 500mg BID, lisinopril 20mg daily, spironolactone 25mg daily, glipizide 5mg BID AC. F/U pulmonology in 2 weeks.","A 91-year-old woman with a history of advanced kidney disease, type 2 diabetes, low blood count [anemia], implanted heart defibrillator, and heart failure with stiff heart muscle was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) spironolactone 25mg once daily [heart-protecting water pill]; (4) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the lung doctor in 2 weeks.",Cardiology,Discharge Summary,high
3536,"Rx: Tab atorvastatin 40mg QHS. Tab tramadol 50mg Q6H PRN pain. Tab pantoprazole 40mg AC breakfast. Adv: fall precautions, home safety evaluation Avoid NSAIDs. F/U 2 weeks.","Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
3537,"US Abdomen: Moderate right hydronephrosis. Spleen 11cm, normal. Left kidney 8cm, cortical thinning consistent with CKD. Pancreas unremarkable. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The spleen is a normal size. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The pancreas looks normal. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
3538,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,high
3539,HbA1c: 11.5% (H). FBS: 98 mg/dL (N).,"Your diabetes blood test results: HbA1c is 11.5%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 98, which is normal (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3540,"55 y/o M with PMH of PPM in situ, gout, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on omeprazole 20mg AC breakfast, Augmentin 875/125 BID x 7 days, escitalopram 10mg daily, atorvastatin 40mg QHS. F/U hematology in 2 weeks.","A 55-year-old man with a history of implanted pacemaker, and gout was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (4) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
3541,"Rx: Tab potassium chloride 20mEq daily. Tab furosemide 40mg daily. prednisone taper. Tab furosemide 40mg BID. Tab Augmentin 875/125 BID x 7 days. Avoid NSAIDs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) Augmentin 875mg twice daily for 7 days [antibiotic]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,high
3542,Delivery Note: G?P? at 37+3 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3543,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3544,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3545,"CBC: WBC 24.7 (H), Hgb 13.7 (N), Plt 292 (N).","Your blood count results: White blood cells are 24.7 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 13.7. Platelets are 292, which is normal.",Hematology,Lab Result,high
3546,"33 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 33-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3547,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3548,"LFTs: AST 148 (H), ALT 474 (H), ALP 89, T.Bili 4.3 (H), Albumin 3.5.","Your liver blood test results: Liver enzymes (AST 148, ALT 474) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 4.3 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.5.",Gastroenterology,Lab Result,high
3549,"CBC: WBC 5.6 (N), Hgb 12.0 (N), Plt 425 (H).","Your blood count results: White blood cells are 5.6 (normal). Hemoglobin is normal at 12.0. Platelets are 425, which is high — your blood may clot too easily.",Hematology,Lab Result,high
3550,"56 y/o M with PMH of ICD in situ, obesity (BMI 38), PAD, anxiety, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on montelukast 10mg QHS, warfarin 5mg daily, ibuprofen 400mg Q6H PRN with food. F/U GI in 1 week.","A 56-year-old man with a history of implanted heart defibrillator, obesity, poor blood flow in the legs [peripheral artery disease], and anxiety was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the stomach doctor in 1 week.",General Surgery,Discharge Summary,high
3551,"85 y/o M with PMH of h/o CVA, BPH, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on sertraline 50mg daily, prednisone taper, furosemide 40mg BID, metformin 1000mg BID. F/U pulmonology in 2 weeks.","A 85-year-old man with a history of history of stroke, and enlarged prostate was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up with the lung doctor in 2 weeks.",Cardiology,Discharge Summary,high
3552,"BMP: Na 142 (N), K 3.0 (L), BUN 80, Cr 3.6 (H), Glucose 333.","Your blood chemistry results: Sodium is normal at 142. Potassium is low at 3.0 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 3.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 333 (high).",Nephrology,Lab Result,high
3553,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab furosemide 40mg BID. Adv: high fiber diet, adequate hydration. F/U 2 weeks.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) furosemide (Lasix) 40mg twice daily [water pill]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
3554,"Rx: Tab hydroxychloroquine 200mg BID. Tab potassium chloride 20mEq daily. Do not stop abruptly, taper as directed. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Rheumatology,Prescription,medium
3555,CXR PA: Osseous structures intact. Patchy bilateral infiltrates. Compression fracture T12.,Chest X-ray results: The bones look normal with no fractures. There are scattered cloudy patches in both lungs suggesting infection or inflammation. There is a compression fracture [collapsed bone] in the lower spine at T12.,Pulmonology,Radiology Report,high
3556,Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab entresto 49/51mg BID. Tab amlodipine 10mg daily. Tab timolol 0.5% OU BID. Tab latanoprost 0.005% OU QHS. Adv: wound care with daily dressing changes. F/U 1 week with wound check.,"Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) amlodipine 10mg once daily [blood pressure medicine]. (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (5) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week to have the wound checked.",Pediatrics,Prescription,high
3557,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,low
3558,"82 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 82-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3559,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,low
3560,"Rx: Tab spironolactone 25mg daily. Tab omeprazole 20mg AC breakfast. Tab empagliflozin 10mg daily. Humalog per SSI. Adv: weight bearing exercise, calcium/vit D supplementation. F/U PCP in 1 week for BP recheck.","Your medicines: (1) spironolactone 25mg once daily [heart-protecting water pill]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (4) Humalog insulin before meals as directed [fast-acting insulin]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. See your primary care doctor in 1 week to recheck blood pressure.",Endocrinology,Prescription,high
3561,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
3562,"84 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 84-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3563,"51 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 51-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
3564,"Rx: Tab metformin 500mg BID. Tab montelukast 10mg QHS. Adv: SMBG BID, diabetic diet. F/U 2 weeks with INR.",Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks for a blood thinner level check [INR].,Pulmonology,Prescription,medium
3565,"Rx: Tab sertraline 50mg daily. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab metformin 1000mg BID. Tab warfarin 5mg daily. Adv: DASH diet, daily BP monitoring Adv: avoid alcohol, hepatotoxic drugs. F/U INR in 3 days.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 3 days for a blood thinner level check [INR].",Endocrinology,Prescription,high
3566,"BMP: Na 125 (L), K 3.0 (L), BUN 23, Cr 5.9 (H), Glucose 283.","Your blood chemistry results: Sodium is low at 125 (normal 136-145), meaning too much water in your body. Potassium is low at 3.0 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 5.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 283 (high).",Nephrology,Lab Result,high
3567,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
3568,"58 y/o M with PMH of COPD, HLD, anxiety, SLE, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on losartan 50mg daily, atorvastatin 40mg QHS, sertraline 50mg daily, Augmentin 875/125 BID x 7 days, albuterol MDI 2 puffs Q4-6H PRN. F/U cardiology in 2 weeks.","A 58-year-old man with a history of chronic lung disease, high cholesterol, anxiety, and lupus was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]; (5) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the heart doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
3569,"CBC: WBC 8.9 (N), Hgb 15.9 (N), Plt 49 (L).","Your blood count results: White blood cells are 8.9 (normal). Hemoglobin is normal at 15.9. Platelets are 49, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
3570,"CBC: WBC 19.3 (H), Hgb 14.5 (N), Plt 405 (H).","Your blood count results: White blood cells are 19.3 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 14.5. Platelets are 405, which is high — your blood may clot too easily.",Hematology,Lab Result,high
3571,"61 y/o F with PMH of HLD, cirrhosis, OSA on CPAP, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on carvedilol 12.5mg BID, ASA 81mg daily. F/U surgery in 10 days.","A 61-year-old woman with a history of high cholesterol, liver scarring [cirrhosis], and sleep apnea [uses a breathing machine at night] was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
3572,"Rx: Tab metformin 500mg BID. prednisone taper. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: elevate affected limb, compression stockings Adv: low salt low sugar diet, regular exercise. F/U 1 week with wound check.","Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week to have the wound checked.",Endocrinology,Prescription,medium
3573,"51 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 51-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
3574,Procedure: TURP for BPH. Pt 48 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 48-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
3575,Procedure: R TKA. Pt 54 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 54-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
3576,"Rx: Spiriva 18mcg daily. Tab ferrous sulfate 325mg BID. Adv: SMBG BID, diabetic diet Avoid grapefruit juice. F/U 1 week with wound check.",Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Do not drink grapefruit juice as it interferes with this medication. Come back in 1 week to have the wound checked.,Pulmonology,Prescription,medium
3577,"71 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 71-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3578,"Rx: Tab ASA 81mg daily. Tab Augmentin 875/125 BID x 7 days. Tab atorvastatin 40mg QHS. Adv: fall precautions, home safety evaluation. F/U 2 weeks with INR.","Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. (3) atorvastatin 40mg at bedtime [cholesterol medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
3579,"Rx: Tab amlodipine 10mg daily. Tab Eliquis 5mg BID. Tab Xarelto 20mg daily with dinner. Tab carvedilol 12.5mg BID. Tab losartan 50mg daily. Avoid grapefruit juice Adv: elevate affected limb, compression stockings. F/U INR in 3 days.",Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) Eliquis 5mg twice daily [blood thinner]. (3) Xarelto 20mg once daily with dinner [blood thinner]. (4) carvedilol 12.5mg twice daily [heart medicine]. (5) losartan 50mg once daily [blood pressure medicine]. Do not drink grapefruit juice as it interferes with this medication Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
3580,Rx: Tab montelukast 10mg QHS. Tab pantoprazole 40mg AC breakfast. Adv: wound care with daily dressing changes. F/U 2 weeks with INR.,"Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks for a blood thinner level check [INR].",Pulmonology,Prescription,medium
3581,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3582,"CBC: WBC 12.0 (H), Hgb 10.2 (L), Plt 313 (N).","Your blood count results: White blood cells are 12.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 10.2, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 313, which is normal.",Hematology,Lab Result,high
3583,"63 y/o M with PMH of anemia, s/p TKR, asthma, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on gabapentin 300mg TID, clopidogrel 75mg daily, metoprolol 25mg BID, calcium + vitamin D 600/400 daily, lisinopril 10mg daily. F/U endocrine in 1 week.","A 63-year-old man with a history of low blood count [anemia], prior knee replacement, and asthma was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the hormone/diabetes doctor in 1 week.",Gastroenterology,Discharge Summary,high
3584,Procedure: Colonoscopy with polypectomy. Pt 23 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 23-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3585,Procedure: TURP for BPH. Pt 33 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 33-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
3586,"23 y/o F with PMH of h/o CVA, osteoporosis, seizure disorder on Keppra, OSA on CPAP, HLD, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on atorvastatin 40mg QHS, latanoprost 0.005% OU QHS, losartan 50mg daily, clopidogrel 75mg daily, sertraline 50mg daily. F/U PCP in 2 weeks.","A 23-year-old woman with a history of history of stroke, weak bones [osteoporosis], seizure disorder [on Keppra], sleep apnea [uses a breathing machine at night], and high cholesterol was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) losartan 50mg once daily [blood pressure medicine]; (4) Plavix (clopidogrel) 75mg once daily [blood thinner]; (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the primary care doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
3587,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,low
3588,"Rx: Tab gabapentin 300mg TID. Tab ferrous sulfate 325mg BID. Tab methotrexate 15mg weekly. Adv: DASH diet, daily BP monitoring. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Neurology,Prescription,medium
3589,CXR PA: Right middle lobe atelectasis. Right lower lobe consolidation. ET tube 3cm above carina.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is an area in the lower right lung that appears infected, suggesting pneumonia. The breathing tube is in good position.",Pulmonology,Radiology Report,high
3590,"Rx: Tab furosemide 40mg daily. Tab amlodipine 5mg daily. Tab atorvastatin 80mg QHS. Tab furosemide 40mg BID. Tab calcium + vitamin D 600/400 daily. Adv: low potassium diet. F/U 1 week with CBC, CMP.","Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) calcium plus vitamin D once daily [bone strengthening]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
3591,"LFTs: AST 137 (H), ALT 312 (H), ALP 120, T.Bili 4.3 (H), Albumin 2.8.","Your liver blood test results: Liver enzymes (AST 137, ALT 312) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 4.3 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.8 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
3592,"45 y/o F with PMH of HTN, A-fib, gout, h/o TIA, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on montelukast 10mg QHS, escitalopram 10mg daily. F/U surgery in 2 weeks for drain removal.","A 45-year-old woman with a history of high blood pressure, irregular heartbeat [atrial fibrillation], gout, and history of mini-stroke was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Infectious Disease,Discharge Summary,high
3593,"Rx: Tab timolol 0.5% OU BID. Tab ciprofloxacin 500mg BID x 5 days. Tab ferrous sulfate 325mg BID. Adv: DASH diet, daily BP monitoring Adv: weight bearing exercise, calcium/vit D supplementation. F/U INR in 3 days.","Your medicines: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 3 days for a blood thinner level check [INR].",Infectious Disease,Prescription,medium
3594,"CBC: WBC 18.5 (H), Hgb 17.4 (H), Plt 87 (L).","Your blood count results: White blood cells are 18.5 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is elevated at 17.4. Platelets are 87, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
3595,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab amoxicillin 500mg TID x 10 days. Tab ferrous sulfate 325mg BID. Tab Dulcolax 10mg QHS PRN. Tab latanoprost 0.005% OU QHS. Adv: low salt diet, fluid restriction 1.5L/day. F/U 1 month with repeat imaging.",Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. (5) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 1 month — a repeat scan will be ordered.,General,Prescription,high
3596,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
3597,"59 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 59-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3598,"57 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 57-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3599,"Rx: Tab Augmentin 875/125 BID x 7 days. Humalog per SSI. Tab gabapentin 300mg TID. Tab hydroxychloroquine 200mg BID. Tab pantoprazole 40mg AC breakfast. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (5) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Neurology,Prescription,high
3600,"LFTs: AST 203 (H), ALT 176 (H), ALP 233, T.Bili 4.8 (H), Albumin 1.7.","Your liver blood test results: Liver enzymes (AST 203, ALT 176) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is high at 4.8 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 1.7 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
3601,"55 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 55-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3602,"73 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 73-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3603,"75 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 75-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3604,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age. Chronic lacunar infarcts in bilateral basal ganglia. Paranasal sinuses clear. No mass effect.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age. There are signs of small old strokes in the deep parts of the brain. The sinuses are clear with no infection. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
3605,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3606,Procedure: Colonoscopy with polypectomy. Pt 57 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 57-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3607,"66 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 66-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
3608,"Rx: Tab Augmentin 875/125 BID x 7 days. prednisone taper. Adv: low salt diet, fluid restriction 1.5L/day Adv: low potassium diet. F/U PCP in 1 week for BP recheck.","Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. See your primary care doctor in 1 week to recheck blood pressure.",Infectious Disease,Prescription,medium
3609,"56 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 56-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3610,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3611,"85 y/o F with PMH of CKD Stage 4, anemia, hypothyroidism, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on empagliflozin 10mg daily, calcium + vitamin D 600/400 daily. F/U wound care in 3 days.","A 85-year-old woman with a history of advanced kidney disease, low blood count [anemia], and underactive thyroid was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (2) calcium plus vitamin D once daily [bone strengthening]. Follow-up at the wound care clinic in 3 days.",Infectious Disease,Discharge Summary,high
3612,HbA1c: 10.7% (H). FBS: 158 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.7%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 158, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3613,"81 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 81-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3614,"43 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 43-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3615,"34 y/o M with PMH of ICD in situ, GERD, OSA on CPAP, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on metoprolol succinate 50mg daily, amlodipine 5mg daily, rosuvastatin 10mg QHS, Dulcolax 10mg QHS PRN. F/U pulmonology in 2 weeks.","A 34-year-old man with a history of implanted heart defibrillator, acid reflux, and sleep apnea [uses a breathing machine at night] was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) amlodipine 5mg once daily [blood pressure medicine]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the lung doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
3616,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab Eliquis 5mg BID. Tab clopidogrel 75mg daily. Tab atorvastatin 80mg QHS. Adv: low salt low sugar diet, regular exercise Avoid grapefruit juice. F/U INR in 3 days.","Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) Eliquis 5mg twice daily [blood thinner]. (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Do not drink grapefruit juice as it interferes with this medication. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
3617,"63 y/o M with PMH of obesity (BMI 38), DM2, s/p TKR, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on losartan 50mg daily, montelukast 10mg QHS, amoxicillin 500mg TID x 10 days, albuterol MDI 2 puffs Q4-6H PRN, ferrous sulfate 325mg BID. F/U surgery in 10 days.","A 63-year-old man with a history of obesity, type 2 diabetes, and prior knee replacement was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (5) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
3618,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3619,"25 y/o F with PMH of obesity (BMI 38), ESRD on HD, PAD, CKD Stage 3, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Strict I&O, daily weights. D/C on clopidogrel 75mg daily, amoxicillin 500mg TID x 10 days. F/U cardiology in 2 weeks.","A 25-year-old woman with a history of obesity, kidney failure requiring dialysis, poor blood flow in the legs [peripheral artery disease], and moderate kidney disease was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
3620,Rx: Tab acetaminophen 650mg Q6H PRN. Tab amlodipine 5mg daily. Tab Dulcolax 10mg QHS PRN. Adv: wound care with daily dressing changes. F/U 6 weeks with LFTs.,"Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 6 weeks for liver function blood tests.",General,Prescription,medium
3621,"61 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 61-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
3622,"Rx: Tab metoprolol succinate 50mg daily. Tab ibuprofen 400mg Q6H PRN with food. Tab Eliquis 5mg BID. albuterol MDI 2 puffs Q4-6H PRN. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks with INR.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (3) Eliquis 5mg twice daily [blood thinner]. (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
3623,"CBC: WBC 9.5 (N), Hgb 10.5 (L), Plt 329 (N).","Your blood count results: White blood cells are 9.5 (normal). Hemoglobin is low at 10.5, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 329, which is normal.",Hematology,Lab Result,high
3624,CXR PA: Left lower lobe consolidation. ET tube 3cm above carina. Clear lung fields bilaterally. Increased interstitial markings suggesting pulmonary edema. No pneumothorax.,"Chest X-ray results: There is an area in the lower left lung that appears infected. The breathing tube is in good position. Both lungs look clear with no problems. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There is no collapsed lung.",Pulmonology,Radiology Report,high
3625,"27 y/o F with PMH of hypothyroidism, HFpEF, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Dulcolax 10mg QHS PRN, amoxicillin 500mg TID x 10 days, Humalog per SSI. F/U PCP in 2 weeks.","A 27-year-old woman with a history of underactive thyroid, and heart failure with stiff heart muscle was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the primary care doctor in 2 weeks.",Neurology,Discharge Summary,high
3626,"29 y/o M with PMH of CKD Stage 3, BPH, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on ondansetron 4mg Q8H PRN N/V, azithromycin 500mg day 1 then 250mg x 4 days. F/U neurology in 2 weeks.","A 29-year-old man with a history of moderate kidney disease, and enlarged prostate was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the brain/nerve doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
3627,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
3628,CXR PA: Clear lung fields bilaterally. Hyperinflated lungs consistent with COPD. Mild cardiomegaly. Bilateral pleural effusions. Cardiomegaly with CTR >0.5.,"Chest X-ray results: Both lungs look clear with no problems. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The heart is slightly larger than normal. There is fluid collecting around both lungs. The heart appears larger than normal.",Pulmonology,Radiology Report,high
3629,"64 y/o M with PMH of gout, HFrEF (EF 30%), admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Low potassium diet. D/C on Xarelto 20mg daily with dinner, carvedilol 12.5mg BID. F/U GI in 1 week.","A 64-year-old man with a history of gout, and heart failure with weak pumping (30%) was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the stomach doctor in 1 week.",Gastroenterology,Discharge Summary,high
3630,CXR PA: Elevated left hemidiaphragm. Right-sided pneumothorax. Osseous structures intact.,Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The bones look normal with no fractures.,Pulmonology,Radiology Report,high
3631,CXR PA: Cardiomegaly with CTR >0.5. Small left pleural effusion. NG tube tip in stomach. Right middle lobe atelectasis. Hyperinflated lungs consistent with COPD.,"Chest X-ray results: The heart appears larger than normal. There is a small amount of fluid around the left lung. The feeding/drainage tube tip is correctly positioned in the stomach. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema].",Pulmonology,Radiology Report,high
3632,"50 y/o M with PMH of gout, anemia, CKD Stage 4, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on Humalog per SSI, ibuprofen 400mg Q6H PRN with food, ASA 81mg daily, ferrous sulfate 325mg BID. F/U surgery in 10 days.","A 50-year-old man with a history of gout, low blood count [anemia], and advanced kidney disease was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) Humalog insulin before meals as directed [fast-acting insulin]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) baby aspirin 81mg once daily [prevents blood clots]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the surgeon in 10 days.",Gastroenterology,Discharge Summary,high
3633,CXR PA: Small left pleural effusion. Cardiomegaly with CTR >0.5. Bilateral pleural effusions. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: There is a small amount of fluid around the left lung. The heart appears larger than normal. There is fluid collecting around both lungs. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
3634,"89 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 89-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3635,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,low
3636,"24 y/o F with PMH of s/p THR, HTN, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on spironolactone 25mg daily, atorvastatin 80mg QHS, clopidogrel 75mg daily, lisinopril 10mg daily, albuterol MDI 2 puffs Q4-6H PRN. F/U PCP in 1 week.","A 24-year-old woman with a history of prior hip replacement, and high blood pressure was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]; (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (5) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the primary care doctor in 1 week.",Orthopedics,Discharge Summary,high
3637,"31 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 31-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3638,"34 y/o M with PMH of ESRD on HD, RA on MTX, CHF, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on carvedilol 12.5mg BID, hydroxychloroquine 200mg BID. F/U hematology in 2 weeks.","A 34-year-old man with a history of kidney failure requiring dialysis, rheumatoid arthritis [on immune-suppressing medicine], and heart failure was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the blood disorder doctor in 2 weeks.",Neurology,Discharge Summary,high
3639,"50 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 50-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3640,CT Head without contrast: No midline shift. No mass effect. Paranasal sinuses clear. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: The brain is centered normally. There are no tumors or masses pushing on the brain. The sinuses are clear with no infection. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
3641,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3642,"55 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 55-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3643,"58 y/o F with PMH of HFrEF (EF 30%), h/o TIA, osteoporosis, CHF, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on pregabalin 75mg BID, azithromycin 500mg day 1 then 250mg x 4 days, rosuvastatin 10mg QHS, metformin 500mg BID. F/U neurology in 2 weeks.","A 58-year-old woman with a history of heart failure with weak pumping (30%), history of mini-stroke, weak bones [osteoporosis], and heart failure was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Endocrinology,Discharge Summary,high
3644,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
3645,"CBC: WBC 24.4 (H), Hgb 12.3 (N), Plt 335 (N).","Your blood count results: White blood cells are 24.4 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 12.3. Platelets are 335, which is normal.",Hematology,Lab Result,high
3646,"Rx: Tab losartan 50mg daily. Tab metformin 1000mg BID. Tab atorvastatin 80mg QHS. Tab ciprofloxacin 500mg BID x 5 days. Adv: elevate affected limb, compression stockings Adv: fall precautions, home safety evaluation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) metformin 1000mg twice daily with meals [blood sugar medicine]. (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
3647,"35 y/o M with PMH of DM1, ICD in situ, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Strict I&O, daily weights. D/C on glipizide 5mg BID AC, ferrous sulfate 325mg BID, gabapentin 300mg TID. F/U surgery in 10 days.","A 35-year-old man with a history of type 1 diabetes, and implanted heart defibrillator was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the surgeon in 10 days.",Orthopedics,Discharge Summary,high
3648,"57 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 57-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3649,HbA1c: 5.5% (N). FBS: 354 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.5%, which is normal — you do not have diabetes. Fasting blood sugar was 354, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
3650,CXR PA: No pneumothorax. Sternotomy wires intact. ET tube 3cm above carina.,Chest X-ray results: There is no collapsed lung. The wires from prior heart surgery are intact. The breathing tube is in good position.,Pulmonology,Radiology Report,high
3651,CXR PA: Small left pleural effusion. Widened mediastinum. Bilateral hilar lymphadenopathy. Osseous structures intact.,"Chest X-ray results: There is a small amount of fluid around the left lung. The space between the lungs appears wider than normal, which needs further evaluation. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The bones look normal with no fractures.",Pulmonology,Radiology Report,high
3652,"61 y/o F with PMH of RA on MTX, OSA on CPAP, COPD, CKD Stage 3, GERD, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on metoprolol 25mg BID, pregabalin 75mg BID, sertraline 50mg daily, albuterol MDI 2 puffs Q4-6H PRN. F/U cardiology in 2 weeks.","A 61-year-old woman with a history of rheumatoid arthritis [on immune-suppressing medicine], sleep apnea [uses a breathing machine at night], chronic lung disease, moderate kidney disease, and acid reflux was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
3653,"BMP: Na 137 (N), K 4.2 (N), BUN 26, Cr 5.1 (H), Glucose 241.","Your blood chemistry results: Sodium is normal at 137. Potassium is normal at 4.2. Creatinine is elevated at 5.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 241 (high).",Nephrology,Lab Result,high
3654,"53 y/o F with PMH of h/o CVA, HFrEF (EF 30%), SLE, GERD, HTN, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on metoprolol succinate 50mg daily, azithromycin 500mg day 1 then 250mg x 4 days, Xarelto 20mg daily with dinner, lisinopril 10mg daily. F/U neurology in 2 weeks.","A 53-year-old woman with a history of history of stroke, heart failure with weak pumping (30%), lupus, acid reflux, and high blood pressure was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) Xarelto 20mg once daily with dinner [blood thinner]; (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the brain/nerve doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
3655,"23 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 23-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3656,"US Abdomen: Simple renal cysts bilaterally. CBD 12mm, dilated. Right kidney 10.5cm, no hydronephrosis. Pancreas unremarkable. Left kidney 8cm, cortical thinning consistent with CKD.","Abdominal ultrasound results: Both kidneys have harmless fluid-filled cysts. The bile duct is wider than normal [dilated], which may indicate a blockage. Right kidney is normal size with no blockage. The pancreas looks normal. Left kidney is small with thin outer layer, consistent with chronic kidney disease.",Gastroenterology,Radiology Report,high
3657,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
3658,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
3659,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. Multilevel degenerative disc disease.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
3660,"61 y/o F with PMH of asthma, DM1, GERD, RA on MTX, Parkinson's disease, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Strict I&O, daily weights. D/C on tramadol 50mg Q6H PRN pain, warfarin 5mg daily. F/U pulmonology in 2 weeks.","A 61-year-old woman with a history of asthma, type 1 diabetes, acid reflux, rheumatoid arthritis [on immune-suppressing medicine], and Parkinson's disease was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up with the lung doctor in 2 weeks.",Cardiology,Discharge Summary,high
3661,"LFTs: AST 137 (H), ALT 555 (H), ALP 94, T.Bili 6.9 (H), Albumin 4.9.","Your liver blood test results: Liver enzymes (AST 137, ALT 555) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.9 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.9.",Gastroenterology,Lab Result,high
3662,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
3663,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
3664,"70 y/o F with PMH of DM1, OSA on CPAP, s/p TKR, DVT/PE on warfarin, ESRD on HD, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on atorvastatin 80mg QHS, carvedilol 12.5mg BID, ferrous sulfate 325mg BID, ASA 81mg daily, sertraline 50mg daily. F/U surgery in 10 days.","A 70-year-old woman with a history of type 1 diabetes, sleep apnea [uses a breathing machine at night], prior knee replacement, blood clots [on blood thinner warfarin], and kidney failure requiring dialysis was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) baby aspirin 81mg once daily [prevents blood clots]; (5) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the surgeon in 10 days.",Neurology,Discharge Summary,high
3665,CXR PA: Hyperinflated lungs consistent with COPD. No pneumothorax. Compression fracture T12.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There is no collapsed lung. There is a compression fracture [collapsed bone] in the lower spine at T12.",Pulmonology,Radiology Report,high
3666,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. Multilevel degenerative disc disease. L5-S1 disc desiccation with mild bulge. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. Multiple discs in the spine are showing wear and aging. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
3667,"US Abdomen: Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Pancreas unremarkable. CBD 5mm, not dilated.","Abdominal ultrasound results: The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The pancreas looks normal. The bile duct is normal size [not blocked].",Gastroenterology,Radiology Report,high
3668,"41 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 41-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3669,"52 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 52-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3670,Delivery Note: G?P? at 38+2 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3671,"Rx: Tab entresto 49/51mg BID. Humalog per SSI. Avoid grapefruit juice Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks with INR.",Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) Humalog insulin before meals as directed [fast-acting insulin]. Do not drink grapefruit juice as it interferes with this medication Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,medium
3672,"57 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 57-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
3673,"24 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 24-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3674,CXR PA: Osseous structures intact. Right lower lobe consolidation. Bilateral hilar lymphadenopathy.,"Chest X-ray results: The bones look normal with no fractures. There is an area in the lower right lung that appears infected, suggesting pneumonia. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
3675,"US Abdomen: Left kidney 8cm, cortical thinning consistent with CKD. Simple renal cysts bilaterally. GB wall thickening with stones, positive Murphy's sign. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Moderate right hydronephrosis. Spleen 11cm, normal.","Abdominal ultrasound results: Left kidney is small with thin outer layer, consistent with chronic kidney disease. Both kidneys have harmless fluid-filled cysts. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The spleen is a normal size.",Gastroenterology,Radiology Report,high
3676,"CBC: WBC 6.6 (N), Hgb 12.7 (N), Plt 217 (N).","Your blood count results: White blood cells are 6.6 (normal). Hemoglobin is normal at 12.7. Platelets are 217, which is normal.",Hematology,Lab Result,medium
3677,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3678,HbA1c: 9.5% (H). FBS: 264 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.5%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 264, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
3679,"Thyroid panel: TSH 4.99 (H), Free T4 1.8.","Your thyroid test results: TSH is elevated at 4.99 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
3680,"Rx: Tab rosuvastatin 10mg QHS. Tab empagliflozin 10mg daily. Tab montelukast 10mg QHS. Tab sertraline 50mg daily. Adv: fall precautions, home safety evaluation. F/U 2 weeks.","Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) montelukast 10mg at bedtime [asthma/allergy medicine]. (4) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
3681,"LFTs: AST 173 (H), ALT 369 (H), ALP 87, T.Bili 6.9 (H), Albumin 2.3.","Your liver blood test results: Liver enzymes (AST 173, ALT 369) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.9 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.3 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
3682,"CBC: WBC 18.9 (H), Hgb 11.0 (L), Plt 459 (H).","Your blood count results: White blood cells are 18.9 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 11.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 459, which is high — your blood may clot too easily.",Hematology,Lab Result,high
3683,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Mild generalized cerebral atrophy appropriate for age. Paranasal sinuses clear. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is mild brain shrinkage, which is normal for your age. The sinuses are clear with no infection. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
3684,"Rx: Tab empagliflozin 10mg daily. Tab ciprofloxacin 500mg BID x 5 days. Tab atorvastatin 40mg QHS. Tab ferrous sulfate 325mg BID. Adv: avoid alcohol, hepatotoxic drugs Adv: elevate affected limb, compression stockings. F/U PCP in 1 week for BP recheck.",Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (3) atorvastatin 40mg at bedtime [cholesterol medicine]. (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: keep the affected leg elevated when resting and wear compression stockings. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,high
3685,"62 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 62-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3686,CXR PA: Hyperinflated lungs consistent with COPD. Sternotomy wires intact. Right-sided pneumothorax. ET tube 3cm above carina. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The wires from prior heart surgery are intact. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The breathing tube is in good position. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
3687,"68 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 68-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3688,"Thyroid panel: TSH 7.7 (H), Free T4 2.0.","Your thyroid test results: TSH is elevated at 7.7 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
3689,"89 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 89-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
3690,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3691,Rx: Tab ASA 81mg daily. Tab metoprolol succinate 50mg daily. Tab sertraline 50mg daily. Adv: low potassium diet Avoid NSAIDs. F/U 1 month with repeat imaging.,"Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
3692,"US Abdomen: Moderate right hydronephrosis. Right kidney 10.5cm, no hydronephrosis. Left kidney 8cm, cortical thinning consistent with CKD. CBD 5mm, not dilated. Spleen 11cm, normal. CBD 12mm, dilated.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. Right kidney is normal size with no blockage. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The bile duct is normal size [not blocked]. The spleen is a normal size. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
3693,"36 y/o F with PMH of PAD, OSA on CPAP, DVT/PE on warfarin, ICD in situ, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Strict I&O, daily weights. D/C on entresto 49/51mg BID, atorvastatin 40mg QHS, empagliflozin 10mg daily. F/U endocrine in 1 week.","A 36-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], sleep apnea [uses a breathing machine at night], blood clots [on blood thinner warfarin], and implanted heart defibrillator was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
3694,"Thyroid panel: TSH 14.62 (H), Free T4 1.3.","Your thyroid test results: TSH is elevated at 14.62 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
3695,"48 y/o F with PMH of Parkinson's disease, s/p TKR, CKD Stage 3, CAD, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on azithromycin 500mg day 1 then 250mg x 4 days, ASA 81mg daily, losartan 50mg daily, prednisone taper, amlodipine 5mg daily. F/U surgery in 2 weeks for drain removal.","A 48-year-old woman with a history of Parkinson's disease, prior knee replacement, moderate kidney disease, and coronary artery disease [heart artery blockages] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) losartan 50mg once daily [blood pressure medicine]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (5) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Neurology,Discharge Summary,high
3696,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
3697,Rx: Tab rosuvastatin 10mg QHS. Tab empagliflozin 10mg daily. Tab latanoprost 0.005% OU QHS. Tab sertraline 50mg daily. Avoid NSAIDs. F/U 6 weeks with LFTs.,Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (4) sertraline 50mg once daily [antidepressant/anxiety medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,high
3698,"72 y/o M with PMH of asthma, CKD Stage 4, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Compression stockings when ambulating. D/C on carvedilol 12.5mg BID, Humalog per SSI, empagliflozin 10mg daily, Dulcolax 10mg QHS PRN, spironolactone 25mg daily. F/U wound care in 3 days.","A 72-year-old man with a history of asthma, and advanced kidney disease was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (4) Dulcolax 10mg at bedtime as needed [for constipation]; (5) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
3699,"Rx: Tab amlodipine 10mg daily. Lantus 20U QHS. Spiriva 18mcg daily. Adv: low salt diet, fluid restriction 1.5L/day. F/U PCP in 1 week for BP recheck.",Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) Lantus insulin 20 units at bedtime [long-acting insulin]. (3) Spiriva inhaler once daily [long-acting lung medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
3700,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,low
3701,"Rx: Tab atorvastatin 80mg QHS. Tab amlodipine 5mg daily. Tab pantoprazole 40mg AC breakfast. Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks.",Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
3702,"MRI Lumbar Spine: C5-C6 disc herniation with cord compression. Conus medullaris at L1, normal.","MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
3703,Procedure: EGD with biopsy. Pt 90 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 90-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3704,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3705,"59 y/o M with PMH of s/p TKR, anxiety, hypothyroidism, CAD, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Low potassium diet. D/C on lisinopril 20mg daily, Lantus 20U QHS, metoprolol 25mg BID, acetaminophen 650mg Q6H PRN, pregabalin 75mg BID. F/U hematology in 2 weeks.","A 59-year-old man with a history of prior knee replacement, anxiety, underactive thyroid, and coronary artery disease [heart artery blockages] was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (5) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
3706,"42 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 42-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3707,"78 y/o F with PMH of GERD, s/p THR, OSA on CPAP, s/p CABG, Parkinson's disease, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on furosemide 40mg BID, Augmentin 875/125 BID x 7 days, Spiriva 18mcg daily, metformin 500mg BID, losartan 50mg daily. F/U surgery in 2 weeks for drain removal.","A 78-year-old woman with a history of acid reflux, prior hip replacement, sleep apnea [uses a breathing machine at night], prior heart bypass surgery, and Parkinson's disease was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) Spiriva inhaler once daily [long-acting lung medicine]; (4) metformin 500mg twice daily with meals [blood sugar medicine]; (5) losartan 50mg once daily [blood pressure medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Gastroenterology,Discharge Summary,high
3708,"Rx: Tab clopidogrel 75mg daily. Tab metformin 500mg BID. Tab pregabalin 75mg BID. Tab metoprolol 25mg BID. Tab acetaminophen 650mg Q6H PRN. Adv: high fiber diet, adequate hydration. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) pregabalin 75mg twice daily [nerve pain medicine]. (4) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
3709,"Rx: Tab lisinopril 10mg daily. Tab spironolactone 25mg daily. Tab Augmentin 875/125 BID x 7 days. Adv: fall precautions, home safety evaluation Adv: low salt low sugar diet, regular exercise. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
3710,"Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab calcium + vitamin D 600/400 daily. Tab amlodipine 10mg daily. Tab tramadol 50mg Q6H PRN pain. Avoid NSAIDs Do not stop abruptly, taper as directed. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) calcium plus vitamin D once daily [bone strengthening]. (3) amlodipine 10mg once daily [blood pressure medicine]. (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",General,Prescription,high
3711,"35 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 35-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
3712,MRI Lumbar Spine: Multilevel degenerative disc disease. No compression fracture.,MRI of the lower back results: Multiple discs in the spine are showing wear and aging. No bones are broken or collapsed.,Orthopedics,Radiology Report,high
3713,"Rx: Tab atorvastatin 40mg QHS. Tab spironolactone 25mg daily. Tab furosemide 40mg BID. Adv: smoking cessation, pulmonary rehab Adv: high fiber diet, adequate hydration. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) furosemide (Lasix) 40mg twice daily [water pill]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
3714,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab Xarelto 20mg daily with dinner. Adv: fall precautions, home safety evaluation Adv: wound care with daily dressing changes. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) Xarelto 20mg once daily with dinner [blood thinner]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Hematology,Prescription,medium
3715,"MRI Lumbar Spine: No compression fracture. C5-C6 disc herniation with cord compression. Conus medullaris at L1, normal. Central canal stenosis at L3-L4.","MRI of the lower back results: No bones are broken or collapsed. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal cord ends at a normal level. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
3716,"BMP: Na 120 (L), K 3.9 (N), BUN 10, Cr 2.9 (H), Glucose 151.","Your blood chemistry results: Sodium is low at 120 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.9. Creatinine is elevated at 2.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 151 (high).",Nephrology,Lab Result,high
3717,"61 y/o M with PMH of ESRD on HD, ICD in situ, CAD, A-fib, COPD, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on losartan 50mg daily, timolol 0.5% OU BID, glipizide 5mg BID AC. F/U orthopedics in 6 weeks with X-ray.","A 61-year-old man with a history of kidney failure requiring dialysis, implanted heart defibrillator, coronary artery disease [heart artery blockages], irregular heartbeat [atrial fibrillation], and chronic lung disease was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (3) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Neurology,Discharge Summary,high
3718,"34 y/o F with PMH of seizure disorder on Keppra, s/p TKR, BPH, CKD Stage 4, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on escitalopram 10mg daily, lisinopril 10mg daily, atorvastatin 80mg QHS, ferrous sulfate 325mg BID, warfarin 5mg daily. F/U INR check in 3 days.","A 34-year-old woman with a history of seizure disorder [on Keppra], prior knee replacement, enlarged prostate, and advanced kidney disease was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (5) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up for a blood thinner level check in 3 days.",Infectious Disease,Discharge Summary,high
3719,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,high
3720,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
3721,"38 y/o F with PMH of BPH, ICD in situ, HFpEF, PPM in situ, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Strict I&O, daily weights. D/C on tramadol 50mg Q6H PRN pain, furosemide 40mg BID, Lantus 20U QHS. F/U hematology in 2 weeks.","A 38-year-old woman with a history of enlarged prostate, implanted heart defibrillator, heart failure with stiff heart muscle, and implanted pacemaker was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) furosemide (Lasix) 40mg twice daily [water pill]; (3) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
3722,Procedure: ERCP with sphincterotomy. Pt 49 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 49-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3723,"74 y/o M with PMH of CHF, BPH, seizure disorder on Keppra, OA, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Low potassium diet. D/C on furosemide 40mg BID, metoprolol 25mg BID, amlodipine 10mg daily. F/U hematology in 2 weeks.","A 74-year-old man with a history of heart failure, enlarged prostate, seizure disorder [on Keppra], and arthritis [osteoarthritis] was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (3) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Pulmonology,Discharge Summary,high
3724,"BMP: Na 130 (L), K 4.0 (N), BUN 82, Cr 2.5 (H), Glucose 282.","Your blood chemistry results: Sodium is low at 130 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.0. Creatinine is elevated at 2.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 282 (high).",Nephrology,Lab Result,high
3725,"79 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 79-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3726,"27 y/o F with PMH of GERD, RA on MTX, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on carvedilol 12.5mg BID, methotrexate 15mg weekly, latanoprost 0.005% OU QHS, spironolactone 25mg daily, pregabalin 75mg BID. F/U GI in 1 week.","A 27-year-old woman with a history of acid reflux, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (4) spironolactone 25mg once daily [heart-protecting water pill]; (5) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the stomach doctor in 1 week.",Neurology,Discharge Summary,high
3727,"70 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 70-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3728,"77 y/o M with PMH of anxiety, DM1, COPD, obesity (BMI 38), h/o TIA, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on tramadol 50mg Q6H PRN pain, Dulcolax 10mg QHS PRN, ASA 81mg daily. F/U PCP in 2 weeks.","A 77-year-old man with a history of anxiety, type 1 diabetes, chronic lung disease, obesity, and history of mini-stroke was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the primary care doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
3729,"24 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 24-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3730,"44 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 44-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3731,"43 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 43-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3732,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No midline shift. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The brain is centered normally. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
3733,"45 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 45-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3734,"Rx: Tab ibuprofen 400mg Q6H PRN with food. Tab tramadol 50mg Q6H PRN pain. Tab glipizide 5mg BID AC. Tab Dulcolax 10mg QHS PRN. Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) glipizide 5mg twice daily before meals [helps release insulin]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",General,Prescription,high
3735,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
3736,"80 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 80-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3737,"90 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 90-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3738,"LFTs: AST 377 (H), ALT 18 (N), ALP 36, T.Bili 5.1 (H), Albumin 1.9.","Your liver blood test results: Liver enzymes (AST 377, ALT 18) are normal (normal is under 40). Bilirubin is high at 5.1 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 1.9 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
3739,HbA1c: 13.9% (H). FBS: 237 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.9%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 237, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3740,"84 y/o F with PMH of s/p CABG, anemia, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on ASA 81mg daily, Xarelto 20mg daily with dinner, metformin 1000mg BID, gabapentin 300mg TID. F/U PCP in 1 week.","A 84-year-old woman with a history of prior heart bypass surgery, and low blood count [anemia] was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) metformin 1000mg twice daily with meals [blood sugar medicine]; (4) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the primary care doctor in 1 week.",Infectious Disease,Discharge Summary,high
3741,"34 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 34-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3742,"69 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 69-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3743,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. C5-C6 disc herniation with cord compression.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
3744,"Rx: Tab spironolactone 25mg daily. Tab ibuprofen 400mg Q6H PRN with food. Tab ciprofloxacin 500mg BID x 5 days. Tab ASA 81mg daily. Tab gabapentin 300mg TID. Adv: elevate affected limb, compression stockings. F/U 2 weeks.",Your medicines: (1) spironolactone 25mg once daily [heart-protecting water pill]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (4) baby aspirin 81mg once daily [prevents blood clots]. (5) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back for a check-up in 2 weeks.,Cardiology,Prescription,high
3745,"68 y/o M with PMH of HLD, gout, h/o TIA, anemia, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on atorvastatin 40mg QHS, warfarin 5mg daily, ibuprofen 400mg Q6H PRN with food, empagliflozin 10mg daily. F/U surgery in 10 days.","A 68-year-old man with a history of high cholesterol, gout, history of mini-stroke, and low blood count [anemia] was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the surgeon in 10 days.",Infectious Disease,Discharge Summary,high
3746,"LFTs: AST 188 (H), ALT 280 (H), ALP 115, T.Bili 7.8 (H), Albumin 4.7.","Your liver blood test results: Liver enzymes (AST 188, ALT 280) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 7.8 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.7.",Gastroenterology,Lab Result,high
3747,"BMP: Na 143 (N), K 4.2 (N), BUN 79, Cr 1.8 (H), Glucose 385.","Your blood chemistry results: Sodium is normal at 143. Potassium is normal at 4.2. Creatinine is elevated at 1.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 385 (high).",Nephrology,Lab Result,high
3748,"27 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 27-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3749,"72 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 72-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3750,"28 y/o F with PMH of OA, BPH, PAD, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on azithromycin 500mg day 1 then 250mg x 4 days, atorvastatin 40mg QHS, ibuprofen 400mg Q6H PRN with food, metoprolol succinate 50mg daily, empagliflozin 10mg daily. F/U oncology in 1 week.","A 28-year-old woman with a history of arthritis [osteoarthritis], enlarged prostate, and poor blood flow in the legs [peripheral artery disease] was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (5) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the cancer doctor in 1 week.",Pulmonology,Discharge Summary,high
3751,Rx: Tab losartan 50mg daily. Tab hydroxychloroquine 200mg BID. Tab pantoprazole 40mg AC breakfast. Tab furosemide 40mg daily. Tab ferrous sulfate 325mg BID. Adv: wound care with daily dressing changes. F/U PCP in 1 week for BP recheck.,"Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (5) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
3752,"34 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 34-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3753,CXR PA: Compression fracture T12. Left lower lobe consolidation. Cardiomegaly with CTR >0.5. NG tube tip in stomach.,Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. There is an area in the lower left lung that appears infected. The heart appears larger than normal. The feeding/drainage tube tip is correctly positioned in the stomach.,Pulmonology,Radiology Report,high
3754,"48 y/o M with PMH of osteoporosis, h/o TIA, cirrhosis, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on empagliflozin 10mg daily, omeprazole 20mg AC breakfast, clopidogrel 75mg daily, methotrexate 15mg weekly, lisinopril 10mg daily. F/U hematology in 2 weeks.","A 48-year-old man with a history of weak bones [osteoporosis], history of mini-stroke, and liver scarring [cirrhosis] was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) Plavix (clopidogrel) 75mg once daily [blood thinner]; (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
3755,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3756,"44 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 44-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3757,"Thyroid panel: TSH 6.4 (H), Free T4 0.5.","Your thyroid test results: TSH is elevated at 6.4 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is low — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
3758,"Rx: prednisone taper. Tab lisinopril 20mg daily. Avoid NSAIDs Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with CBC, CMP.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) lisinopril 20mg once daily [blood pressure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,medium
3759,"41 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 41-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3760,"77 y/o F with PMH of Parkinson's disease, A-fib, BPH, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on sertraline 50mg daily, gabapentin 300mg TID, ASA 81mg daily. F/U INR check in 3 days.","A 77-year-old woman with a history of Parkinson's disease, irregular heartbeat [atrial fibrillation], and enlarged prostate was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) baby aspirin 81mg once daily [prevents blood clots]. Follow-up for a blood thinner level check in 3 days.",Pulmonology,Discharge Summary,high
3761,"74 y/o F with PMH of obesity (BMI 38), seizure disorder on Keppra, s/p CABG, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Dulcolax 10mg QHS PRN, furosemide 40mg BID, tramadol 50mg Q6H PRN pain, amlodipine 5mg daily, metformin 500mg BID. F/U cardiology in 2 weeks.","A 74-year-old woman with a history of obesity, seizure disorder [on Keppra], and prior heart bypass surgery was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) furosemide (Lasix) 40mg twice daily [water pill]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (4) amlodipine 5mg once daily [blood pressure medicine]; (5) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
3762,HbA1c: 13.5% (H). FBS: 127 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.5%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 127, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3763,"US Abdomen: GB sludge, no stones. Pancreas unremarkable. CBD 12mm, dilated. Right kidney 10.5cm, no hydronephrosis. Spleen 11cm, normal.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. The pancreas looks normal. The bile duct is wider than normal [dilated], which may indicate a blockage. Right kidney is normal size with no blockage. The spleen is a normal size.",Gastroenterology,Radiology Report,high
3764,"91 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 91-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3765,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3766,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3767,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
3768,CXR PA: Moderate right pleural effusion. Right-sided pneumothorax. Left lower lobe consolidation. Bilateral pleural effusions.,Chest X-ray results: There is a moderate amount of fluid around the right lung. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There is an area in the lower left lung that appears infected. There is fluid collecting around both lungs.,Pulmonology,Radiology Report,high
3769,"26 y/o M with PMH of COPD, PPM in situ, SLE, BPH, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on lisinopril 10mg daily, montelukast 10mg QHS, rosuvastatin 10mg QHS, atorvastatin 40mg QHS. F/U oncology in 1 week.","A 26-year-old man with a history of chronic lung disease, implanted pacemaker, lupus, and enlarged prostate was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the cancer doctor in 1 week.",Cardiology,Discharge Summary,high
3770,"36 y/o F with PMH of A-fib, anxiety, SLE, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on ASA 81mg daily, Humalog per SSI, losartan 50mg daily. F/U INR check in 3 days.","A 36-year-old woman with a history of irregular heartbeat [atrial fibrillation], anxiety, and lupus was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) Humalog insulin before meals as directed [fast-acting insulin]; (3) losartan 50mg once daily [blood pressure medicine]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
3771,"49 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 49-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3772,"Lipid panel: TC 249, LDL 80, HDL 27, TG 164.","Your cholesterol results: Total cholesterol is 249. LDL (bad cholesterol) is at goal (80). HDL (good cholesterol) is too low at 27 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are high at 164.",Cardiology,Lab Result,high
3773,Procedure: ERCP with sphincterotomy. Pt 64 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 64-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3774,"US Abdomen: Simple renal cysts bilaterally. GB wall thickening with stones, positive Murphy's sign. Right kidney 10.5cm, no hydronephrosis. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: Both kidneys have harmless fluid-filled cysts. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Right kidney is normal size with no blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
3775,"41 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 41-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3776,"US Abdomen: CBD 12mm, dilated. Pancreas unremarkable. Spleen 16cm, splenomegaly.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. The pancreas looks normal. The spleen is enlarged [splenomegaly].",Gastroenterology,Radiology Report,high
3777,Procedure: PCI with DES to LAD. Pt 71 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 71-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
3778,"Rx: Tab pregabalin 75mg BID. Tab spironolactone 25mg daily. Tab atorvastatin 40mg QHS. Adv: smoking cessation, pulmonary rehab. F/U 6 weeks with LFTs.",Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) atorvastatin 40mg at bedtime [cholesterol medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,medium
3779,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,high
3780,"75 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 75-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3781,"56 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 56-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3782,CXR PA: Right lower lobe consolidation. Patchy bilateral infiltrates. Pacemaker leads in appropriate position. No pneumothorax. Widened mediastinum.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The pacemaker wires are in the correct position. There is no collapsed lung. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
3783,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
3784,"Rx: Tab Xarelto 20mg daily with dinner. Tab pregabalin 75mg BID. Adv: smoking cessation, pulmonary rehab. F/U 6 weeks with LFTs.",Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) pregabalin 75mg twice daily [nerve pain medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 6 weeks for liver function blood tests.,Neurology,Prescription,medium
3785,"Rx: Tab pregabalin 75mg BID. Tab metoprolol succinate 50mg daily. Tab gabapentin 300mg TID. Tab metoprolol 25mg BID. Tab lisinopril 10mg daily. Adv: smoking cessation, pulmonary rehab Adv: elevate affected limb, compression stockings. F/U 1 month with repeat imaging.",Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,high
3786,Delivery Note: G?P? at 39+1 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3787,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
3788,"Thyroid panel: TSH 13.38 (H), Free T4 0.7.","Your thyroid test results: TSH is elevated at 13.38 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is low — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
3789,CT Head without contrast: No midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Acute ischemic infarct in R MCA territory. Paranasal sinuses clear. No mass effect.,"CT scan of the head results: The brain is centered normally. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The sinuses are clear with no infection. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
3790,"Rx: Tab amlodipine 5mg daily. Tab omeprazole 20mg AC breakfast. Tab furosemide 40mg daily. Tab Eliquis 5mg BID. Humalog per SSI. Adv: low potassium diet Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks.","Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (4) Eliquis 5mg twice daily [blood thinner]. (5) Humalog insulin before meals as directed [fast-acting insulin]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
3791,"Rx: Tab warfarin 5mg daily. Tab metformin 1000mg BID. Tab furosemide 40mg daily. Tab timolol 0.5% OU BID. Avoid NSAIDs Adv: DASH diet, daily BP monitoring. F/U 2 weeks.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) metformin 1000mg twice daily with meals [blood sugar medicine]. (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
3792,"Lipid panel: TC 141, LDL 76, HDL 66, TG 390.",Your cholesterol results: Total cholesterol is 141. LDL (bad cholesterol) is at goal (76). HDL (good cholesterol) is good at 66. Triglycerides are very high at 390 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
3793,"Rx: Tab metoprolol 25mg BID. Tab ibuprofen 400mg Q6H PRN with food. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
3794,Delivery Note: G?P? at 39+1 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3795,"69 y/o F with PMH of h/o CVA, OA, ICD in situ, obesity (BMI 38), DM1, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Low potassium diet. D/C on glipizide 5mg BID AC, gabapentin 300mg TID, empagliflozin 10mg daily. F/U hematology in 2 weeks.","A 69-year-old woman with a history of history of stroke, arthritis [osteoarthritis], implanted heart defibrillator, obesity, and type 1 diabetes was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the blood disorder doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
3796,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
3797,CXR PA: No pneumothorax. Hyperinflated lungs consistent with COPD. Pacemaker leads in appropriate position. ET tube 3cm above carina.,"Chest X-ray results: There is no collapsed lung. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The pacemaker wires are in the correct position. The breathing tube is in good position.",Pulmonology,Radiology Report,high
3798,"Rx: Tab gabapentin 300mg TID. Humalog per SSI. Adv: fall precautions, home safety evaluation. F/U 2 weeks with INR.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) Humalog insulin before meals as directed [fast-acting insulin]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks for a blood thinner level check [INR].",Neurology,Prescription,medium
3799,"78 y/o M with PMH of seizure disorder on Keppra, COPD, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Strict I&O, daily weights. D/C on potassium chloride 20mEq daily, atorvastatin 80mg QHS, levothyroxine 75mcg daily on empty stomach, losartan 50mg daily, Humalog per SSI. F/U hematology in 2 weeks.","A 78-year-old man with a history of seizure disorder [on Keppra], and chronic lung disease was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (4) losartan 50mg once daily [blood pressure medicine]; (5) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
3800,"45 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 45-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3801,"US Abdomen: Left kidney 8cm, cortical thinning consistent with CKD. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. CBD 12mm, dilated. Spleen 16cm, splenomegaly. GB sludge, no stones.","Abdominal ultrasound results: Left kidney is small with thin outer layer, consistent with chronic kidney disease. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The bile duct is wider than normal [dilated], which may indicate a blockage. The spleen is enlarged [splenomegaly]. The gallbladder contains thickened bile [sludge] but no stones.",Gastroenterology,Radiology Report,high
3802,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3803,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab sertraline 50mg daily. Adv: low potassium diet. F/U 1 week with CBC, CMP.","Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Psychiatry,Prescription,medium
3804,"83 y/o M with PMH of obesity (BMI 38), anxiety, s/p TKR, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on ASA 81mg daily, pregabalin 75mg BID, albuterol MDI 2 puffs Q4-6H PRN, tramadol 50mg Q6H PRN pain. F/U oncology in 1 week.","A 83-year-old man with a history of obesity, anxiety, and prior knee replacement was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the cancer doctor in 1 week.",Gastroenterology,Discharge Summary,high
3805,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3806,"Lipid panel: TC 185, LDL 162, HDL 55, TG 269.","Your cholesterol results: Total cholesterol is 185. LDL (bad cholesterol) is very high at 162 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 55. Triglycerides are high at 269.",Cardiology,Lab Result,high
3807,"85 y/o F with PMH of s/p CABG, HTN, A-fib, gout, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on calcium + vitamin D 600/400 daily, Xarelto 20mg daily with dinner, ondansetron 4mg Q8H PRN N/V, clopidogrel 75mg daily. F/U oncology in 1 week.","A 85-year-old woman with a history of prior heart bypass surgery, high blood pressure, irregular heartbeat [atrial fibrillation], and gout was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) calcium plus vitamin D once daily [bone strengthening]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Follow-up with the cancer doctor in 1 week.",Pulmonology,Discharge Summary,high
3808,"US Abdomen: Spleen 11cm, normal. Right kidney 10.5cm, no hydronephrosis. Spleen 16cm, splenomegaly. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The spleen is a normal size. Right kidney is normal size with no blockage. The spleen is enlarged [splenomegaly]. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
3809,"Rx: Tab carvedilol 12.5mg BID. Tab spironolactone 25mg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab entresto 49/51mg BID. Adv: elevate affected limb, compression stockings Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) Entresto 49/51mg twice daily [heart failure medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,high
3810,"Rx: Tab metformin 500mg BID. Tab Xarelto 20mg daily with dinner. Tab furosemide 40mg daily. Tab glipizide 5mg BID AC. Tab escitalopram 10mg daily. Adv: DASH diet, daily BP monitoring Adv: low salt diet, fluid restriction 1.5L/day. F/U 2 weeks.","Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (4) glipizide 5mg twice daily before meals [helps release insulin]. (5) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back for a check-up in 2 weeks.",Endocrinology,Prescription,high
3811,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
3812,"44 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 44-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3813,HbA1c: 13.7% (H). FBS: 128 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.7%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 128, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3814,Procedure: Laparoscopic appendectomy. Pt 67 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 67-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
3815,"40 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 40-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
3816,"Rx: Tab spironolactone 25mg daily. Tab omeprazole 20mg AC breakfast. Tab amlodipine 5mg daily. Humalog per SSI. Tab pantoprazole 40mg AC breakfast. Adv: smoking cessation, pulmonary rehab Adv: avoid alcohol, hepatotoxic drugs. F/U 1 month with repeat imaging.",Your medicines: (1) spironolactone 25mg once daily [heart-protecting water pill]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) amlodipine 5mg once daily [blood pressure medicine]. (4) Humalog insulin before meals as directed [fast-acting insulin]. (5) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,high
3817,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
3818,"48 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 48-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3819,"46 y/o F with PMH of A-fib, Parkinson's disease, h/o TIA, CHF, osteoporosis, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on atorvastatin 80mg QHS, lisinopril 10mg daily, glipizide 5mg BID AC. F/U cardiology in 2 weeks.","A 46-year-old woman with a history of irregular heartbeat [atrial fibrillation], Parkinson's disease, history of mini-stroke, heart failure, and weak bones [osteoporosis] was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (3) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the heart doctor in 2 weeks.",General Surgery,Discharge Summary,high
3820,Procedure: ERCP with sphincterotomy. Pt 51 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 51-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3821,Procedure: PCI with DES to LAD. Pt 65 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 65-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
3822,"45 y/o F with PMH of HFpEF, DVT/PE on warfarin, h/o CVA, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on gabapentin 300mg TID, hydroxychloroquine 200mg BID, tramadol 50mg Q6H PRN pain, potassium chloride 20mEq daily. F/U cardiology in 2 weeks.","A 45-year-old woman with a history of heart failure with stiff heart muscle, blood clots [on blood thinner warfarin], and history of stroke was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the heart doctor in 2 weeks.",Endocrinology,Discharge Summary,high
3823,"BMP: Na 133 (L), K 4.9 (N), BUN 56, Cr 2.7 (H), Glucose 64.","Your blood chemistry results: Sodium is low at 133 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.9. Creatinine is elevated at 2.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 64 (low).",Nephrology,Lab Result,high
3824,"86 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 86-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3825,"Rx: Tab carvedilol 12.5mg BID. Tab Dulcolax 10mg QHS PRN. Spiriva 18mcg daily. Adv: low salt low sugar diet, regular exercise. F/U 1 week with wound check.","Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) Spiriva inhaler once daily [long-acting lung medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
3826,"Rx: Tab metoprolol 25mg BID. Tab amlodipine 10mg daily. Tab levothyroxine 75mcg daily on empty stomach. Tab methotrexate 15mg weekly. Adv: high fiber diet, adequate hydration. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
3827,"44 y/o F with PMH of GERD, s/p TKR, anemia, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on pantoprazole 40mg AC breakfast, rosuvastatin 10mg QHS, spironolactone 25mg daily, acetaminophen 650mg Q6H PRN. F/U surgery in 2 weeks for drain removal.","A 44-year-old woman with a history of acid reflux, prior knee replacement, and low blood count [anemia] was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) spironolactone 25mg once daily [heart-protecting water pill]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
3828,"86 y/o M with PMH of PAD, DVT/PE on warfarin, ESRD on HD, GERD, anxiety, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Augmentin 875/125 BID x 7 days, empagliflozin 10mg daily, carvedilol 12.5mg BID. F/U endocrine in 1 week.","A 86-year-old man with a history of poor blood flow in the legs [peripheral artery disease], blood clots [on blood thinner warfarin], kidney failure requiring dialysis, acid reflux, and anxiety was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Endocrinology,Discharge Summary,high
3829,"BMP: Na 120 (L), K 4.1 (N), BUN 30, Cr 6.1 (H), Glucose 336.","Your blood chemistry results: Sodium is low at 120 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.1. Creatinine is elevated at 6.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 336 (high).",Nephrology,Lab Result,high
3830,"CBC: WBC 22.8 (H), Hgb 17.3 (H), Plt 403 (H).","Your blood count results: White blood cells are 22.8 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is elevated at 17.3. Platelets are 403, which is high — your blood may clot too easily.",Hematology,Lab Result,high
3831,"23 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 23-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3832,"66 y/o F with PMH of COPD, gout, CAD, h/o CVA, SLE, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on metformin 500mg BID, Augmentin 875/125 BID x 7 days. F/U pulmonology in 2 weeks.","A 66-year-old woman with a history of chronic lung disease, gout, coronary artery disease [heart artery blockages], history of stroke, and lupus was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the lung doctor in 2 weeks.",Pulmonology,Discharge Summary,high
3833,"Rx: Tab sertraline 50mg daily. Tab levothyroxine 75mcg daily on empty stomach. Spiriva 18mcg daily. Avoid NSAIDs Adv: elevate affected limb, compression stockings. F/U 2 weeks with INR.",Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) Spiriva inhaler once daily [long-acting lung medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks for a blood thinner level check [INR].,Pulmonology,Prescription,medium
3834,CT Head without contrast: No midline shift. Acute ischemic infarct in R MCA territory. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: The brain is centered normally. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
3835,CXR PA: Right lower lobe consolidation. Clear lung fields bilaterally. Mild cardiomegaly.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. Both lungs look clear with no problems. The heart is slightly larger than normal.",Pulmonology,Radiology Report,high
3836,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
3837,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Acute ischemic infarct in R MCA territory. No mass effect.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
3838,"53 y/o M with PMH of osteoporosis, anxiety, PAD, s/p THR, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Low potassium diet. D/C on warfarin 5mg daily, metoprolol succinate 50mg daily, sertraline 50mg daily, entresto 49/51mg BID, metformin 1000mg BID. F/U INR check in 3 days.","A 53-year-old man with a history of weak bones [osteoporosis], anxiety, poor blood flow in the legs [peripheral artery disease], and prior hip replacement was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) Entresto 49/51mg twice daily [heart failure medicine]; (5) metformin 1000mg twice daily with meals [blood sugar medicine]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
3839,"79 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 79-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3840,HbA1c: 6.0% (H). FBS: 398 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.0%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 398, which is high (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,high
3841,Procedure: Laparoscopic cholecystectomy. Pt 50 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 50-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
3842,"Lipid panel: TC 267, LDL 157, HDL 67, TG 416.",Your cholesterol results: Total cholesterol is 267. LDL (bad cholesterol) is high at 157 (goal under 100). HDL (good cholesterol) is good at 67. Triglycerides are very high at 416 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
3843,"78 y/o M with PMH of obesity (BMI 38), CAD, PPM in situ, A-fib, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Low potassium diet. D/C on entresto 49/51mg BID, sertraline 50mg daily, tramadol 50mg Q6H PRN pain, acetaminophen 650mg Q6H PRN, lisinopril 20mg daily. F/U PCP in 2 weeks.","A 78-year-old man with a history of obesity, coronary artery disease [heart artery blockages], implanted pacemaker, and irregular heartbeat [atrial fibrillation] was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (5) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the primary care doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
3844,"82 y/o M with PMH of ESRD on HD, CHF, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Low potassium diet. D/C on tramadol 50mg Q6H PRN pain, hydroxychloroquine 200mg BID, warfarin 5mg daily, prednisone taper, amlodipine 10mg daily. F/U PCP in 1 week.","A 82-year-old man with a history of kidney failure requiring dialysis, and heart failure was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (5) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the primary care doctor in 1 week.",Neurology,Discharge Summary,high
3845,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,low
3846,"42 y/o M with PMH of s/p CABG, SLE, h/o CVA, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on ASA 81mg daily, Lantus 20U QHS. F/U surgery in 2 weeks for drain removal.","A 42-year-old man with a history of prior heart bypass surgery, lupus, and history of stroke was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the surgeon in 2 weeks to remove the drain.",General Surgery,Discharge Summary,high
3847,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. Mild generalized cerebral atrophy appropriate for age. Paranasal sinuses clear. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is mild brain shrinkage, which is normal for your age. The sinuses are clear with no infection. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
3848,"Rx: Tab metoprolol succinate 50mg daily. Tab amlodipine 10mg daily. Tab atorvastatin 80mg QHS. Tab Dulcolax 10mg QHS PRN. Tab calcium + vitamin D 600/400 daily. Adv: SMBG BID, diabetic diet Adv: elevate affected limb, compression stockings. F/U INR in 3 days.",Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. (5) calcium plus vitamin D once daily [bone strengthening]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
3849,"26 y/o F with PMH of s/p CABG, RA on MTX, ESRD on HD, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on prednisone taper, Dulcolax 10mg QHS PRN, methotrexate 15mg weekly, sertraline 50mg daily, Spiriva 18mcg daily. F/U surgery in 10 days.","A 26-year-old woman with a history of prior heart bypass surgery, rheumatoid arthritis [on immune-suppressing medicine], and kidney failure requiring dialysis was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (4) sertraline 50mg once daily [antidepressant/anxiety medicine]; (5) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the surgeon in 10 days.",General Surgery,Discharge Summary,high
3850,"US Abdomen: CBD 12mm, dilated. GB sludge, no stones. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. The gallbladder contains thickened bile [sludge] but no stones. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
3851,Procedure: R TKA. Pt 23 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 23-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
3852,"US Abdomen: GB sludge, no stones. Left kidney 8cm, cortical thinning consistent with CKD. CBD 12mm, dilated.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
3853,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3854,"US Abdomen: Moderate right hydronephrosis. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. CBD 12mm, dilated.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
3855,"BMP: Na 121 (L), K 4.8 (N), BUN 66, Cr 7.4 (H), Glucose 69.","Your blood chemistry results: Sodium is low at 121 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.8. Creatinine is elevated at 7.4 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 69 (low).",Nephrology,Lab Result,high
3856,"BMP: Na 137 (N), K 6.3 (H), BUN 33, Cr 5.8 (H), Glucose 140.","Your blood chemistry results: Sodium is normal at 137. Potassium is dangerously high at 6.3 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 5.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 140 (high).",Nephrology,Lab Result,high
3857,"54 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 54-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3858,CT Head without contrast: Acute ischemic infarct in R MCA territory. No mass effect. Chronic lacunar infarcts in bilateral basal ganglia. 4cm right subdural hematoma with 5mm midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are no tumors or masses pushing on the brain. There are signs of small old strokes in the deep parts of the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
3859,"22 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 22-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3860,"25 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 25-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3861,"52 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 52-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3862,"US Abdomen: Spleen 11cm, normal. Ascites moderate amount. CBD 5mm, not dilated.",Abdominal ultrasound results: The spleen is a normal size. There is a moderate amount of fluid in the belly [ascites]. The bile duct is normal size [not blocked].,Gastroenterology,Radiology Report,high
3863,"55 y/o M with PMH of CHF, PPM in situ, DM1, anemia, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on ciprofloxacin 500mg BID x 5 days, tramadol 50mg Q6H PRN pain, montelukast 10mg QHS, spironolactone 25mg daily, ferrous sulfate 325mg BID. F/U PCP in 1 week.","A 55-year-old man with a history of heart failure, implanted pacemaker, type 1 diabetes, and low blood count [anemia] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]; (4) spironolactone 25mg once daily [heart-protecting water pill]; (5) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the primary care doctor in 1 week.",Orthopedics,Discharge Summary,high
3864,"58 y/o F with PMH of h/o CVA, CAD, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Low potassium diet. D/C on azithromycin 500mg day 1 then 250mg x 4 days, entresto 49/51mg BID, furosemide 40mg BID, furosemide 40mg daily. F/U endocrine in 1 week.","A 58-year-old woman with a history of history of stroke, and coronary artery disease [heart artery blockages] was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Follow-up with the hormone/diabetes doctor in 1 week.",Gastroenterology,Discharge Summary,high
3865,CT Head without contrast: No mass effect. Chronic lacunar infarcts in bilateral basal ganglia. 4cm right subdural hematoma with 5mm midline shift. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There are signs of small old strokes in the deep parts of the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
3866,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
3867,"22 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 22-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
3868,CXR PA: NG tube tip in stomach. Pacemaker leads in appropriate position. Clear lung fields bilaterally. Left lower lobe consolidation. Elevated left hemidiaphragm.,Chest X-ray results: The feeding/drainage tube tip is correctly positioned in the stomach. The pacemaker wires are in the correct position. Both lungs look clear with no problems. There is an area in the lower left lung that appears infected. The left side of the breathing muscle [diaphragm] is sitting higher than normal.,Pulmonology,Radiology Report,high
3869,"88 y/o F with PMH of COPD, h/o TIA, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Augmentin 875/125 BID x 7 days, albuterol MDI 2 puffs Q4-6H PRN. F/U neurology in 2 weeks.","A 88-year-old woman with a history of chronic lung disease, and history of mini-stroke was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the brain/nerve doctor in 2 weeks.",Nephrology,Discharge Summary,high
3870,"Rx: Tab gabapentin 300mg TID. Tab omeprazole 20mg AC breakfast. Tab metformin 1000mg BID. Adv: avoid alcohol, hepatotoxic drugs Adv: low potassium diet. F/U INR in 3 days.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 3 days for a blood thinner level check [INR].",Neurology,Prescription,medium
3871,Delivery Note: G?P? at 38+2 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3872,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Spiriva 18mcg daily. albuterol MDI 2 puffs Q4-6H PRN. Tab metformin 1000mg BID. Adv: weight bearing exercise, calcium/vit D supplementation Adv: wound care with daily dressing changes. F/U 1 week with CBC, CMP.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) metformin 1000mg twice daily with meals [blood sugar medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Pulmonology,Prescription,high
3873,"US Abdomen: Ascites moderate amount. Moderate right hydronephrosis. Spleen 16cm, splenomegaly. CBD 5mm, not dilated.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The spleen is enlarged [splenomegaly]. The bile duct is normal size [not blocked].",Gastroenterology,Radiology Report,high
3874,CXR PA: No cardiomegaly. Moderate right pleural effusion. Clear lung fields bilaterally.,Chest X-ray results: The heart is a normal size. There is a moderate amount of fluid around the right lung. Both lungs look clear with no problems.,Pulmonology,Radiology Report,high
3875,"81 y/o M with PMH of anemia, OA, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Low potassium diet. D/C on amlodipine 10mg daily, metoprolol succinate 50mg daily, spironolactone 25mg daily, tramadol 50mg Q6H PRN pain. F/U hematology in 2 weeks.","A 81-year-old man with a history of low blood count [anemia], and arthritis [osteoarthritis] was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) spironolactone 25mg once daily [heart-protecting water pill]; (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the blood disorder doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
3876,"Rx: Tab entresto 49/51mg BID. Tab ASA 81mg daily. Tab ibuprofen 400mg Q6H PRN with food. Tab atorvastatin 40mg QHS. Avoid NSAIDs Adv: avoid alcohol, hepatotoxic drugs. F/U INR in 3 days.",Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (4) atorvastatin 40mg at bedtime [cholesterol medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
3877,"Lipid panel: TC 268, LDL 63, HDL 30, TG 462.","Your cholesterol results: Total cholesterol is 268. LDL (bad cholesterol) is at goal (63). HDL (good cholesterol) is too low at 30 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 462 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
3878,"56 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 56-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
3879,"Lipid panel: TC 205, LDL 184, HDL 20, TG 63.","Your cholesterol results: Total cholesterol is 205. LDL (bad cholesterol) is very high at 184 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is too low at 20 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are normal at 63.",Cardiology,Lab Result,high
3880,"62 y/o F with PMH of OA, s/p THR, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on sertraline 50mg daily, spironolactone 25mg daily, ferrous sulfate 325mg BID. F/U hematology in 2 weeks.","A 62-year-old woman with a history of arthritis [osteoarthritis], and prior hip replacement was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the blood disorder doctor in 2 weeks.",Neurology,Discharge Summary,high
3881,"44 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 44-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
3882,CXR PA: Elevated left hemidiaphragm. Bilateral hilar lymphadenopathy. Increased interstitial markings suggesting pulmonary edema. Right middle lobe atelectasis.,"Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
3883,Rx: Tab Xarelto 20mg daily with dinner. Tab omeprazole 20mg AC breakfast. Tab amlodipine 5mg daily. Tab Augmentin 875/125 BID x 7 days. Tab furosemide 40mg daily. Adv: low potassium diet. F/U 1 week with wound check.,"Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) amlodipine 5mg once daily [blood pressure medicine]. (4) Augmentin 875mg twice daily for 7 days [antibiotic]. (5) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
3884,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3885,"Rx: Tab escitalopram 10mg daily. prednisone taper. Tab pantoprazole 40mg AC breakfast. Tab glipizide 5mg BID AC. Adv: low salt diet, fluid restriction 1.5L/day Adv: fall precautions, home safety evaluation. F/U 2 weeks.","Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. (4) glipizide 5mg twice daily before meals [helps release insulin]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back for a check-up in 2 weeks.",Gastroenterology,Prescription,high
3886,CXR PA: Osseous structures intact. Cardiomegaly with CTR >0.5. Left lower lobe consolidation. Right lower lobe consolidation.,"Chest X-ray results: The bones look normal with no fractures. The heart appears larger than normal. There is an area in the lower left lung that appears infected. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
3887,"US Abdomen: Ascites moderate amount. GB wall thickening with stones, positive Murphy's sign. Right kidney 10.5cm, no hydronephrosis.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Right kidney is normal size with no blockage.",Gastroenterology,Radiology Report,high
3888,"63 y/o F with PMH of ESRD on HD, asthma, hypothyroidism, HFrEF (EF 30%), DM1, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on losartan 50mg daily, azithromycin 500mg day 1 then 250mg x 4 days. F/U wound care in 3 days.","A 63-year-old woman with a history of kidney failure requiring dialysis, asthma, underactive thyroid, heart failure with weak pumping (30%), and type 1 diabetes was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up at the wound care clinic in 3 days.",Neurology,Discharge Summary,high
3889,"31 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 31-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3890,"76 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 76-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3891,"22 y/o F with PMH of osteoporosis, ICD in situ, A-fib, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Dulcolax 10mg QHS PRN, glipizide 5mg BID AC, pantoprazole 40mg AC breakfast. F/U GI in 1 week.","A 22-year-old woman with a history of weak bones [osteoporosis], implanted heart defibrillator, and irregular heartbeat [atrial fibrillation] was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
3892,Rx: prednisone taper. Tab furosemide 40mg BID. Tab metoprolol 25mg BID. Adv: wound care with daily dressing changes Adv: low potassium diet. F/U 1 week with wound check.,"Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
3893,"61 y/o F with PMH of asthma, CKD Stage 4, DVT/PE on warfarin, HTN, HFpEF, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on Eliquis 5mg BID, spironolactone 25mg daily, levothyroxine 75mcg daily on empty stomach. F/U cardiology in 2 weeks.","A 61-year-old woman with a history of asthma, advanced kidney disease, blood clots [on blood thinner warfarin], high blood pressure, and heart failure with stiff heart muscle was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Eliquis 5mg twice daily [blood thinner]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
3894,"Rx: Tab amlodipine 5mg daily. Tab rosuvastatin 10mg QHS. Tab clopidogrel 75mg daily. Adv: DASH diet, daily BP monitoring Adv: wound care with daily dressing changes. F/U PCP in 1 week for BP recheck.","Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
3895,"78 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 78-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3896,"Rx: Tab pregabalin 75mg BID. Tab pantoprazole 40mg AC breakfast. albuterol MDI 2 puffs Q4-6H PRN. Adv: low salt low sugar diet, regular exercise. F/U 1 month with repeat imaging.","Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 month — a repeat scan will be ordered.",Pulmonology,Prescription,medium
3897,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
3898,"BMP: Na 136 (N), K 6.1 (H), BUN 6, Cr 3.0 (H), Glucose 147.","Your blood chemistry results: Sodium is normal at 136. Potassium is dangerously high at 6.1 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 3.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 147 (high).",Nephrology,Lab Result,high
3899,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,high
3900,"70 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 70-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
3901,"BMP: Na 142 (N), K 4.9 (N), BUN 30, Cr 2.0 (H), Glucose 208.","Your blood chemistry results: Sodium is normal at 142. Potassium is normal at 4.9. Creatinine is elevated at 2.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 208 (high).",Nephrology,Lab Result,high
3902,"90 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 90-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3903,HbA1c: 6.9% (H). FBS: 351 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.9%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 351, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
3904,"56 y/o M with PMH of SLE, depression, CKD Stage 4, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on metoprolol succinate 50mg daily, empagliflozin 10mg daily, prednisone taper, Dulcolax 10mg QHS PRN, potassium chloride 20mEq daily. F/U orthopedics in 6 weeks with X-ray.","A 56-year-old man with a history of lupus, depression, and advanced kidney disease was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (4) Dulcolax 10mg at bedtime as needed [for constipation]; (5) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
3905,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3906,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3907,CXR PA: Pacemaker leads in appropriate position. No cardiomegaly. No pneumothorax. NG tube tip in stomach.,Chest X-ray results: The pacemaker wires are in the correct position. The heart is a normal size. There is no collapsed lung. The feeding/drainage tube tip is correctly positioned in the stomach.,Pulmonology,Radiology Report,high
3908,"53 y/o F with PMH of PAD, SLE, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on ferrous sulfate 325mg BID, potassium chloride 20mEq daily, ASA 81mg daily. F/U INR check in 3 days.","A 53-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], and lupus was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) baby aspirin 81mg once daily [prevents blood clots]. Follow-up for a blood thinner level check in 3 days.",Psychiatry,Discharge Summary,high
3909,"67 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 67-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3910,"84 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 84-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3911,"73 y/o F with PMH of obesity (BMI 38), HFrEF (EF 30%), admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on ondansetron 4mg Q8H PRN N/V, atorvastatin 80mg QHS, levothyroxine 75mcg daily on empty stomach. F/U nephrology in 5 days.","A 73-year-old woman with a history of obesity, and heart failure with weak pumping (30%) was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the kidney doctor in 5 days.",Endocrinology,Discharge Summary,high
3912,"CBC: WBC 16.0 (H), Hgb 17.3 (H), Plt 153 (N).","Your blood count results: White blood cells are 16.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is elevated at 17.3. Platelets are 153, which is normal.",Hematology,Lab Result,high
3913,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. The brain is centered normally. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
3914,HbA1c: 12.6% (H). FBS: 178 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.6%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 178, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3915,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. Central canal stenosis at L3-L4.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
3916,"84 y/o F with PMH of HTN, gout, RA on MTX, PPM in situ, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on Spiriva 18mcg daily, Xarelto 20mg daily with dinner. F/U nephrology in 5 days.","A 84-year-old woman with a history of high blood pressure, gout, rheumatoid arthritis [on immune-suppressing medicine], and implanted pacemaker was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the kidney doctor in 5 days.",Nephrology,Discharge Summary,high
3917,"LFTs: AST 422 (H), ALT 576 (H), ALP 91, T.Bili 6.4 (H), Albumin 4.2.","Your liver blood test results: Liver enzymes (AST 422, ALT 576) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.4 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.2.",Gastroenterology,Lab Result,high
3918,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
3919,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab amoxicillin 500mg TID x 10 days. Tab levothyroxine 75mcg daily on empty stomach. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab lisinopril 10mg daily. Adv: low salt diet, fluid restriction 1.5L/day Adv: smoking cessation, pulmonary rehab. F/U 1 week with wound check.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week to have the wound checked.",Infectious Disease,Prescription,high
3920,CXR PA: Port-a-cath in appropriate position. Right-sided pneumothorax. No cardiomegaly.,Chest X-ray results: The implanted medication port is in the correct position. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The heart is a normal size.,Pulmonology,Radiology Report,high
3921,"Rx: Tab entresto 49/51mg BID. albuterol MDI 2 puffs Q4-6H PRN. Tab Dulcolax 10mg QHS PRN. Tab glipizide 5mg BID AC. Humalog per SSI. Adv: low salt diet, fluid restriction 1.5L/day. F/U 1 week with wound check.",Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. (4) glipizide 5mg twice daily before meals [helps release insulin]. (5) Humalog insulin before meals as directed [fast-acting insulin]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 1 week to have the wound checked.,Endocrinology,Prescription,high
3922,"76 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 76-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
3923,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab ondansetron 4mg Q8H PRN N/V. Tab carvedilol 12.5mg BID. Tab ibuprofen 400mg Q6H PRN with food. Adv: SMBG BID, diabetic diet Adv: wound care with daily dressing changes. F/U 1 week with CBC, CMP.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (3) carvedilol 12.5mg twice daily [heart medicine]. (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",General,Prescription,high
3924,"91 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 91-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
3925,Procedure: Port-a-cath placement. Pt 80 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 80-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
3926,"Rx: Tab amoxicillin 500mg TID x 10 days. Tab timolol 0.5% OU BID. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: low salt diet, fluid restriction 1.5L/day Adv: avoid alcohol, hepatotoxic drugs. F/U 6 weeks with LFTs.","Your medicines: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 6 weeks for liver function blood tests.",Infectious Disease,Prescription,medium
3927,Procedure: Laparoscopic cholecystectomy. Pt 78 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 78-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
3928,"60 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 60-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
3929,CT Head without contrast: Paranasal sinuses clear. 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: The sinuses are clear with no infection. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
3930,"59 y/o M with PMH of PAD, osteoporosis, CHF, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on metformin 1000mg BID, methotrexate 15mg weekly. F/U surgery in 2 weeks for drain removal.","A 59-year-old man with a history of poor blood flow in the legs [peripheral artery disease], weak bones [osteoporosis], and heart failure was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the surgeon in 2 weeks to remove the drain.",General Surgery,Discharge Summary,high
3931,"37 y/o F with PMH of h/o TIA, depression, CKD Stage 3, DM2, A-fib, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on losartan 50mg daily, sertraline 50mg daily. F/U cardiology in 2 weeks.","A 37-year-old woman with a history of history of mini-stroke, depression, moderate kidney disease, type 2 diabetes, and irregular heartbeat [atrial fibrillation] was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the heart doctor in 2 weeks.",General Surgery,Discharge Summary,high
3932,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
3933,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
3934,"52 y/o M with PMH of Parkinson's disease, GERD, CAD, seizure disorder on Keppra, h/o CVA, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Augmentin 875/125 BID x 7 days, potassium chloride 20mEq daily, warfarin 5mg daily, amoxicillin 500mg TID x 10 days, prednisone taper. F/U neurology in 2 weeks.","A 52-year-old man with a history of Parkinson's disease, acid reflux, coronary artery disease [heart artery blockages], seizure disorder [on Keppra], and history of stroke was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (5) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the brain/nerve doctor in 2 weeks.",Urology,Discharge Summary,high
3935,Rx: Tab carvedilol 12.5mg BID. Tab ASA 81mg daily. Adv: low potassium diet. F/U 1 month with repeat imaging.,"Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
3936,"23 y/o M with PMH of Parkinson's disease, hypothyroidism, CKD Stage 4, SLE, osteoporosis, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on amlodipine 5mg daily, amlodipine 10mg daily, atorvastatin 80mg QHS. F/U surgery in 10 days.","A 23-year-old man with a history of Parkinson's disease, underactive thyroid, advanced kidney disease, lupus, and weak bones [osteoporosis] was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
3937,"US Abdomen: Left kidney 8cm, cortical thinning consistent with CKD. Spleen 16cm, splenomegaly. Moderate right hydronephrosis. CBD 12mm, dilated. CBD 5mm, not dilated.","Abdominal ultrasound results: Left kidney is small with thin outer layer, consistent with chronic kidney disease. The spleen is enlarged [splenomegaly]. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The bile duct is wider than normal [dilated], which may indicate a blockage. The bile duct is normal size [not blocked].",Gastroenterology,Radiology Report,high
3938,HbA1c: 13.7% (H). FBS: 317 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.7%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 317, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3939,CXR PA: No cardiomegaly. NG tube tip in stomach. Elevated left hemidiaphragm.,Chest X-ray results: The heart is a normal size. The feeding/drainage tube tip is correctly positioned in the stomach. The left side of the breathing muscle [diaphragm] is sitting higher than normal.,Pulmonology,Radiology Report,high
3940,HbA1c: 11.8% (H). FBS: 335 mg/dL (H).,"Your diabetes blood test results: HbA1c is 11.8%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 335, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
3941,"US Abdomen: Right kidney 10.5cm, no hydronephrosis. Ascites moderate amount. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Left kidney 8cm, cortical thinning consistent with CKD. Moderate right hydronephrosis. Pancreas unremarkable.","Abdominal ultrasound results: Right kidney is normal size with no blockage. There is a moderate amount of fluid in the belly [ascites]. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The pancreas looks normal.",Gastroenterology,Radiology Report,high
3942,"Rx: Humalog per SSI. Tab pregabalin 75mg BID. Tab Xarelto 20mg daily with dinner. Tab warfarin 5mg daily. Tab glipizide 5mg BID AC. Adv: avoid alcohol, hepatotoxic drugs Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) Xarelto 20mg once daily with dinner [blood thinner]. (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (5) glipizide 5mg twice daily before meals [helps release insulin]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Endocrinology,Prescription,high
3943,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
3944,CXR PA: Clear lung fields bilaterally. Mild cardiomegaly. NG tube tip in stomach. Widened mediastinum. Hyperinflated lungs consistent with COPD.,"Chest X-ray results: Both lungs look clear with no problems. The heart is slightly larger than normal. The feeding/drainage tube tip is correctly positioned in the stomach. The space between the lungs appears wider than normal, which needs further evaluation. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema].",Pulmonology,Radiology Report,high
3945,Procedure: Laparoscopic cholecystectomy. Pt 91 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 91-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
3946,"78 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 78-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
3947,"Rx: Tab warfarin 5mg daily. Tab ibuprofen 400mg Q6H PRN with food. Do not stop abruptly, taper as directed Adv: wound care with daily dressing changes. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Hematology,Prescription,medium
3948,"CBC: WBC 11.4 (H), Hgb 5.2 (L), Plt 408 (H).","Your blood count results: White blood cells are 11.4 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 5.2, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 408, which is high — your blood may clot too easily.",Hematology,Lab Result,high
3949,CT Head without contrast: Acute ischemic infarct in R MCA territory. No midline shift. Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage. No mass effect.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The brain is centered normally. There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
3950,"LFTs: AST 322 (H), ALT 513 (H), ALP 70, T.Bili 2.3 (H), Albumin 4.7.","Your liver blood test results: Liver enzymes (AST 322, ALT 513) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 2.3 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.7.",Gastroenterology,Lab Result,high
3951,"60 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 60-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3952,"32 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 32-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
3953,"LFTs: AST 72 (H), ALT 599 (H), ALP 153, T.Bili 6.3 (H), Albumin 1.8.","Your liver blood test results: Liver enzymes (AST 72, ALT 599) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.3 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 1.8 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
3954,HbA1c: 7.6% (H). FBS: 228 mg/dL (H).,"Your diabetes blood test results: HbA1c is 7.6%, which is above the target of 7.0%. Your blood sugar has been somewhat poorly controlled over the past 3 months. Fasting blood sugar was 228, which is high (normal is 70-100). Your diabetes medicines may need adjustment. Discuss with your doctor.",Endocrinology,Lab Result,high
3955,CT Head without contrast: No midline shift. Paranasal sinuses clear. 4cm right subdural hematoma with 5mm midline shift. No mass effect. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: The brain is centered normally. The sinuses are clear with no infection. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
3956,CXR PA: Elevated left hemidiaphragm. Port-a-cath in appropriate position. Widened mediastinum. Right lower lobe consolidation. No cardiomegaly.,"Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. The implanted medication port is in the correct position. The space between the lungs appears wider than normal, which needs further evaluation. There is an area in the lower right lung that appears infected, suggesting pneumonia. The heart is a normal size.",Pulmonology,Radiology Report,high
3957,"CBC: WBC 6.2 (N), Hgb 8.4 (L), Plt 217 (N).","Your blood count results: White blood cells are 6.2 (normal). Hemoglobin is low at 8.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 217, which is normal.",Hematology,Lab Result,high
3958,"Rx: Tab tramadol 50mg Q6H PRN pain. Tab ibuprofen 400mg Q6H PRN with food. Adv: avoid alcohol, hepatotoxic drugs Avoid NSAIDs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,General,Prescription,medium
3959,CXR PA: Mild cardiomegaly. No pneumothorax. Bilateral pleural effusions.,Chest X-ray results: The heart is slightly larger than normal. There is no collapsed lung. There is fluid collecting around both lungs.,Pulmonology,Radiology Report,high
3960,"37 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 37-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3961,Procedure: Port-a-cath placement. Pt 90 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 90-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
3962,"39 y/o M with PMH of s/p TKR, HFrEF (EF 30%), h/o TIA, SLE, osteoporosis, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on amlodipine 5mg daily, prednisone taper, metoprolol succinate 50mg daily. F/U nephrology in 1 week.","A 39-year-old man with a history of prior knee replacement, heart failure with weak pumping (30%), history of mini-stroke, lupus, and weak bones [osteoporosis] was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the kidney doctor in 1 week.",Neurology,Discharge Summary,high
3963,"CBC: WBC 10.5 (N), Hgb 11.1 (L), Plt 24 (L).","Your blood count results: White blood cells are 10.5 (normal). Hemoglobin is low at 11.1, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 24, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
3964,"Rx: Tab latanoprost 0.005% OU QHS. Tab tramadol 50mg Q6H PRN pain. Tab amoxicillin 500mg TID x 10 days. Adv: elevate affected limb, compression stockings. F/U 2 weeks with INR.",Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks for a blood thinner level check [INR].,Infectious Disease,Prescription,medium
3965,"47 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 47-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3966,"Thyroid panel: TSH 2.12 (N), Free T4 1.8.",Your thyroid test results: TSH is normal at 2.12. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
3967,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. Left kidney 8cm, cortical thinning consistent with CKD. CBD 12mm, dilated. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The bile duct is wider than normal [dilated], which may indicate a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
3968,"BMP: Na 128 (L), K 3.6 (N), BUN 72, Cr 7.2 (H), Glucose 341.","Your blood chemistry results: Sodium is low at 128 (normal 136-145), meaning too much water in your body. Potassium is normal at 3.6. Creatinine is elevated at 7.2 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 341 (high).",Nephrology,Lab Result,high
3969,CXR PA: Sternotomy wires intact. Right middle lobe atelectasis. No pneumothorax.,"Chest X-ray results: The wires from prior heart surgery are intact. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is no collapsed lung.",Pulmonology,Radiology Report,high
3970,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,medium
3971,CT Head without contrast: Paranasal sinuses clear. No mass effect. Acute ischemic infarct in R MCA territory. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: The sinuses are clear with no infection. There are no tumors or masses pushing on the brain. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
3972,"39 y/o F with PMH of depression, CHF, RA on MTX, PPM in situ, s/p CABG, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on glipizide 5mg BID AC, metoprolol 25mg BID, ferrous sulfate 325mg BID, Dulcolax 10mg QHS PRN. F/U cardiology in 2 weeks.","A 39-year-old woman with a history of depression, heart failure, rheumatoid arthritis [on immune-suppressing medicine], implanted pacemaker, and prior heart bypass surgery was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the heart doctor in 2 weeks.",Endocrinology,Discharge Summary,high
3973,"34 y/o M with PMH of osteoporosis, DM1, ICD in situ, BPH, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on amlodipine 5mg daily, spironolactone 25mg daily, entresto 49/51mg BID. F/U orthopedics in 6 weeks with X-ray.","A 34-year-old man with a history of weak bones [osteoporosis], type 1 diabetes, implanted heart defibrillator, and enlarged prostate was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",General Surgery,Discharge Summary,high
3974,Procedure: R TKA. Pt 54 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 54-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
3975,CT Head without contrast: Acute ischemic infarct in R MCA territory. 4cm right subdural hematoma with 5mm midline shift. No mass effect. No midline shift.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain. The brain is centered normally.",Neurology,Radiology Report,high
3976,"47 y/o F with PMH of DM1, s/p THR, HLD, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on atorvastatin 40mg QHS, pregabalin 75mg BID, pantoprazole 40mg AC breakfast. F/U GI in 1 week.","A 47-year-old woman with a history of type 1 diabetes, prior hip replacement, and high cholesterol was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the stomach doctor in 1 week.",Gastroenterology,Discharge Summary,high
3977,CXR PA: Widened mediastinum. Right lower lobe consolidation. Pacemaker leads in appropriate position. Cardiomegaly with CTR >0.5. Patchy bilateral infiltrates.,"Chest X-ray results: The space between the lungs appears wider than normal, which needs further evaluation. There is an area in the lower right lung that appears infected, suggesting pneumonia. The pacemaker wires are in the correct position. The heart appears larger than normal. There are scattered cloudy patches in both lungs suggesting infection or inflammation.",Pulmonology,Radiology Report,high
3978,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
3979,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
3980,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. 4cm right subdural hematoma with 5mm midline shift. Acute ischemic infarct in R MCA territory. No midline shift. No acute intracranial hemorrhage.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The brain is centered normally. There is no bleeding in the brain.",Neurology,Radiology Report,high
3981,"62 y/o M with PMH of s/p CABG, HFrEF (EF 30%), admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on levothyroxine 75mcg daily on empty stomach, spironolactone 25mg daily, ondansetron 4mg Q8H PRN N/V, prednisone taper. F/U surgery in 2 weeks for drain removal.","A 62-year-old man with a history of prior heart bypass surgery, and heart failure with weak pumping (30%) was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the surgeon in 2 weeks to remove the drain.",Gastroenterology,Discharge Summary,high
3982,"34 y/o F with PMH of CKD Stage 3, seizure disorder on Keppra, OSA on CPAP, cirrhosis, h/o CVA, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on metoprolol succinate 50mg daily, Augmentin 875/125 BID x 7 days, amoxicillin 500mg TID x 10 days, gabapentin 300mg TID. F/U hematology in 2 weeks.","A 34-year-old woman with a history of moderate kidney disease, seizure disorder [on Keppra], sleep apnea [uses a breathing machine at night], liver scarring [cirrhosis], and history of stroke was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (4) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
3983,CXR PA: Left lower lobe consolidation. ET tube 3cm above carina. Clear lung fields bilaterally.,Chest X-ray results: There is an area in the lower left lung that appears infected. The breathing tube is in good position. Both lungs look clear with no problems.,Pulmonology,Radiology Report,high
3984,"MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. Conus medullaris at L1, normal. C5-C6 disc herniation with cord compression. Central canal stenosis at L3-L4.","MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal cord ends at a normal level. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
3985,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
3986,"38 y/o M with PMH of DM2, DM1, Parkinson's disease, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on levothyroxine 75mcg daily on empty stomach, pregabalin 75mg BID, albuterol MDI 2 puffs Q4-6H PRN, furosemide 40mg BID. F/U wound care in 3 days.","A 38-year-old man with a history of type 2 diabetes, type 1 diabetes, and Parkinson's disease was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (4) furosemide (Lasix) 40mg twice daily [water pill]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
3987,"US Abdomen: GB sludge, no stones. Left kidney 8cm, cortical thinning consistent with CKD. No focal hepatic lesion.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. Left kidney is small with thin outer layer, consistent with chronic kidney disease. No tumors or masses were found in the liver.",Gastroenterology,Radiology Report,high
3988,"73 y/o M with PMH of hypothyroidism, ESRD on HD, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on spironolactone 25mg daily, tramadol 50mg Q6H PRN pain, ondansetron 4mg Q8H PRN N/V, rosuvastatin 10mg QHS, atorvastatin 40mg QHS. F/U endocrine in 1 week.","A 73-year-old man with a history of underactive thyroid, and kidney failure requiring dialysis was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]; (5) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Endocrinology,Discharge Summary,high
3989,"BMP: Na 139 (N), K 5.6 (H), BUN 69, Cr 5.6 (H), Glucose 96.","Your blood chemistry results: Sodium is normal at 139. Potassium is dangerously high at 5.6 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 5.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 96 (normal).",Nephrology,Lab Result,high
3990,"34 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 34-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3991,"LFTs: AST 283 (H), ALT 62 (H), ALP 48, T.Bili 1.7 (H), Albumin 2.8.","Your liver blood test results: Liver enzymes (AST 283, ALT 62) are mildly elevated (normal is under 40). Bilirubin is mildly elevated at 1.7. Albumin is low at 2.8 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
3992,Procedure: Laparoscopic appendectomy. Pt 27 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 27-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
3993,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
3994,Procedure: EGD with biopsy. Pt 27 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 27-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
3995,"73 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 73-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
3996,"75 y/o M with PMH of hypothyroidism, CAD, A-fib, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Low potassium diet. D/C on gabapentin 300mg TID, Augmentin 875/125 BID x 7 days. F/U PCP in 1 week.","A 75-year-old man with a history of underactive thyroid, coronary artery disease [heart artery blockages], and irregular heartbeat [atrial fibrillation] was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the primary care doctor in 1 week.",Cardiology,Discharge Summary,high
3997,"42 y/o F with PMH of cirrhosis, OSA on CPAP, s/p TKR, Parkinson's disease, depression, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on ASA 81mg daily, carvedilol 12.5mg BID, calcium + vitamin D 600/400 daily. F/U endocrine in 1 week.","A 42-year-old woman with a history of liver scarring [cirrhosis], sleep apnea [uses a breathing machine at night], prior knee replacement, Parkinson's disease, and depression was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) baby aspirin 81mg once daily [prevents blood clots]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) calcium plus vitamin D once daily [bone strengthening]. Follow-up with the hormone/diabetes doctor in 1 week.",Infectious Disease,Discharge Summary,high
3998,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab omeprazole 20mg AC breakfast. Adv: low salt low sugar diet, regular exercise Avoid grapefruit juice. F/U 2 weeks.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Do not drink grapefruit juice as it interferes with this medication. Come back for a check-up in 2 weeks.",Gastroenterology,Prescription,medium
3999,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
4000,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4001,"Rx: Tab metformin 500mg BID. Tab lisinopril 20mg daily. Tab tramadol 50mg Q6H PRN pain. Tab empagliflozin 10mg daily. Adv: avoid alcohol, hepatotoxic drugs Adv: smoking cessation, pulmonary rehab. F/U 6 weeks with LFTs.",Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) lisinopril 20mg once daily [blood pressure medicine]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 6 weeks for liver function blood tests.,Pediatrics,Prescription,high
4002,"Rx: Tab warfarin 5mg daily. Tab metformin 500mg BID. Tab Augmentin 875/125 BID x 7 days. Adv: weight bearing exercise, calcium/vit D supplementation Adv: fall precautions, home safety evaluation. F/U 1 week with CBC, CMP.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,medium
4003,"30 y/o M with PMH of hypothyroidism, DM1, HLD, obesity (BMI 38), admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on azithromycin 500mg day 1 then 250mg x 4 days, ferrous sulfate 325mg BID, escitalopram 10mg daily, methotrexate 15mg weekly. F/U orthopedics in 6 weeks with X-ray.","A 30-year-old man with a history of underactive thyroid, type 1 diabetes, high cholesterol, and obesity was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Pulmonology,Discharge Summary,high
4004,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4005,CXR PA: Elevated left hemidiaphragm. Left lower lobe consolidation. Patchy bilateral infiltrates. Right-sided pneumothorax. Hyperinflated lungs consistent with COPD.,"Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. There is an area in the lower left lung that appears infected. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema].",Pulmonology,Radiology Report,high
4006,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4007,HbA1c: 9.7% (H). FBS: 308 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.7%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 308, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
4008,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4009,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,low
4010,"US Abdomen: CBD 12mm, dilated. GB wall thickening with stones, positive Murphy's sign. Moderate right hydronephrosis. No focal hepatic lesion. GB sludge, no stones. Ascites moderate amount.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. No tumors or masses were found in the liver. The gallbladder contains thickened bile [sludge] but no stones. There is a moderate amount of fluid in the belly [ascites].",Gastroenterology,Radiology Report,high
4011,"58 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 58-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4012,"BMP: Na 123 (L), K 6.3 (H), BUN 9, Cr 1.7 (H), Glucose 131.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.3 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 1.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 131 (high).",Nephrology,Lab Result,high
4013,"63 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 63-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4014,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4015,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,low
4016,"73 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 73-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4017,"Lipid panel: TC 167, LDL 70, HDL 21, TG 461.","Your cholesterol results: Total cholesterol is 167. LDL (bad cholesterol) is at goal (70). HDL (good cholesterol) is too low at 21 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 461 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
4018,"60 y/o M with PMH of s/p CABG, osteoporosis, CKD Stage 3, s/p THR, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on montelukast 10mg QHS, Eliquis 5mg BID, Augmentin 875/125 BID x 7 days, albuterol MDI 2 puffs Q4-6H PRN. F/U nephrology in 5 days.","A 60-year-old man with a history of prior heart bypass surgery, weak bones [osteoporosis], moderate kidney disease, and prior hip replacement was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) Eliquis 5mg twice daily [blood thinner]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]; (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Follow-up with the kidney doctor in 5 days.",Neurology,Discharge Summary,high
4019,"49 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 49-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4020,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4021,"Rx: Tab lisinopril 20mg daily. Tab tramadol 50mg Q6H PRN pain. Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
4022,"Thyroid panel: TSH 12.24 (H), Free T4 2.9.","Your thyroid test results: TSH is elevated at 12.24 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
4023,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,low
4024,"76 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 76-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4025,"BMP: Na 122 (L), K 6.2 (H), BUN 15, Cr 1.8 (H), Glucose 137.","Your blood chemistry results: Sodium is low at 122 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.2 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 1.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 137 (high).",Nephrology,Lab Result,high
4026,"Rx: Lantus 20U QHS. Tab entresto 49/51mg BID. prednisone taper. Avoid grapefruit juice Do not stop abruptly, taper as directed. F/U 6 weeks with LFTs.",Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Do not drink grapefruit juice as it interferes with this medication Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,medium
4027,"LFTs: AST 109 (H), ALT 139 (H), ALP 232, T.Bili 0.4 (N), Albumin 4.1.","Your liver blood test results: Liver enzymes (AST 109, ALT 139) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is normal at 0.4. Albumin is normal at 4.1.",Gastroenterology,Lab Result,high
4028,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
4029,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4030,HbA1c: 13.1% (H). FBS: 382 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.1%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 382, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4031,"59 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 59-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4032,"US Abdomen: Pancreas unremarkable. Right kidney 10.5cm, no hydronephrosis. Moderate right hydronephrosis. CBD 5mm, not dilated. CBD 12mm, dilated. GB sludge, no stones.","Abdominal ultrasound results: The pancreas looks normal. Right kidney is normal size with no blockage. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The bile duct is normal size [not blocked]. The bile duct is wider than normal [dilated], which may indicate a blockage. The gallbladder contains thickened bile [sludge] but no stones.",Gastroenterology,Radiology Report,high
4033,"CBC: WBC 13.4 (H), Hgb 7.2 (L), Plt 92 (L).","Your blood count results: White blood cells are 13.4 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 7.2, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 92, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
4034,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
4035,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4036,MRI Lumbar Spine: Multilevel degenerative disc disease. L5-S1 disc desiccation with mild bulge. Central canal stenosis at L3-L4.,"MRI of the lower back results: Multiple discs in the spine are showing wear and aging. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
4037,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4038,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,high
4039,"36 y/o F with PMH of anxiety, HLD, s/p THR, CHF, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on latanoprost 0.005% OU QHS, losartan 50mg daily, ondansetron 4mg Q8H PRN N/V, albuterol MDI 2 puffs Q4-6H PRN, methotrexate 15mg weekly. F/U surgery in 2 weeks for drain removal.","A 36-year-old woman with a history of anxiety, high cholesterol, prior hip replacement, and heart failure was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) losartan 50mg once daily [blood pressure medicine]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (5) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
4040,"Rx: Tab warfarin 5mg daily. Tab latanoprost 0.005% OU QHS. Adv: weight bearing exercise, calcium/vit D supplementation Do not stop abruptly, taper as directed. F/U PCP in 1 week for BP recheck.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. See your primary care doctor in 1 week to recheck blood pressure.",Ophthalmology,Prescription,medium
4041,"39 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 39-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
4042,"Thyroid panel: TSH 3.97 (N), Free T4 1.8.",Your thyroid test results: TSH is normal at 3.97. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
4043,"MRI Lumbar Spine: Conus medullaris at L1, normal. Multilevel degenerative disc disease. L4-L5 disc herniation with moderate bilateral foraminal stenosis.","MRI of the lower back results: The spinal cord ends at a normal level. Multiple discs in the spine are showing wear and aging. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
4044,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. No compression fracture.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
4045,Rx: Tab spironolactone 25mg daily. Tab Xarelto 20mg daily with dinner. Adv: low potassium diet. F/U 2 weeks.,"Your medicines: (1) spironolactone 25mg once daily [heart-protecting water pill]. (2) Xarelto 20mg once daily with dinner [blood thinner]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
4046,"73 y/o M with PMH of DM2, ESRD on HD, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on acetaminophen 650mg Q6H PRN, amlodipine 10mg daily. F/U INR check in 3 days.","A 73-year-old man with a history of type 2 diabetes, and kidney failure requiring dialysis was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) amlodipine 10mg once daily [blood pressure medicine]. Follow-up for a blood thinner level check in 3 days.",Nephrology,Discharge Summary,high
4047,"52 y/o F with PMH of BPH, s/p CABG, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on lisinopril 20mg daily, clopidogrel 75mg daily, furosemide 40mg BID, glipizide 5mg BID AC. F/U surgery in 10 days.","A 52-year-old woman with a history of enlarged prostate, and prior heart bypass surgery was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the surgeon in 10 days.",Psychiatry,Discharge Summary,high
4048,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
4049,CXR PA: Right-sided pneumothorax. Right lower lobe consolidation. Right middle lobe atelectasis. Compression fracture T12.,"Chest X-ray results: The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There is an area in the lower right lung that appears infected, suggesting pneumonia. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is a compression fracture [collapsed bone] in the lower spine at T12.",Pulmonology,Radiology Report,high
4050,Procedure: ERCP with sphincterotomy. Pt 26 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 26-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4051,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
4052,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Left kidney 8cm, cortical thinning consistent with CKD.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. Left kidney is small with thin outer layer, consistent with chronic kidney disease.",Gastroenterology,Radiology Report,high
4053,"Rx: Tab lisinopril 10mg daily. Tab timolol 0.5% OU BID. Adv: fall precautions, home safety evaluation Adv: SMBG BID, diabetic diet. F/U 2 weeks.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
4054,"MRI Lumbar Spine: Multilevel degenerative disc disease. Conus medullaris at L1, normal.",MRI of the lower back results: Multiple discs in the spine are showing wear and aging. The spinal cord ends at a normal level.,Orthopedics,Radiology Report,high
4055,Procedure: Laparoscopic cholecystectomy. Pt 54 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 54-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
4056,MRI Lumbar Spine: Multilevel degenerative disc disease. Facet joint hypertrophy at L4-L5. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: Multiple discs in the spine are showing wear and aging. The small joints in the spine at L4-L5 are enlarged from arthritis. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
4057,"Rx: Lantus 20U QHS. Tab pregabalin 75mg BID. Tab atorvastatin 80mg QHS. Tab pantoprazole 40mg AC breakfast. Adv: high fiber diet, adequate hydration. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
4058,"Rx: Tab amlodipine 10mg daily. Tab Eliquis 5mg BID. Tab ibuprofen 400mg Q6H PRN with food. Tab metformin 1000mg BID. Do not stop abruptly, taper as directed. F/U 1 week with CBC, CMP.",Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) Eliquis 5mg twice daily [blood thinner]. (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (4) metformin 1000mg twice daily with meals [blood sugar medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,high
4059,"Rx: Tab pantoprazole 40mg AC breakfast. Tab amlodipine 5mg daily. Tab sertraline 50mg daily. Tab warfarin 5mg daily. Adv: low salt diet, fluid restriction 1.5L/day. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,high
4060,"Rx: Tab montelukast 10mg QHS. Tab glipizide 5mg BID AC. Tab metoprolol 25mg BID. Tab amoxicillin 500mg TID x 10 days. Adv: low potassium diet Adv: low salt low sugar diet, regular exercise. F/U 1 week with wound check.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) glipizide 5mg twice daily before meals [helps release insulin]. (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
4061,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,high
4062,Delivery Note: G?P? at 37+3 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4063,CXR PA: Bilateral hilar lymphadenopathy. Right middle lobe atelectasis. Compression fracture T12. NG tube tip in stomach. Right-sided pneumothorax.,"Chest X-ray results: There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is a compression fracture [collapsed bone] in the lower spine at T12. The feeding/drainage tube tip is correctly positioned in the stomach. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax].",Pulmonology,Radiology Report,high
4064,Procedure: Laparoscopic appendectomy. Pt 47 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 47-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
4065,CXR PA: No cardiomegaly. Bilateral hilar lymphadenopathy. Cardiomegaly with CTR >0.5.,"Chest X-ray results: The heart is a normal size. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The heart appears larger than normal.",Pulmonology,Radiology Report,high
4066,"75 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 75-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4067,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
4068,"90 y/o M with PMH of asthma, DM1, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on carvedilol 12.5mg BID, losartan 50mg daily. F/U pulmonology in 2 weeks.","A 90-year-old man with a history of asthma, and type 1 diabetes was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) losartan 50mg once daily [blood pressure medicine]. Follow-up with the lung doctor in 2 weeks.",Pulmonology,Discharge Summary,high
4069,CXR PA: Mild cardiomegaly. Elevated left hemidiaphragm. No cardiomegaly. Right middle lobe atelectasis.,"Chest X-ray results: The heart is slightly larger than normal. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The heart is a normal size. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
4070,"LFTs: AST 435 (H), ALT 346 (H), ALP 262, T.Bili 1.3 (H), Albumin 3.2.","Your liver blood test results: Liver enzymes (AST 435, ALT 346) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.3. Albumin is low at 3.2 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4071,CT Head without contrast: Acute ischemic infarct in R MCA territory. Chronic lacunar infarcts in bilateral basal ganglia. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are signs of small old strokes in the deep parts of the brain. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
4072,Procedure: Port-a-cath placement. Pt 77 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 77-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
4073,"Rx: Tab montelukast 10mg QHS. Tab Augmentin 875/125 BID x 7 days. Tab amlodipine 10mg daily. Adv: low salt low sugar diet, regular exercise Do not stop abruptly, taper as directed. F/U INR in 3 days.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. (3) amlodipine 10mg once daily [blood pressure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
4074,"US Abdomen: Moderate right hydronephrosis. Right kidney 10.5cm, no hydronephrosis. Pancreas unremarkable.","Abdominal ultrasound results: The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. Right kidney is normal size with no blockage. The pancreas looks normal.",Gastroenterology,Radiology Report,high
4075,"80 y/o F with PMH of h/o CVA, depression, CKD Stage 4, asthma, BPH, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on potassium chloride 20mEq daily, acetaminophen 650mg Q6H PRN, warfarin 5mg daily. F/U neurology in 2 weeks.","A 80-year-old woman with a history of history of stroke, depression, advanced kidney disease, asthma, and enlarged prostate was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up with the brain/nerve doctor in 2 weeks.",Endocrinology,Discharge Summary,high
4076,"Rx: Tab amlodipine 10mg daily. Tab losartan 50mg daily. Tab escitalopram 10mg daily. Tab gabapentin 300mg TID. Adv: DASH diet, daily BP monitoring. F/U 1 week with CBC, CMP.","Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) losartan 50mg once daily [blood pressure medicine]. (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (4) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
4077,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4078,"Rx: Tab gabapentin 300mg TID. Lantus 20U QHS. Tab pregabalin 75mg BID. Tab ciprofloxacin 500mg BID x 5 days. Tab furosemide 40mg daily. Adv: low salt low sugar diet, regular exercise Adv: wound care with daily dressing changes. F/U INR in 3 days.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) Lantus insulin 20 units at bedtime [long-acting insulin]. (3) pregabalin 75mg twice daily [nerve pain medicine]. (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (5) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 3 days for a blood thinner level check [INR].",Neurology,Prescription,high
4079,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4080,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,low
4081,Procedure: PCI with DES to LAD. Pt 46 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 46-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4082,"CBC: WBC 12.8 (H), Hgb 5.9 (L), Plt 374 (N).","Your blood count results: White blood cells are 12.8 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 5.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 374, which is normal.",Hematology,Lab Result,high
4083,HbA1c: 6.1% (H). FBS: 175 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.1%, which is in the pre-diabetes range (5.7-6.4%). This means your blood sugar is higher than normal but not yet diabetic. Fasting blood sugar was 175, which is high (normal is 70-100). Lifestyle changes (diet, exercise, weight loss) can prevent progression to diabetes.",Endocrinology,Lab Result,high
4084,"72 y/o F with PMH of ESRD on HD, h/o TIA, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on losartan 50mg daily, methotrexate 15mg weekly. F/U orthopedics in 6 weeks with X-ray.","A 72-year-old woman with a history of kidney failure requiring dialysis, and history of mini-stroke was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
4085,"Rx: Tab pregabalin 75mg BID. Tab entresto 49/51mg BID. Tab atorvastatin 80mg QHS. Tab calcium + vitamin D 600/400 daily. Tab carvedilol 12.5mg BID. Adv: low salt low sugar diet, regular exercise. F/U INR in 3 days.","Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (4) calcium plus vitamin D once daily [bone strengthening]. (5) carvedilol 12.5mg twice daily [heart medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
4086,"BMP: Na 141 (N), K 6.1 (H), BUN 80, Cr 7.1 (H), Glucose 255.","Your blood chemistry results: Sodium is normal at 141. Potassium is dangerously high at 6.1 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 7.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 255 (high).",Nephrology,Lab Result,high
4087,"68 y/o M with PMH of COPD, anxiety, gout, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on metformin 500mg BID, hydroxychloroquine 200mg BID. F/U pulmonology in 2 weeks.","A 68-year-old man with a history of chronic lung disease, anxiety, and gout was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the lung doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4088,"Thyroid panel: TSH 1.89 (N), Free T4 2.1.",Your thyroid test results: TSH is normal at 1.89. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
4089,CXR PA: Mild cardiomegaly. Patchy bilateral infiltrates. Pacemaker leads in appropriate position. No pneumothorax.,Chest X-ray results: The heart is slightly larger than normal. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The pacemaker wires are in the correct position. There is no collapsed lung.,Pulmonology,Radiology Report,high
4090,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4091,"36 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 36-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4092,"67 y/o F with PMH of s/p TKR, OSA on CPAP, RA on MTX, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Compression stockings when ambulating. D/C on atorvastatin 80mg QHS, Dulcolax 10mg QHS PRN, furosemide 40mg daily, calcium + vitamin D 600/400 daily, timolol 0.5% OU BID. F/U GI in 1 week.","A 67-year-old woman with a history of prior knee replacement, sleep apnea [uses a breathing machine at night], and rheumatoid arthritis [on immune-suppressing medicine] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up with the stomach doctor in 1 week.",Pulmonology,Discharge Summary,high
4093,Procedure: TURP for BPH. Pt 77 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 77-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
4094,"CBC: WBC 4.3 (N), Hgb 6.1 (L), Plt 44 (L).","Your blood count results: White blood cells are 4.3 (normal). Hemoglobin is low at 6.1, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 44, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
4095,"79 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 79-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4096,"US Abdomen: Ascites moderate amount. GB wall thickening with stones, positive Murphy's sign. Simple renal cysts bilaterally. Spleen 11cm, normal.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Both kidneys have harmless fluid-filled cysts. The spleen is a normal size.",Gastroenterology,Radiology Report,high
4097,"70 y/o F with PMH of cirrhosis, HLD, depression, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on timolol 0.5% OU BID, entresto 49/51mg BID. F/U hematology in 2 weeks.","A 70-year-old woman with a history of liver scarring [cirrhosis], high cholesterol, and depression was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
4098,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4099,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Tab ASA 81mg daily. Tab metoprolol 25mg BID. Adv: low potassium diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
4100,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
4101,Procedure: ORIF L distal radius. Pt 24 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 24-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
4102,"Rx: Tab entresto 49/51mg BID. Tab Dulcolax 10mg QHS PRN. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: fall precautions, home safety evaluation Adv: SMBG BID, diabetic diet. F/U PCP in 1 week for BP recheck.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,medium
4103,"Lipid panel: TC 309, LDL 200, HDL 29, TG 470.","Your cholesterol results: Total cholesterol is 309. LDL (bad cholesterol) is very high at 200 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is too low at 29 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are very high at 470 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
4104,"35 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 35-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4105,"US Abdomen: Pancreas unremarkable. CBD 12mm, dilated. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The pancreas looks normal. The bile duct is wider than normal [dilated], which may indicate a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
4106,"US Abdomen: Pancreas unremarkable. Ascites moderate amount. Moderate right hydronephrosis. Right kidney 10.5cm, no hydronephrosis. Spleen 16cm, splenomegaly.","Abdominal ultrasound results: The pancreas looks normal. There is a moderate amount of fluid in the belly [ascites]. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. Right kidney is normal size with no blockage. The spleen is enlarged [splenomegaly].",Gastroenterology,Radiology Report,high
4107,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4108,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4109,"US Abdomen: Liver 18cm, diffusely echogenic consistent with hepatic steatosis. GB wall thickening with stones, positive Murphy's sign. Pancreas unremarkable.","Abdominal ultrasound results: The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The pancreas looks normal.",Gastroenterology,Radiology Report,high
4110,CXR PA: Osseous structures intact. Left lower lobe consolidation. Widened mediastinum. Compression fracture T12. Clear lung fields bilaterally.,"Chest X-ray results: The bones look normal with no fractures. There is an area in the lower left lung that appears infected. The space between the lungs appears wider than normal, which needs further evaluation. There is a compression fracture [collapsed bone] in the lower spine at T12. Both lungs look clear with no problems.",Pulmonology,Radiology Report,high
4111,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab empagliflozin 10mg daily. Tab warfarin 5mg daily. Tab furosemide 40mg BID. Adv: elevate affected limb, compression stockings Adv: smoking cessation, pulmonary rehab. F/U 1 week with CBC, CMP.",Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (4) furosemide (Lasix) 40mg twice daily [water pill]. Advice: keep the affected leg elevated when resting and wear compression stockings Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,high
4112,"Rx: Tab losartan 50mg daily. Tab metformin 1000mg BID. Tab Xarelto 20mg daily with dinner. Adv: SMBG BID, diabetic diet. F/U PCP in 1 week for BP recheck.",Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) metformin 1000mg twice daily with meals [blood sugar medicine]. (3) Xarelto 20mg once daily with dinner [blood thinner]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
4113,"73 y/o M with PMH of ESRD on HD, seizure disorder on Keppra, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on entresto 49/51mg BID, tramadol 50mg Q6H PRN pain, spironolactone 25mg daily, ferrous sulfate 325mg BID. F/U pulmonology in 2 weeks.","A 73-year-old man with a history of kidney failure requiring dialysis, and seizure disorder [on Keppra] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (3) spironolactone 25mg once daily [heart-protecting water pill]; (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Follow-up with the lung doctor in 2 weeks.",Nephrology,Discharge Summary,high
4114,"MRI Lumbar Spine: No compression fracture. Conus medullaris at L1, normal. Central canal stenosis at L3-L4. L5-S1 disc desiccation with mild bulge.","MRI of the lower back results: No bones are broken or collapsed. The spinal cord ends at a normal level. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
4115,"68 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 68-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4116,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
4117,"42 y/o F with PMH of CKD Stage 3, seizure disorder on Keppra, RA on MTX, BPH, gout, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on empagliflozin 10mg daily, Lantus 20U QHS, ciprofloxacin 500mg BID x 5 days, Augmentin 875/125 BID x 7 days, losartan 50mg daily. F/U surgery in 2 weeks for drain removal.","A 42-year-old woman with a history of moderate kidney disease, seizure disorder [on Keppra], rheumatoid arthritis [on immune-suppressing medicine], enlarged prostate, and gout was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]; (5) losartan 50mg once daily [blood pressure medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
4118,Procedure: Laparoscopic cholecystectomy. Pt 82 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 82-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
4119,"Rx: Tab spironolactone 25mg daily. Tab sertraline 50mg daily. Tab montelukast 10mg QHS. Tab methotrexate 15mg weekly. Tab losartan 50mg daily. Adv: SMBG BID, diabetic diet. F/U INR in 3 days.",Your medicines: (1) spironolactone 25mg once daily [heart-protecting water pill]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. (3) montelukast 10mg at bedtime [asthma/allergy medicine]. (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (5) losartan 50mg once daily [blood pressure medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
4120,Procedure: PCI with DES to LAD. Pt 60 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 60-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4121,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4122,"LFTs: AST 170 (H), ALT 40 (N), ALP 60, T.Bili 0.9 (N), Albumin 2.4.","Your liver blood test results: Liver enzymes (AST 170, ALT 40) are normal (normal is under 40). Bilirubin is normal at 0.9. Albumin is low at 2.4 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4123,"85 y/o M with PMH of anxiety, asthma, CKD Stage 4, gout, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on losartan 50mg daily, gabapentin 300mg TID, Augmentin 875/125 BID x 7 days, levothyroxine 75mcg daily on empty stomach, amoxicillin 500mg TID x 10 days. F/U hematology in 2 weeks.","A 85-year-old man with a history of anxiety, asthma, advanced kidney disease, and gout was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]; (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (5) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the blood disorder doctor in 2 weeks.",General Surgery,Discharge Summary,high
4124,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4125,"88 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 88-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4126,"Lipid panel: TC 268, LDL 212, HDL 54, TG 445.","Your cholesterol results: Total cholesterol is 268. LDL (bad cholesterol) is very high at 212 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 54. Triglycerides are very high at 445 (normal under 150) — increases risk of pancreatitis.",Cardiology,Lab Result,high
4127,"42 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 42-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4128,"Rx: Spiriva 18mcg daily. Tab pantoprazole 40mg AC breakfast. Tab Eliquis 5mg BID. Tab ondansetron 4mg Q8H PRN N/V. Lantus 20U QHS. Do not stop abruptly, taper as directed Adv: weight bearing exercise, calcium/vit D supplementation. F/U INR in 3 days.","Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) Eliquis 5mg twice daily [blood thinner]. (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (5) Lantus insulin 20 units at bedtime [long-acting insulin]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 3 days for a blood thinner level check [INR].",Pulmonology,Prescription,high
4129,"71 y/o F with PMH of A-fib, asthma, DVT/PE on warfarin, PPM in situ, OSA on CPAP, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on ibuprofen 400mg Q6H PRN with food, entresto 49/51mg BID, timolol 0.5% OU BID, amoxicillin 500mg TID x 10 days, atorvastatin 80mg QHS. F/U nephrology in 5 days.","A 71-year-old woman with a history of irregular heartbeat [atrial fibrillation], asthma, blood clots [on blood thinner warfarin], implanted pacemaker, and sleep apnea [uses a breathing machine at night] was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (5) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the kidney doctor in 5 days.",Cardiology,Discharge Summary,high
4130,"35 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 35-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
4131,"BMP: Na 137 (N), K 4.1 (N), BUN 35, Cr 0.6 (N), Glucose 288.",Your blood chemistry results: Sodium is normal at 137. Potassium is normal at 4.1. Creatinine is normal at 0.6. Blood sugar is 288 (high).,Nephrology,Lab Result,medium
4132,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4133,"39 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 39-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4134,Rx: Tab omeprazole 20mg AC breakfast. Tab hydroxychloroquine 200mg BID. Tab ASA 81mg daily. Tab entresto 49/51mg BID. Avoid NSAIDs. F/U 2 weeks with INR.,Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (3) baby aspirin 81mg once daily [prevents blood clots]. (4) Entresto 49/51mg twice daily [heart failure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,high
4135,"76 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 76-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4136,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,high
4137,Procedure: R TKA. Pt 43 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 43-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
4138,"Rx: Tab methotrexate 15mg weekly. Tab amlodipine 10mg daily. Humalog per SSI. Tab carvedilol 12.5mg BID. Adv: low potassium diet Adv: low salt diet, fluid restriction 1.5L/day. F/U PCP in 1 week for BP recheck.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) Humalog insulin before meals as directed [fast-acting insulin]. (4) carvedilol 12.5mg twice daily [heart medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: eat less salt and limit your total fluid intake to about 6 cups per day. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
4139,"65 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 65-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4140,"80 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 80-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4141,CXR PA: Pacemaker leads in appropriate position. Left lower lobe consolidation. Patchy bilateral infiltrates.,Chest X-ray results: The pacemaker wires are in the correct position. There is an area in the lower left lung that appears infected. There are scattered cloudy patches in both lungs suggesting infection or inflammation.,Pulmonology,Radiology Report,high
4142,"22 y/o F with PMH of ESRD on HD, HTN, HLD, h/o CVA, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on ibuprofen 400mg Q6H PRN with food, ASA 81mg daily, Eliquis 5mg BID, azithromycin 500mg day 1 then 250mg x 4 days. F/U nephrology in 5 days.","A 22-year-old woman with a history of kidney failure requiring dialysis, high blood pressure, high cholesterol, and history of stroke was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) Eliquis 5mg twice daily [blood thinner]; (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the kidney doctor in 5 days.",Gastroenterology,Discharge Summary,high
4143,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4144,"57 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 57-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4145,"73 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 73-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4146,"Rx: Tab furosemide 40mg daily. Tab amlodipine 5mg daily. Adv: smoking cessation, pulmonary rehab Adv: SMBG BID, diabetic diet. F/U INR in 3 days.",Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) amlodipine 5mg once daily [blood pressure medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,medium
4147,"Rx: Tab methotrexate 15mg weekly. Tab pantoprazole 40mg AC breakfast. Tab ibuprofen 400mg Q6H PRN with food. Adv: weight bearing exercise, calcium/vit D supplementation. F/U INR in 3 days.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 3 days for a blood thinner level check [INR].",Gastroenterology,Prescription,medium
4148,"Thyroid panel: TSH 6.41 (H), Free T4 1.3.","Your thyroid test results: TSH is elevated at 6.41 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
4149,"CBC: WBC 20.1 (H), Hgb 12.8 (N), Plt 461 (H).","Your blood count results: White blood cells are 20.1 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 12.8. Platelets are 461, which is high — your blood may clot too easily.",Hematology,Lab Result,high
4150,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
4151,"50 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 50-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4152,"Rx: Tab lisinopril 20mg daily. Tab amlodipine 10mg daily. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab warfarin 5mg daily. Tab furosemide 40mg BID. Adv: smoking cessation, pulmonary rehab Adv: avoid alcohol, hepatotoxic drugs. F/U 1 week with CBC, CMP.","Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (5) furosemide (Lasix) 40mg twice daily [water pill]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
4153,"52 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 52-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4154,"30 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 30-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4155,"LFTs: AST 336 (H), ALT 40 (N), ALP 137, T.Bili 4.3 (H), Albumin 2.7.","Your liver blood test results: Liver enzymes (AST 336, ALT 40) are normal (normal is under 40). Bilirubin is high at 4.3 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.7 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4156,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4157,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4158,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4159,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
4160,"77 y/o F with PMH of ICD in situ, s/p CABG, CKD Stage 4, h/o CVA, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on spironolactone 25mg daily, Xarelto 20mg daily with dinner, metoprolol 25mg BID, montelukast 10mg QHS. F/U surgery in 2 weeks for drain removal.","A 77-year-old woman with a history of implanted heart defibrillator, prior heart bypass surgery, advanced kidney disease, and history of stroke was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (4) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Gastroenterology,Discharge Summary,high
4161,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4162,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4163,"LFTs: AST 17 (N), ALT 281 (H), ALP 139, T.Bili 1.5 (H), Albumin 1.8.","Your liver blood test results: Liver enzymes (AST 17, ALT 281) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.5. Albumin is low at 1.8 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4164,"41 y/o F with PMH of HFpEF, OA, s/p CABG, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on pregabalin 75mg BID, omeprazole 20mg AC breakfast, latanoprost 0.005% OU QHS, calcium + vitamin D 600/400 daily, amoxicillin 500mg TID x 10 days. F/U pulmonology in 2 weeks.","A 41-year-old woman with a history of heart failure with stiff heart muscle, arthritis [osteoarthritis], and prior heart bypass surgery was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (4) calcium plus vitamin D once daily [bone strengthening]; (5) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the lung doctor in 2 weeks.",General Surgery,Discharge Summary,high
4165,"51 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 51-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4166,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
4167,"Rx: Spiriva 18mcg daily. Tab lisinopril 10mg daily. Adv: high fiber diet, adequate hydration. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
4168,"86 y/o M with PMH of depression, BPH, anemia, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on methotrexate 15mg weekly, clopidogrel 75mg daily, glipizide 5mg BID AC. F/U PCP in 2 weeks.","A 86-year-old man with a history of depression, enlarged prostate, and low blood count [anemia] was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the primary care doctor in 2 weeks.",Neurology,Discharge Summary,high
4169,HbA1c: 10.0% (H). FBS: 297 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.0%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 297, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4170,"57 y/o F with PMH of h/o TIA, cirrhosis, ICD in situ, HTN, CHF, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Low potassium diet. D/C on azithromycin 500mg day 1 then 250mg x 4 days, acetaminophen 650mg Q6H PRN, potassium chloride 20mEq daily, Eliquis 5mg BID, losartan 50mg daily. F/U hematology in 2 weeks.","A 57-year-old woman with a history of history of mini-stroke, liver scarring [cirrhosis], implanted heart defibrillator, high blood pressure, and heart failure was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) Eliquis 5mg twice daily [blood thinner]; (5) losartan 50mg once daily [blood pressure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",General Surgery,Discharge Summary,high
4171,"LFTs: AST 177 (H), ALT 72 (H), ALP 99, T.Bili 2.5 (H), Albumin 4.0.","Your liver blood test results: Liver enzymes (AST 177, ALT 72) are mildly elevated (normal is under 40). Bilirubin is high at 2.5 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.0.",Gastroenterology,Lab Result,high
4172,MRI Lumbar Spine: Central canal stenosis at L3-L4. No compression fracture. L5-S1 disc desiccation with mild bulge.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. No bones are broken or collapsed. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
4173,CXR PA: Pacemaker leads in appropriate position. Patchy bilateral infiltrates. Osseous structures intact. Port-a-cath in appropriate position.,Chest X-ray results: The pacemaker wires are in the correct position. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The bones look normal with no fractures. The implanted medication port is in the correct position.,Pulmonology,Radiology Report,high
4174,"40 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 40-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4175,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4176,"32 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 32-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4177,"59 y/o F with PMH of h/o CVA, anxiety, PAD, s/p TKR, CKD Stage 4, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on Augmentin 875/125 BID x 7 days, escitalopram 10mg daily, Dulcolax 10mg QHS PRN. F/U surgery in 2 weeks for drain removal.","A 59-year-old woman with a history of history of stroke, anxiety, poor blood flow in the legs [peripheral artery disease], prior knee replacement, and advanced kidney disease was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (3) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the surgeon in 2 weeks to remove the drain.",Endocrinology,Discharge Summary,high
4178,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4179,"54 y/o F with PMH of s/p THR, obesity (BMI 38), admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on calcium + vitamin D 600/400 daily, losartan 50mg daily, entresto 49/51mg BID. F/U INR check in 3 days.","A 54-year-old woman with a history of prior hip replacement, and obesity was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) calcium plus vitamin D once daily [bone strengthening]; (2) losartan 50mg once daily [blood pressure medicine]; (3) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
4180,"55 y/o M with PMH of CHF, gout, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on metformin 500mg BID, glipizide 5mg BID AC, Eliquis 5mg BID, pantoprazole 40mg AC breakfast. F/U INR check in 3 days.","A 55-year-old man with a history of heart failure, and gout was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) Eliquis 5mg twice daily [blood thinner]; (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up for a blood thinner level check in 3 days.",Gastroenterology,Discharge Summary,high
4181,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. No acute intracranial hemorrhage. No midline shift. No mass effect. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is no bleeding in the brain. The brain is centered normally. There are no tumors or masses pushing on the brain. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
4182,"60 y/o F with PMH of ESRD on HD, A-fib, PAD, DM1, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on metoprolol 25mg BID, azithromycin 500mg day 1 then 250mg x 4 days, Humalog per SSI. F/U nephrology in 1 week.","A 60-year-old woman with a history of kidney failure requiring dialysis, irregular heartbeat [atrial fibrillation], poor blood flow in the legs [peripheral artery disease], and type 1 diabetes was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the kidney doctor in 1 week.",Neurology,Discharge Summary,high
4183,"Rx: Tab amlodipine 10mg daily. Tab levothyroxine 75mcg daily on empty stomach. Spiriva 18mcg daily. Tab ibuprofen 400mg Q6H PRN with food. Adv: wound care with daily dressing changes Adv: high fiber diet, adequate hydration. F/U 2 weeks.","Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) Spiriva inhaler once daily [long-acting lung medicine]. (4) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back for a check-up in 2 weeks.",Cardiology,Prescription,low
4184,"BMP: Na 150 (H), K 4.6 (N), BUN 55, Cr 3.5 (H), Glucose 343.","Your blood chemistry results: Sodium is high at 150, meaning you may be dehydrated. Potassium is normal at 4.6. Creatinine is elevated at 3.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 343 (high).",Nephrology,Lab Result,high
4185,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4186,"83 y/o M with PMH of osteoporosis, ESRD on HD, depression, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Lantus 20U QHS, rosuvastatin 10mg QHS, metformin 1000mg BID, metformin 500mg BID. F/U oncology in 1 week.","A 83-year-old man with a history of weak bones [osteoporosis], kidney failure requiring dialysis, and depression was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) metformin 1000mg twice daily with meals [blood sugar medicine]; (4) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the cancer doctor in 1 week.",Cardiology,Discharge Summary,high
4187,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4188,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Humalog per SSI. Tab metformin 500mg BID. Tab timolol 0.5% OU BID. Adv: high fiber diet, adequate hydration Adv: DASH diet, daily BP monitoring. F/U PCP in 1 week for BP recheck.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. See your primary care doctor in 1 week to recheck blood pressure.",Endocrinology,Prescription,high
4189,"39 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 39-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4190,"73 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 73-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4191,"53 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 53-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4192,HbA1c: 9.3% (H). FBS: 156 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.3%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 156, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
4193,Procedure: TURP for BPH. Pt 66 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 66-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
4194,"87 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 87-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4195,"32 y/o M with PMH of ESRD on HD, HLD, CHF, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on acetaminophen 650mg Q6H PRN, omeprazole 20mg AC breakfast, sertraline 50mg daily, Augmentin 875/125 BID x 7 days, gabapentin 300mg TID. F/U orthopedics in 6 weeks with X-ray.","A 32-year-old man with a history of kidney failure requiring dialysis, high cholesterol, and heart failure was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) Augmentin 875mg twice daily for 7 days [antibiotic]; (5) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
4196,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4197,CT Head without contrast: No mass effect. Mild generalized cerebral atrophy appropriate for age. Chronic lacunar infarcts in bilateral basal ganglia. Paranasal sinuses clear.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is mild brain shrinkage, which is normal for your age. There are signs of small old strokes in the deep parts of the brain. The sinuses are clear with no infection.",Neurology,Radiology Report,high
4198,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
4199,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,medium
4200,CXR PA: Right middle lobe atelectasis. Left lower lobe consolidation. Right lower lobe consolidation. Hyperinflated lungs consistent with COPD.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is an area in the lower left lung that appears infected. There is an area in the lower right lung that appears infected, suggesting pneumonia. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema].",Pulmonology,Radiology Report,high
4201,"83 y/o F with PMH of s/p TKR, s/p CABG, anemia, PAD, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Low potassium diet. D/C on glipizide 5mg BID AC, potassium chloride 20mEq daily, empagliflozin 10mg daily, prednisone taper. F/U hematology in 2 weeks.","A 83-year-old woman with a history of prior knee replacement, prior heart bypass surgery, low blood count [anemia], and poor blood flow in the legs [peripheral artery disease] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the blood disorder doctor in 2 weeks.",Orthopedics,Discharge Summary,high
4202,"79 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 79-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
4203,CXR PA: Widened mediastinum. Clear lung fields bilaterally. ET tube 3cm above carina. Right lower lobe consolidation.,"Chest X-ray results: The space between the lungs appears wider than normal, which needs further evaluation. Both lungs look clear with no problems. The breathing tube is in good position. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
4204,"64 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 64-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4205,Rx: Spiriva 18mcg daily. Tab metformin 500mg BID. Avoid grapefruit juice. F/U 2 weeks.,Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. Do not drink grapefruit juice as it interferes with this medication. Come back for a check-up in 2 weeks.,Pulmonology,Prescription,medium
4206,"Thyroid panel: TSH 13.69 (H), Free T4 2.1.","Your thyroid test results: TSH is elevated at 13.69 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
4207,"84 y/o M with PMH of s/p TKR, Parkinson's disease, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on pantoprazole 40mg AC breakfast, levothyroxine 75mcg daily on empty stomach. F/U endocrine in 1 week.","A 84-year-old man with a history of prior knee replacement, and Parkinson's disease was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
4208,"Rx: Tab warfarin 5mg daily. Tab metformin 500mg BID. Tab montelukast 10mg QHS. Adv: smoking cessation, pulmonary rehab. F/U 1 week with wound check.",Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week to have the wound checked.,Pulmonology,Prescription,medium
4209,"50 y/o M with PMH of HLD, h/o CVA, HFpEF, Parkinson's disease, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on metformin 500mg BID, amlodipine 10mg daily, empagliflozin 10mg daily. F/U nephrology in 1 week.","A 50-year-old man with a history of high cholesterol, history of stroke, heart failure with stiff heart muscle, and Parkinson's disease was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the kidney doctor in 1 week.",General Surgery,Discharge Summary,high
4210,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4211,CXR PA: Mild cardiomegaly. Hyperinflated lungs consistent with COPD. Increased interstitial markings suggesting pulmonary edema. Elevated left hemidiaphragm.,"Chest X-ray results: The heart is slightly larger than normal. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. The left side of the breathing muscle [diaphragm] is sitting higher than normal.",Pulmonology,Radiology Report,high
4212,"LFTs: AST 473 (H), ALT 249 (H), ALP 204, T.Bili 1.5 (H), Albumin 4.0.","Your liver blood test results: Liver enzymes (AST 473, ALT 249) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.5. Albumin is normal at 4.0.",Gastroenterology,Lab Result,high
4213,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,medium
4214,CXR PA: Moderate right pleural effusion. Right middle lobe atelectasis. Osseous structures intact. Hyperinflated lungs consistent with COPD. Cardiomegaly with CTR >0.5.,"Chest X-ray results: There is a moderate amount of fluid around the right lung. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The bones look normal with no fractures. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The heart appears larger than normal.",Pulmonology,Radiology Report,high
4215,"85 y/o M with PMH of CKD Stage 4, DVT/PE on warfarin, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on sertraline 50mg daily, amlodipine 10mg daily. F/U wound care in 3 days.","A 85-year-old man with a history of advanced kidney disease, and blood clots [on blood thinner warfarin] was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) amlodipine 10mg once daily [blood pressure medicine]. Follow-up at the wound care clinic in 3 days.",Hematology,Discharge Summary,high
4216,"55 y/o F with PMH of DVT/PE on warfarin, PAD, cirrhosis, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Strict I&O, daily weights. D/C on metoprolol 25mg BID, pregabalin 75mg BID. F/U surgery in 10 days.","A 55-year-old woman with a history of blood clots [on blood thinner warfarin], poor blood flow in the legs [peripheral artery disease], and liver scarring [cirrhosis] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the surgeon in 10 days.",Orthopedics,Discharge Summary,high
4217,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab ferrous sulfate 325mg BID. Tab rosuvastatin 10mg QHS. Avoid grapefruit juice Adv: high fiber diet, adequate hydration. F/U INR in 3 days.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. Do not drink grapefruit juice as it interferes with this medication Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 3 days for a blood thinner level check [INR].",General,Prescription,medium
4218,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4219,HbA1c: 9.1% (H). FBS: 111 mg/dL (H).,"Your diabetes blood test results: HbA1c is 9.1%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 111, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
4220,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4221,"90 y/o F with PMH of PAD, RA on MTX, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on metformin 1000mg BID, Spiriva 18mcg daily, lisinopril 10mg daily. F/U hematology in 2 weeks.","A 90-year-old woman with a history of poor blood flow in the legs [peripheral artery disease], and rheumatoid arthritis [on immune-suppressing medicine] was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the blood disorder doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
4222,"Lipid panel: TC 125, LDL 93, HDL 63, TG 143.",Your cholesterol results: Total cholesterol is 125. LDL (bad cholesterol) is at goal (93). HDL (good cholesterol) is good at 63. Triglycerides are normal at 143.,Cardiology,Lab Result,medium
4223,"MRI Lumbar Spine: Central canal stenosis at L3-L4. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Conus medullaris at L1, normal. L5-S1 disc desiccation with mild bulge.","MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The spinal cord ends at a normal level. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure.",Orthopedics,Radiology Report,high
4224,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,high
4225,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4226,"70 y/o M with PMH of hypothyroidism, GERD, s/p THR, HTN, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on metoprolol succinate 50mg daily, carvedilol 12.5mg BID, escitalopram 10mg daily, latanoprost 0.005% OU QHS. F/U surgery in 10 days.","A 70-year-old man with a history of underactive thyroid, acid reflux, prior hip replacement, and high blood pressure was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) carvedilol 12.5mg twice daily [heart medicine]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Follow-up with the surgeon in 10 days.",Gastroenterology,Discharge Summary,high
4227,HbA1c: 5.0% (N). FBS: 119 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.0%, which is normal — you do not have diabetes. Fasting blood sugar was 119, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
4228,"37 y/o F with PMH of HTN, DM1, ICD in situ, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Low potassium diet. D/C on potassium chloride 20mEq daily, Augmentin 875/125 BID x 7 days, rosuvastatin 10mg QHS, Xarelto 20mg daily with dinner, methotrexate 15mg weekly. F/U PCP in 2 weeks.","A 37-year-old woman with a history of high blood pressure, type 1 diabetes, and implanted heart defibrillator was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) Xarelto 20mg once daily with dinner [blood thinner]; (5) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the primary care doctor in 2 weeks.",General Surgery,Discharge Summary,high
4229,"55 y/o M with PMH of DM1, CKD Stage 3, h/o TIA, OA, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on omeprazole 20mg AC breakfast, spironolactone 25mg daily, furosemide 40mg daily, ciprofloxacin 500mg BID x 5 days. F/U pulmonology in 2 weeks.","A 55-year-old man with a history of type 1 diabetes, moderate kidney disease, history of mini-stroke, and arthritis [osteoarthritis] was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Follow-up with the lung doctor in 2 weeks.",General Surgery,Discharge Summary,high
4230,"Rx: Tab entresto 49/51mg BID. Tab ASA 81mg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: low salt diet, fluid restriction 1.5L/day Adv: DASH diet, daily BP monitoring. F/U INR in 3 days.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
4231,"89 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 89-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4232,"Rx: Tab lisinopril 10mg daily. Tab losartan 50mg daily. Tab entresto 49/51mg BID. Tab Xarelto 20mg daily with dinner. Tab rosuvastatin 10mg QHS. Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) losartan 50mg once daily [blood pressure medicine]. (3) Entresto 49/51mg twice daily [heart failure medicine]. (4) Xarelto 20mg once daily with dinner [blood thinner]. (5) rosuvastatin 10mg at bedtime [cholesterol medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
4233,CXR PA: Pacemaker leads in appropriate position. Right-sided pneumothorax. Small left pleural effusion. Left lower lobe consolidation.,Chest X-ray results: The pacemaker wires are in the correct position. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There is a small amount of fluid around the left lung. There is an area in the lower left lung that appears infected.,Pulmonology,Radiology Report,high
4234,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,low
4235,"52 y/o M with PMH of CHF, OA, obesity (BMI 38), admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on clopidogrel 75mg daily, amoxicillin 500mg TID x 10 days, glipizide 5mg BID AC, montelukast 10mg QHS, metoprolol 25mg BID. F/U PCP in 2 weeks.","A 52-year-old man with a history of heart failure, arthritis [osteoarthritis], and obesity was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) montelukast 10mg at bedtime [asthma/allergy medicine]; (5) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the primary care doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4236,"76 y/o F with PMH of gout, CKD Stage 4, DVT/PE on warfarin, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on Eliquis 5mg BID, amlodipine 10mg daily, furosemide 40mg BID, sertraline 50mg daily. F/U oncology in 1 week.","A 76-year-old woman with a history of gout, advanced kidney disease, and blood clots [on blood thinner warfarin] was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) Eliquis 5mg twice daily [blood thinner]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) furosemide (Lasix) 40mg twice daily [water pill]; (4) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the cancer doctor in 1 week.",Cardiology,Discharge Summary,high
4237,Procedure: EGD with biopsy. Pt 80 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 80-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4238,"57 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 57-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4239,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,low
4240,"Rx: Tab lisinopril 10mg daily. Tab Dulcolax 10mg QHS PRN. Tab rosuvastatin 10mg QHS. Tab pantoprazole 40mg AC breakfast. albuterol MDI 2 puffs Q4-6H PRN. Avoid NSAIDs Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 month with repeat imaging.","Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. (5) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
4241,"65 y/o F with PMH of s/p THR, HFpEF, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on Lantus 20U QHS, Eliquis 5mg BID, hydroxychloroquine 200mg BID, losartan 50mg daily, tramadol 50mg Q6H PRN pain. F/U endocrine in 1 week.","A 65-year-old woman with a history of prior hip replacement, and heart failure with stiff heart muscle was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) Eliquis 5mg twice daily [blood thinner]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (4) losartan 50mg once daily [blood pressure medicine]; (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the hormone/diabetes doctor in 1 week.",Neurology,Discharge Summary,high
4242,"US Abdomen: Pancreas unremarkable. Right kidney 10.5cm, no hydronephrosis. No focal hepatic lesion. Simple renal cysts bilaterally. Spleen 16cm, splenomegaly.",Abdominal ultrasound results: The pancreas looks normal. Right kidney is normal size with no blockage. No tumors or masses were found in the liver. Both kidneys have harmless fluid-filled cysts. The spleen is enlarged [splenomegaly].,Gastroenterology,Radiology Report,high
4243,"BMP: Na 130 (L), K 3.4 (L), BUN 55, Cr 1.9 (H), Glucose 109.","Your blood chemistry results: Sodium is low at 130 (normal 136-145), meaning too much water in your body. Potassium is low at 3.4 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 1.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 109 (high).",Nephrology,Lab Result,high
4244,"91 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 91-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4245,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,low
4246,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
4247,"Rx: Tab Dulcolax 10mg QHS PRN. Tab potassium chloride 20mEq daily. albuterol MDI 2 puffs Q4-6H PRN. Adv: DASH diet, daily BP monitoring. F/U 2 weeks.","Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back for a check-up in 2 weeks.",General,Prescription,medium
4248,"63 y/o M with PMH of HFrEF (EF 30%), HTN, s/p CABG, PAD, SLE, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Compression stockings when ambulating. D/C on montelukast 10mg QHS, Xarelto 20mg daily with dinner, ciprofloxacin 500mg BID x 5 days. F/U INR check in 3 days.","A 63-year-old man with a history of heart failure with weak pumping (30%), high blood pressure, prior heart bypass surgery, poor blood flow in the legs [peripheral artery disease], and lupus was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
4249,"MRI Lumbar Spine: Facet joint hypertrophy at L4-L5. Conus medullaris at L1, normal. Multilevel degenerative disc disease.",MRI of the lower back results: The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal cord ends at a normal level. Multiple discs in the spine are showing wear and aging.,Orthopedics,Radiology Report,high
4250,"77 y/o F with PMH of ESRD on HD, anemia, depression, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on omeprazole 20mg AC breakfast, azithromycin 500mg day 1 then 250mg x 4 days. F/U nephrology in 1 week.","A 77-year-old woman with a history of kidney failure requiring dialysis, low blood count [anemia], and depression was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
4251,CXR PA: Sternotomy wires intact. Widened mediastinum. No cardiomegaly. Hyperinflated lungs consistent with COPD. Compression fracture T12.,"Chest X-ray results: The wires from prior heart surgery are intact. The space between the lungs appears wider than normal, which needs further evaluation. The heart is a normal size. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There is a compression fracture [collapsed bone] in the lower spine at T12.",Pulmonology,Radiology Report,high
4252,"91 y/o M with PMH of s/p THR, gout, HFpEF, s/p CABG, DVT/PE on warfarin, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on levothyroxine 75mcg daily on empty stomach, albuterol MDI 2 puffs Q4-6H PRN, Humalog per SSI, timolol 0.5% OU BID. F/U PCP in 2 weeks.","A 91-year-old man with a history of prior hip replacement, gout, heart failure with stiff heart muscle, prior heart bypass surgery, and blood clots [on blood thinner warfarin] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (3) Humalog insulin before meals as directed [fast-acting insulin]; (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up with the primary care doctor in 2 weeks.",Orthopedics,Discharge Summary,high
4253,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
4254,"67 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 67-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4255,"51 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 51-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4256,Procedure: ORIF L distal radius. Pt 55 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 55-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
4257,HbA1c: 10.8% (H). FBS: 230 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.8%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 230, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4258,"Rx: Tab empagliflozin 10mg daily. Humalog per SSI. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab metoprolol 25mg BID. Tab entresto 49/51mg BID. Avoid grapefruit juice Adv: weight bearing exercise, calcium/vit D supplementation. F/U 2 weeks.","Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (4) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (5) Entresto 49/51mg twice daily [heart failure medicine]. Do not drink grapefruit juice as it interferes with this medication Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
4259,"25 y/o F with PMH of s/p CABG, ESRD on HD, s/p THR, PPM in situ, anemia, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on hydroxychloroquine 200mg BID, ondansetron 4mg Q8H PRN N/V. F/U endocrine in 1 week.","A 25-year-old woman with a history of prior heart bypass surgery, kidney failure requiring dialysis, prior hip replacement, implanted pacemaker, and low blood count [anemia] was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Infectious Disease,Discharge Summary,high
4260,Procedure: Port-a-cath placement. Pt 54 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 54-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
4261,HbA1c: 10.4% (H). FBS: 154 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.4%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 154, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4262,CXR PA: NG tube tip in stomach. Bilateral hilar lymphadenopathy. Elevated left hemidiaphragm.,"Chest X-ray results: The feeding/drainage tube tip is correctly positioned in the stomach. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The left side of the breathing muscle [diaphragm] is sitting higher than normal.",Pulmonology,Radiology Report,high
4263,"58 y/o F with PMH of asthma, anemia, h/o TIA, s/p THR, PPM in situ, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on metformin 1000mg BID, furosemide 40mg BID. F/U hematology in 2 weeks.","A 58-year-old woman with a history of asthma, low blood count [anemia], history of mini-stroke, prior hip replacement, and implanted pacemaker was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) furosemide (Lasix) 40mg twice daily [water pill]. Follow-up with the blood disorder doctor in 2 weeks.",Neurology,Discharge Summary,high
4264,Procedure: Port-a-cath placement. Pt 46 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 46-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
4265,CXR PA: Compression fracture T12. Elevated left hemidiaphragm. Cardiomegaly with CTR >0.5. Left lower lobe consolidation. Mild cardiomegaly.,Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The heart appears larger than normal. There is an area in the lower left lung that appears infected. The heart is slightly larger than normal.,Pulmonology,Radiology Report,high
4266,Procedure: TURP for BPH. Pt 28 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 28-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
4267,"Lipid panel: TC 251, LDL 212, HDL 46, TG 114.","Your cholesterol results: Total cholesterol is 251. LDL (bad cholesterol) is very high at 212 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 46. Triglycerides are normal at 114.",Cardiology,Lab Result,high
4268,"Rx: Tab Dulcolax 10mg QHS PRN. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab atorvastatin 40mg QHS. Tab Augmentin 875/125 BID x 7 days. Adv: DASH diet, daily BP monitoring Adv: low potassium diet. F/U 2 weeks.","Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (3) atorvastatin 40mg at bedtime [cholesterol medicine]. (4) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back for a check-up in 2 weeks.",Infectious Disease,Prescription,high
4269,"25 y/o M with PMH of DM2, CKD Stage 4, anxiety, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on acetaminophen 650mg Q6H PRN, atorvastatin 40mg QHS, prednisone taper, Lantus 20U QHS, pregabalin 75mg BID. F/U pulmonology in 2 weeks.","A 25-year-old man with a history of type 2 diabetes, advanced kidney disease, and anxiety was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (4) Lantus insulin 20 units at bedtime [long-acting insulin]; (5) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the lung doctor in 2 weeks.",Pulmonology,Discharge Summary,high
4270,"Rx: Tab metoprolol succinate 50mg daily. Tab spironolactone 25mg daily. Tab atorvastatin 40mg QHS. Adv: SMBG BID, diabetic diet. F/U 1 week with CBC, CMP.",Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) atorvastatin 40mg at bedtime [cholesterol medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,medium
4271,"47 y/o M with PMH of HFpEF, HFrEF (EF 30%), OA, ESRD on HD, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Strict I&O, daily weights. D/C on timolol 0.5% OU BID, spironolactone 25mg daily, Dulcolax 10mg QHS PRN, warfarin 5mg daily, atorvastatin 40mg QHS. F/U wound care in 3 days.","A 47-year-old man with a history of heart failure with stiff heart muscle, heart failure with weak pumping (30%), arthritis [osteoarthritis], and kidney failure requiring dialysis was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) spironolactone 25mg once daily [heart-protecting water pill]; (3) Dulcolax 10mg at bedtime as needed [for constipation]; (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (5) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up at the wound care clinic in 3 days.",Gastroenterology,Discharge Summary,high
4272,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4273,HbA1c: 8.2% (H). FBS: 284 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.2%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 284, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
4274,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. No compression fracture. Facet joint hypertrophy at L4-L5. Multilevel degenerative disc disease.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. No bones are broken or collapsed. The small joints in the spine at L4-L5 are enlarged from arthritis. Multiple discs in the spine are showing wear and aging.",Orthopedics,Radiology Report,high
4275,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4276,"84 y/o M with PMH of h/o CVA, COPD, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on pregabalin 75mg BID, metformin 500mg BID, spironolactone 25mg daily, methotrexate 15mg weekly, Eliquis 5mg BID. F/U surgery in 2 weeks for drain removal.","A 84-year-old man with a history of history of stroke, and chronic lung disease was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) metformin 500mg twice daily with meals [blood sugar medicine]; (3) spironolactone 25mg once daily [heart-protecting water pill]; (4) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (5) Eliquis 5mg twice daily [blood thinner]. Follow-up with the surgeon in 2 weeks to remove the drain.",Gastroenterology,Discharge Summary,high
4277,"Rx: Tab atorvastatin 40mg QHS. Tab ondansetron 4mg Q8H PRN N/V. Tab gabapentin 300mg TID. Adv: low salt low sugar diet, regular exercise Adv: DASH diet, daily BP monitoring. F/U 1 month with repeat imaging.","Your medicines: (1) atorvastatin 40mg at bedtime [cholesterol medicine]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
4278,"Lipid panel: TC 310, LDL 170, HDL 50, TG 88.","Your cholesterol results: Total cholesterol is 310. LDL (bad cholesterol) is very high at 170 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 50. Triglycerides are normal at 88.",Cardiology,Lab Result,high
4279,"25 y/o M with PMH of RA on MTX, osteoporosis, GERD, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Low potassium diet. D/C on lisinopril 10mg daily, metoprolol succinate 50mg daily, glipizide 5mg BID AC, spironolactone 25mg daily. F/U GI in 1 week.","A 25-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], weak bones [osteoporosis], and acid reflux was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up with the stomach doctor in 1 week.",Infectious Disease,Discharge Summary,high
4280,"BMP: Na 136 (N), K 4.0 (N), BUN 54, Cr 5.3 (H), Glucose 204.","Your blood chemistry results: Sodium is normal at 136. Potassium is normal at 4.0. Creatinine is elevated at 5.3 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 204 (high).",Nephrology,Lab Result,high
4281,"US Abdomen: Spleen 11cm, normal. Spleen 16cm, splenomegaly. CBD 5mm, not dilated.",Abdominal ultrasound results: The spleen is a normal size. The spleen is enlarged [splenomegaly]. The bile duct is normal size [not blocked].,Gastroenterology,Radiology Report,high
4282,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4283,"76 y/o F with PMH of depression, CKD Stage 3, HFrEF (EF 30%), h/o TIA, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on atorvastatin 40mg QHS, rosuvastatin 10mg QHS. F/U GI in 1 week.","A 76-year-old woman with a history of depression, moderate kidney disease, heart failure with weak pumping (30%), and history of mini-stroke was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
4284,"62 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 62-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4285,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4286,Procedure: Colonoscopy with polypectomy. Pt 39 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 39-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4287,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab furosemide 40mg daily. Tab warfarin 5mg daily. Adv: wound care with daily dressing changes Adv: smoking cessation, pulmonary rehab. F/U 1 week with wound check.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
4288,"BMP: Na 129 (L), K 4.5 (N), BUN 72, Cr 6.0 (H), Glucose 211.","Your blood chemistry results: Sodium is low at 129 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.5. Creatinine is elevated at 6.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 211 (high).",Nephrology,Lab Result,high
4289,"36 y/o F with PMH of s/p CABG, DM1, osteoporosis, hypothyroidism, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on Dulcolax 10mg QHS PRN, tramadol 50mg Q6H PRN pain. F/U nephrology in 1 week.","A 36-year-old woman with a history of prior heart bypass surgery, type 1 diabetes, weak bones [osteoporosis], and underactive thyroid was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the kidney doctor in 1 week.",Endocrinology,Discharge Summary,high
4290,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,low
4291,"75 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 75-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
4292,"48 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 48-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4293,"54 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 54-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4294,CXR PA: Increased interstitial markings suggesting pulmonary edema. Pacemaker leads in appropriate position. No cardiomegaly. Clear lung fields bilaterally.,"Chest X-ray results: There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. The pacemaker wires are in the correct position. The heart is a normal size. Both lungs look clear with no problems.",Pulmonology,Radiology Report,high
4295,"27 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 27-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4296,HbA1c: 8.0% (H). FBS: 391 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.0%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 391, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
4297,"65 y/o F with PMH of ESRD on HD, gout, HLD, obesity (BMI 38), DM1, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on prednisone taper, lisinopril 20mg daily, azithromycin 500mg day 1 then 250mg x 4 days. F/U endocrine in 1 week.","A 65-year-old woman with a history of kidney failure requiring dialysis, gout, high cholesterol, obesity, and type 1 diabetes was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the hormone/diabetes doctor in 1 week.",Infectious Disease,Discharge Summary,high
4298,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
4299,CT Head without contrast: No mass effect. Mild generalized cerebral atrophy appropriate for age. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is mild brain shrinkage, which is normal for your age. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
4300,"61 y/o M with PMH of DM1, anxiety, OA, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on prednisone taper, hydroxychloroquine 200mg BID. F/U INR check in 3 days.","A 61-year-old man with a history of type 1 diabetes, anxiety, and arthritis [osteoarthritis] was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
4301,"Rx: Tab glipizide 5mg BID AC. Tab Augmentin 875/125 BID x 7 days. Tab rosuvastatin 10mg QHS. Tab ciprofloxacin 500mg BID x 5 days. Tab warfarin 5mg daily. Do not stop abruptly, taper as directed Adv: elevate affected limb, compression stockings. F/U 1 month with repeat imaging.",Your medicines: (1) glipizide 5mg twice daily before meals [helps release insulin]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (5) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 month — a repeat scan will be ordered.,Infectious Disease,Prescription,high
4302,"Rx: Tab sertraline 50mg daily. Tab amlodipine 5mg daily. Tab metformin 1000mg BID. Tab furosemide 40mg daily. Adv: high fiber diet, adequate hydration Do not stop abruptly, taper as directed. F/U 1 week with wound check.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
4303,CXR PA: Sternotomy wires intact. Elevated left hemidiaphragm. Pacemaker leads in appropriate position. Cardiomegaly with CTR >0.5. Right-sided pneumothorax.,Chest X-ray results: The wires from prior heart surgery are intact. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The pacemaker wires are in the correct position. The heart appears larger than normal. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax].,Pulmonology,Radiology Report,high
4304,Procedure: Laparoscopic appendectomy. Pt 86 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 86-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
4305,Procedure: PCI with DES to LAD. Pt 73 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 73-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4306,"37 y/o M with PMH of osteoporosis, BPH, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on calcium + vitamin D 600/400 daily, hydroxychloroquine 200mg BID, escitalopram 10mg daily, ciprofloxacin 500mg BID x 5 days, metformin 500mg BID. F/U hematology in 2 weeks.","A 37-year-old man with a history of weak bones [osteoporosis], and enlarged prostate was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) calcium plus vitamin D once daily [bone strengthening]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (5) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
4307,"48 y/o F with PMH of h/o CVA, ESRD on HD, PPM in situ, s/p THR, DVT/PE on warfarin, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on escitalopram 10mg daily, ferrous sulfate 325mg BID, ibuprofen 400mg Q6H PRN with food. F/U wound care in 3 days.","A 48-year-old woman with a history of history of stroke, kidney failure requiring dialysis, implanted pacemaker, prior hip replacement, and blood clots [on blood thinner warfarin] was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up at the wound care clinic in 3 days.",Cardiology,Discharge Summary,high
4308,Delivery Note: G?P? at 40+0 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4309,"77 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 77-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4310,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab carvedilol 12.5mg BID. Adv: DASH diet, daily BP monitoring. F/U 1 week with wound check.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) carvedilol 12.5mg twice daily [heart medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 week to have the wound checked.",Cardiology,Prescription,medium
4311,Procedure: Port-a-cath placement. Pt 79 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 79-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
4312,"Rx: Tab Xarelto 20mg daily with dinner. Tab Dulcolax 10mg QHS PRN. Tab metoprolol succinate 50mg daily. Avoid NSAIDs Adv: avoid alcohol, hepatotoxic drugs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
4313,CXR PA: Mild cardiomegaly. Sternotomy wires intact. Bilateral hilar lymphadenopathy.,"Chest X-ray results: The heart is slightly larger than normal. The wires from prior heart surgery are intact. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
4314,"29 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 29-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4315,"78 y/o F with PMH of h/o CVA, DM1, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on carvedilol 12.5mg BID, metoprolol succinate 50mg daily. F/U hematology in 2 weeks.","A 78-year-old woman with a history of history of stroke, and type 1 diabetes was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Pulmonology,Discharge Summary,high
4316,"CBC: WBC 7.7 (N), Hgb 7.4 (L), Plt 313 (N).","Your blood count results: White blood cells are 7.7 (normal). Hemoglobin is low at 7.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 313, which is normal.",Hematology,Lab Result,high
4317,"Thyroid panel: TSH 5.62 (H), Free T4 1.7.","Your thyroid test results: TSH is elevated at 5.62 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
4318,"Rx: Tab potassium chloride 20mEq daily. Tab escitalopram 10mg daily. Tab pantoprazole 40mg AC breakfast. Adv: elevate affected limb, compression stockings. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Gastroenterology,Prescription,medium
4319,"43 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 43-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4320,"Rx: Tab Eliquis 5mg BID. Spiriva 18mcg daily. Do not stop abruptly, taper as directed. F/U 1 week with wound check.",Your medicines: (1) Eliquis 5mg twice daily [blood thinner]. (2) Spiriva inhaler once daily [long-acting lung medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week to have the wound checked.,Pulmonology,Prescription,medium
4321,"Rx: Tab ciprofloxacin 500mg BID x 5 days. Tab amlodipine 10mg daily. Tab empagliflozin 10mg daily. Humalog per SSI. Adv: SMBG BID, diabetic diet Adv: wound care with daily dressing changes. F/U INR in 3 days.","Your medicines: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (4) Humalog insulin before meals as directed [fast-acting insulin]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 3 days for a blood thinner level check [INR].",Endocrinology,Prescription,high
4322,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4323,"52 y/o M with PMH of CKD Stage 3, DM1, Parkinson's disease, s/p CABG, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Compression stockings when ambulating. D/C on methotrexate 15mg weekly, ibuprofen 400mg Q6H PRN with food, pregabalin 75mg BID. F/U INR check in 3 days.","A 52-year-old man with a history of moderate kidney disease, type 1 diabetes, Parkinson's disease, and prior heart bypass surgery was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up for a blood thinner level check in 3 days.",Gastroenterology,Discharge Summary,high
4324,HbA1c: 8.5% (H). FBS: 354 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.5%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 354, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
4325,"85 y/o M with PMH of CKD Stage 4, DVT/PE on warfarin, HTN, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on ciprofloxacin 500mg BID x 5 days, potassium chloride 20mEq daily, glipizide 5mg BID AC, atorvastatin 40mg QHS, losartan 50mg daily. F/U cardiology in 2 weeks.","A 85-year-old man with a history of advanced kidney disease, blood clots [on blood thinner warfarin], and high blood pressure was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) atorvastatin 40mg at bedtime [cholesterol medicine]; (5) losartan 50mg once daily [blood pressure medicine]. Follow-up with the heart doctor in 2 weeks.",General Surgery,Discharge Summary,high
4326,"Rx: albuterol MDI 2 puffs Q4-6H PRN. Tab levothyroxine 75mcg daily on empty stomach. Tab spironolactone 25mg daily. Tab amlodipine 10mg daily. Adv: low salt low sugar diet, regular exercise. F/U INR in 3 days.","Your medicines: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (3) spironolactone 25mg once daily [heart-protecting water pill]. (4) amlodipine 10mg once daily [blood pressure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
4327,"41 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 41-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4328,"79 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 79-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4329,Rx: Tab hydroxychloroquine 200mg BID. Tab gabapentin 300mg TID. Tab atorvastatin 40mg QHS. Tab acetaminophen 650mg Q6H PRN. Spiriva 18mcg daily. Adv: low potassium diet. F/U 2 weeks with INR.,"Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (3) atorvastatin 40mg at bedtime [cholesterol medicine]. (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (5) Spiriva inhaler once daily [long-acting lung medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
4330,"65 y/o M with PMH of anxiety, h/o CVA, Parkinson's disease, anemia, CKD Stage 4, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on metoprolol 25mg BID, tramadol 50mg Q6H PRN pain. F/U GI in 1 week.","A 65-year-old man with a history of anxiety, history of stroke, Parkinson's disease, low blood count [anemia], and advanced kidney disease was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
4331,"28 y/o M with PMH of DVT/PE on warfarin, osteoporosis, HLD, PPM in situ, HTN, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on methotrexate 15mg weekly, glipizide 5mg BID AC, empagliflozin 10mg daily, Xarelto 20mg daily with dinner, amlodipine 5mg daily. F/U cardiology in 2 weeks.","A 28-year-old man with a history of blood clots [on blood thinner warfarin], weak bones [osteoporosis], high cholesterol, implanted pacemaker, and high blood pressure was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (4) Xarelto 20mg once daily with dinner [blood thinner]; (5) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
4332,CXR PA: Left lower lobe consolidation. Compression fracture T12. NG tube tip in stomach.,Chest X-ray results: There is an area in the lower left lung that appears infected. There is a compression fracture [collapsed bone] in the lower spine at T12. The feeding/drainage tube tip is correctly positioned in the stomach.,Pulmonology,Radiology Report,high
4333,"Lipid panel: TC 238, LDL 95, HDL 59, TG 286.",Your cholesterol results: Total cholesterol is 238. LDL (bad cholesterol) is at goal (95). HDL (good cholesterol) is good at 59. Triglycerides are high at 286.,Cardiology,Lab Result,high
4334,Levetiracetam 500mg BID; do not stop suddenly; report mood changes.,Anti-seizure medicine twice daily; taper only with clinician guidance; watch for mood side effects.,Neurology,Medication Instruction,low
4335,CT Head without contrast: Paranasal sinuses clear. Chronic lacunar infarcts in bilateral basal ganglia. No midline shift. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: The sinuses are clear with no infection. There are signs of small old strokes in the deep parts of the brain. The brain is centered normally. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
4336,"US Abdomen: GB sludge, no stones. Moderate right hydronephrosis. Pancreas unremarkable. GB wall thickening with stones, positive Murphy's sign. No focal hepatic lesion. Spleen 16cm, splenomegaly.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The pancreas looks normal. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. No tumors or masses were found in the liver. The spleen is enlarged [splenomegaly].",Gastroenterology,Radiology Report,high
4337,"Rx: prednisone taper. Tab atorvastatin 80mg QHS. Adv: fall precautions, home safety evaluation. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
4338,Procedure: PCI with DES to LAD. Pt 26 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 26-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4339,"69 y/o M with PMH of hypothyroidism, SLE, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on amlodipine 10mg daily, ferrous sulfate 325mg BID, albuterol MDI 2 puffs Q4-6H PRN, hydroxychloroquine 200mg BID, prednisone taper. F/U GI in 1 week.","A 69-year-old man with a history of underactive thyroid, and lupus was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (5) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up with the stomach doctor in 1 week.",Gastroenterology,Discharge Summary,high
4340,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab entresto 49/51mg BID. Tab ondansetron 4mg Q8H PRN N/V. prednisone taper. Tab potassium chloride 20mEq daily. Adv: low salt diet, fluid restriction 1.5L/day. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (5) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,General,Prescription,high
4341,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
4342,"MRI Lumbar Spine: Conus medullaris at L1, normal. Central canal stenosis at L3-L4.","MRI of the lower back results: The spinal cord ends at a normal level. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
4343,"59 y/o M with PMH of CHF, OA, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on ferrous sulfate 325mg BID, hydroxychloroquine 200mg BID, azithromycin 500mg day 1 then 250mg x 4 days, rosuvastatin 10mg QHS, Dulcolax 10mg QHS PRN. F/U hematology in 2 weeks.","A 59-year-old man with a history of heart failure, and arthritis [osteoarthritis] was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]; (5) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the blood disorder doctor in 2 weeks.",Pulmonology,Discharge Summary,high
4344,"US Abdomen: Spleen 16cm, splenomegaly. CBD 5mm, not dilated. GB sludge, no stones. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. GB wall thickening with stones, positive Murphy's sign. No focal hepatic lesion.","Abdominal ultrasound results: The spleen is enlarged [splenomegaly]. The bile duct is normal size [not blocked]. The gallbladder contains thickened bile [sludge] but no stones. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. No tumors or masses were found in the liver.",Gastroenterology,Radiology Report,high
4345,"CBC: WBC 24.2 (H), Hgb 12.2 (N), Plt 240 (N).","Your blood count results: White blood cells are 24.2 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 12.2. Platelets are 240, which is normal.",Hematology,Lab Result,high
4346,"Rx: Tab lisinopril 20mg daily. Tab atorvastatin 80mg QHS. Adv: SMBG BID, diabetic diet Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
4347,"38 y/o F with PMH of BPH, OSA on CPAP, hypothyroidism, s/p TKR, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on acetaminophen 650mg Q6H PRN, entresto 49/51mg BID. F/U oncology in 1 week.","A 38-year-old woman with a history of enlarged prostate, sleep apnea [uses a breathing machine at night], underactive thyroid, and prior knee replacement was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the cancer doctor in 1 week.",Urology,Discharge Summary,high
4348,"Rx: Tab pantoprazole 40mg AC breakfast. Tab ferrous sulfate 325mg BID. Adv: smoking cessation, pulmonary rehab Adv: SMBG BID, diabetic diet. F/U 6 weeks with LFTs.",Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 6 weeks for liver function blood tests.,Gastroenterology,Prescription,medium
4349,"58 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 58-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4350,"Lipid panel: TC 316, LDL 91, HDL 45, TG 361.",Your cholesterol results: Total cholesterol is 316. LDL (bad cholesterol) is at goal (91). HDL (good cholesterol) is good at 45. Triglycerides are very high at 361 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
4351,"25 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 25-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4352,"LFTs: AST 453 (H), ALT 598 (H), ALP 238, T.Bili 1.8 (H), Albumin 2.1.","Your liver blood test results: Liver enzymes (AST 453, ALT 598) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.8. Albumin is low at 2.1 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4353,"LFTs: AST 286 (H), ALT 429 (H), ALP 297, T.Bili 2.5 (H), Albumin 2.5.","Your liver blood test results: Liver enzymes (AST 286, ALT 429) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 2.5 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.5 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4354,"71 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 71-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4355,"Rx: Tab hydroxychloroquine 200mg BID. Tab glipizide 5mg BID AC. Adv: avoid alcohol, hepatotoxic drugs Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 month with repeat imaging.","Your medicines: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (2) glipizide 5mg twice daily before meals [helps release insulin]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 month — a repeat scan will be ordered.",Endocrinology,Prescription,medium
4356,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. 4cm right subdural hematoma with 5mm midline shift. No mass effect. No acute intracranial hemorrhage.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain. There is no bleeding in the brain.",Neurology,Radiology Report,high
4357,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Mild generalized cerebral atrophy appropriate for age. No acute intracranial hemorrhage. No mass effect.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is mild brain shrinkage, which is normal for your age. There is no bleeding in the brain. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
4358,"64 y/o M with PMH of ICD in situ, HFrEF (EF 30%), admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on potassium chloride 20mEq daily, Lantus 20U QHS. F/U surgery in 2 weeks for drain removal.","A 64-year-old man with a history of implanted heart defibrillator, and heart failure with weak pumping (30%) was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the surgeon in 2 weeks to remove the drain.",General Surgery,Discharge Summary,high
4359,CXR PA: No pneumothorax. Osseous structures intact. Sternotomy wires intact.,Chest X-ray results: There is no collapsed lung. The bones look normal with no fractures. The wires from prior heart surgery are intact.,Pulmonology,Radiology Report,high
4360,"Rx: Tab ferrous sulfate 325mg BID. Tab Dulcolax 10mg QHS PRN. Tab lisinopril 20mg daily. Adv: low potassium diet Adv: low salt low sugar diet, regular exercise. F/U PCP in 1 week for BP recheck.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) lisinopril 20mg once daily [blood pressure medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: eat less salt and sugar, and exercise at least 30 minutes most days. See your primary care doctor in 1 week to recheck blood pressure.",General,Prescription,medium
4361,Rx: Tab sertraline 50mg daily. Tab Dulcolax 10mg QHS PRN. Adv: wound care with daily dressing changes Adv: low potassium diet. F/U 6 weeks with LFTs.,"Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 6 weeks for liver function blood tests.",Psychiatry,Prescription,medium
4362,"84 y/o F with PMH of s/p TKR, s/p THR, HLD, obesity (BMI 38), admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on lisinopril 20mg daily, Lantus 20U QHS, latanoprost 0.005% OU QHS. F/U pulmonology in 2 weeks.","A 84-year-old woman with a history of prior knee replacement, prior hip replacement, high cholesterol, and obesity was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Follow-up with the lung doctor in 2 weeks.",Pulmonology,Discharge Summary,high
4363,"LFTs: AST 192 (H), ALT 365 (H), ALP 89, T.Bili 1.0 (N), Albumin 2.5.","Your liver blood test results: Liver enzymes (AST 192, ALT 365) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is normal at 1.0. Albumin is low at 2.5 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4364,"US Abdomen: Left kidney 8cm, cortical thinning consistent with CKD. GB wall thickening with stones, positive Murphy's sign. Right kidney 10.5cm, no hydronephrosis.","Abdominal ultrasound results: Left kidney is small with thin outer layer, consistent with chronic kidney disease. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. Right kidney is normal size with no blockage.",Gastroenterology,Radiology Report,high
4365,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,medium
4366,CXR PA: Elevated left hemidiaphragm. ET tube 3cm above carina. Bilateral pleural effusions.,Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. The breathing tube is in good position. There is fluid collecting around both lungs.,Pulmonology,Radiology Report,high
4367,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,medium
4368,"Rx: Tab potassium chloride 20mEq daily. Tab amlodipine 5mg daily. Tab tramadol 50mg Q6H PRN pain. Do not stop abruptly, taper as directed Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",General,Prescription,medium
4369,"60 y/o F with PMH of CHF, ICD in situ, HTN, HFrEF (EF 30%), admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on spironolactone 25mg daily, lisinopril 20mg daily, Xarelto 20mg daily with dinner. F/U PCP in 1 week.","A 60-year-old woman with a history of heart failure, implanted heart defibrillator, high blood pressure, and heart failure with weak pumping (30%) was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the primary care doctor in 1 week.",Endocrinology,Discharge Summary,high
4370,Doxycycline 100mg BID x 14 days with water; stay upright 30 min; avoid sun.,"Take this antibiotic twice daily for 14 days with plenty of water, stay upright after doses, and use sun protection.",Infectious Disease,Medication Instruction,high
4371,"US Abdomen: Spleen 11cm, normal. GB sludge, no stones. Pancreas unremarkable.",Abdominal ultrasound results: The spleen is a normal size. The gallbladder contains thickened bile [sludge] but no stones. The pancreas looks normal.,Gastroenterology,Radiology Report,high
4372,"42 y/o M with PMH of DM1, CHF, COPD, HFrEF (EF 30%), admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Low potassium diet. D/C on albuterol MDI 2 puffs Q4-6H PRN, metformin 500mg BID, omeprazole 20mg AC breakfast, acetaminophen 650mg Q6H PRN. F/U cardiology in 2 weeks.","A 42-year-old man with a history of type 1 diabetes, heart failure, chronic lung disease, and heart failure with weak pumping (30%) was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) metformin 500mg twice daily with meals [blood sugar medicine]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the heart doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4373,"BMP: Na 127 (L), K 4.5 (N), BUN 64, Cr 5.5 (H), Glucose 138.","Your blood chemistry results: Sodium is low at 127 (normal 136-145), meaning too much water in your body. Potassium is normal at 4.5. Creatinine is elevated at 5.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 138 (high).",Nephrology,Lab Result,high
4374,Procedure: R TKA. Pt 91 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 91-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
4375,HbA1c: 12.7% (H). FBS: 191 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.7%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 191, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4376,"22 y/o M with PMH of HFrEF (EF 30%), s/p TKR, hypothyroidism, PAD, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on latanoprost 0.005% OU QHS, lisinopril 20mg daily, Humalog per SSI, pregabalin 75mg BID. F/U neurology in 2 weeks.","A 22-year-old man with a history of heart failure with weak pumping (30%), prior knee replacement, underactive thyroid, and poor blood flow in the legs [peripheral artery disease] was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) Humalog insulin before meals as directed [fast-acting insulin]; (4) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4377,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4378,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4379,CXR PA: Right middle lobe atelectasis. Osseous structures intact. Right lower lobe consolidation.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The bones look normal with no fractures. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
4380,"MRI Lumbar Spine: Central canal stenosis at L3-L4. L4-L5 disc herniation with moderate bilateral foraminal stenosis. Conus medullaris at L1, normal.","MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The spinal cord ends at a normal level.",Orthopedics,Radiology Report,high
4381,CXR PA: Increased interstitial markings suggesting pulmonary edema. Clear lung fields bilaterally. Osseous structures intact. Small left pleural effusion. Right middle lobe atelectasis.,"Chest X-ray results: There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. Both lungs look clear with no problems. The bones look normal with no fractures. There is a small amount of fluid around the left lung. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
4382,"Rx: Tab metoprolol succinate 50mg daily. Tab gabapentin 300mg TID. Tab Augmentin 875/125 BID x 7 days. Tab tramadol 50mg Q6H PRN pain. Tab acetaminophen 650mg Q6H PRN. Adv: high fiber diet, adequate hydration Adv: SMBG BID, diabetic diet. F/U 1 week with CBC, CMP.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",General,Prescription,high
4383,"62 y/o M with PMH of PAD, CKD Stage 4, h/o TIA, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on atorvastatin 40mg QHS, hydroxychloroquine 200mg BID, ibuprofen 400mg Q6H PRN with food, pantoprazole 40mg AC breakfast. F/U pulmonology in 2 weeks.","A 62-year-old man with a history of poor blood flow in the legs [peripheral artery disease], advanced kidney disease, and history of mini-stroke was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the lung doctor in 2 weeks.",Cardiology,Discharge Summary,high
4384,CXR PA: ET tube 3cm above carina. No pneumothorax. Left lower lobe consolidation. Mild cardiomegaly.,Chest X-ray results: The breathing tube is in good position. There is no collapsed lung. There is an area in the lower left lung that appears infected. The heart is slightly larger than normal.,Pulmonology,Radiology Report,high
4385,"27 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 27-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4386,"22 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 22-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4387,"Rx: Tab ASA 81mg daily. Tab Xarelto 20mg daily with dinner. Tab metformin 1000mg BID. Adv: high fiber diet, adequate hydration. F/U 2 weeks.","Your medicines: (1) baby aspirin 81mg once daily [prevents blood clots]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
4388,"Rx: prednisone taper. Tab warfarin 5mg daily. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab losartan 50mg daily. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 week with CBC, CMP.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (4) losartan 50mg once daily [blood pressure medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Pediatrics,Prescription,high
4389,"CBC: WBC 5.0 (N), Hgb 15.1 (N), Plt 39 (L).","Your blood count results: White blood cells are 5.0 (normal). Hemoglobin is normal at 15.1. Platelets are 39, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
4390,"23 y/o F with PMH of anxiety, CAD, Parkinson's disease, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on calcium + vitamin D 600/400 daily, metoprolol 25mg BID. F/U PCP in 1 week.","A 23-year-old woman with a history of anxiety, coronary artery disease [heart artery blockages], and Parkinson's disease was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) calcium plus vitamin D once daily [bone strengthening]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the primary care doctor in 1 week.",Gastroenterology,Discharge Summary,high
4391,"CBC: WBC 4.8 (N), Hgb 16.7 (N), Plt 421 (H).","Your blood count results: White blood cells are 4.8 (normal). Hemoglobin is normal at 16.7. Platelets are 421, which is high — your blood may clot too easily.",Hematology,Lab Result,high
4392,HbA1c: 13.8% (H). FBS: 88 mg/dL (N).,"Your diabetes blood test results: HbA1c is 13.8%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 88, which is normal (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4393,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4394,Procedure: R TKA. Pt 27 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 27-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
4395,"85 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 85-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
4396,"83 y/o M with PMH of gout, s/p CABG, GERD, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on methotrexate 15mg weekly, pregabalin 75mg BID, rosuvastatin 10mg QHS, levothyroxine 75mcg daily on empty stomach. F/U orthopedics in 6 weeks with X-ray.","A 83-year-old man with a history of gout, prior heart bypass surgery, and acid reflux was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) pregabalin 75mg twice daily [nerve pain medicine]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
4397,"CBC: WBC 13.0 (H), Hgb 12.9 (N), Plt 404 (H).","Your blood count results: White blood cells are 13.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 12.9. Platelets are 404, which is high — your blood may clot too easily.",Hematology,Lab Result,high
4398,CXR PA: Right middle lobe atelectasis. Patchy bilateral infiltrates. Cardiomegaly with CTR >0.5. Port-a-cath in appropriate position. Right-sided pneumothorax.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The heart appears larger than normal. The implanted medication port is in the correct position. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax].",Pulmonology,Radiology Report,high
4399,"91 y/o F with PMH of HFrEF (EF 30%), PAD, OA, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Compression stockings when ambulating. D/C on warfarin 5mg daily, metformin 500mg BID. F/U wound care in 3 days.","A 91-year-old woman with a history of heart failure with weak pumping (30%), poor blood flow in the legs [peripheral artery disease], and arthritis [osteoarthritis] was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up at the wound care clinic in 3 days.",Infectious Disease,Discharge Summary,high
4400,CXR PA: Port-a-cath in appropriate position. Increased interstitial markings suggesting pulmonary edema. Bilateral hilar lymphadenopathy.,"Chest X-ray results: The implanted medication port is in the correct position. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
4401,"51 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 51-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4402,"53 y/o M with PMH of PAD, anemia, OSA on CPAP, s/p THR, A-fib, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on empagliflozin 10mg daily, metformin 500mg BID. F/U pulmonology in 2 weeks.","A 53-year-old man with a history of poor blood flow in the legs [peripheral artery disease], low blood count [anemia], sleep apnea [uses a breathing machine at night], prior hip replacement, and irregular heartbeat [atrial fibrillation] was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (2) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the lung doctor in 2 weeks.",Endocrinology,Discharge Summary,high
4403,CXR PA: Bilateral pleural effusions. Osseous structures intact. Compression fracture T12.,Chest X-ray results: There is fluid collecting around both lungs. The bones look normal with no fractures. There is a compression fracture [collapsed bone] in the lower spine at T12.,Pulmonology,Radiology Report,high
4404,"73 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 73-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4405,"58 y/o F with PMH of DM1, DM2, CHF, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Strict I&O, daily weights. D/C on Augmentin 875/125 BID x 7 days, azithromycin 500mg day 1 then 250mg x 4 days, atorvastatin 40mg QHS. F/U surgery in 10 days.","A 58-year-old woman with a history of type 1 diabetes, type 2 diabetes, and heart failure was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
4406,"65 y/o M with PMH of CAD, seizure disorder on Keppra, A-fib, s/p TKR, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on spironolactone 25mg daily, furosemide 40mg daily, calcium + vitamin D 600/400 daily, acetaminophen 650mg Q6H PRN, Augmentin 875/125 BID x 7 days. F/U surgery in 2 weeks for drain removal.","A 65-year-old man with a history of coronary artery disease [heart artery blockages], seizure disorder [on Keppra], irregular heartbeat [atrial fibrillation], and prior knee replacement was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) calcium plus vitamin D once daily [bone strengthening]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (5) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the surgeon in 2 weeks to remove the drain.",Infectious Disease,Discharge Summary,high
4407,"Rx: Spiriva 18mcg daily. Tab sertraline 50mg daily. Adv: SMBG BID, diabetic diet. F/U 1 month with repeat imaging.",Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 month — a repeat scan will be ordered.,Pulmonology,Prescription,medium
4408,"71 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 71-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4409,"45 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 45-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4410,Procedure: Port-a-cath placement. Pt 84 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 84-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
4411,"Rx: Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab Eliquis 5mg BID. Tab levothyroxine 75mcg daily on empty stomach. Do not stop abruptly, taper as directed. F/U INR in 3 days.","Your medicines: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (2) Eliquis 5mg twice daily [blood thinner]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 3 days for a blood thinner level check [INR].",Endocrinology,Prescription,medium
4412,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4413,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage. 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. No mass effect.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
4414,Procedure: PCI with DES to LAD. Pt 26 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 26-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4415,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
4416,"71 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 71-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4417,"Rx: Tab escitalopram 10mg daily. Tab metoprolol succinate 50mg daily. Tab carvedilol 12.5mg BID. Adv: high fiber diet, adequate hydration. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) carvedilol 12.5mg twice daily [heart medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
4418,"80 y/o M with PMH of CKD Stage 4, RA on MTX, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on amlodipine 5mg daily, losartan 50mg daily, sertraline 50mg daily. F/U oncology in 1 week.","A 80-year-old man with a history of advanced kidney disease, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) losartan 50mg once daily [blood pressure medicine]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the cancer doctor in 1 week.",Gastroenterology,Discharge Summary,high
4419,CT Head without contrast: Acute ischemic infarct in R MCA territory. 4cm right subdural hematoma with 5mm midline shift. Paranasal sinuses clear. Mild generalized cerebral atrophy appropriate for age. No acute intracranial hemorrhage.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. The sinuses are clear with no infection. There is mild brain shrinkage, which is normal for your age. There is no bleeding in the brain.",Neurology,Radiology Report,high
4420,"23 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 23-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4421,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
4422,"33 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 33-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4423,"Lipid panel: TC 123, LDL 76, HDL 41, TG 142.",Your cholesterol results: Total cholesterol is 123. LDL (bad cholesterol) is at goal (76). HDL (good cholesterol) is good at 41. Triglycerides are normal at 142.,Cardiology,Lab Result,medium
4424,"61 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 61-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4425,HbA1c: 8.1% (H). FBS: 193 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.1%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 193, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
4426,"71 y/o F with PMH of HFpEF, GERD, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on metformin 500mg BID, omeprazole 20mg AC breakfast, furosemide 40mg daily, potassium chloride 20mEq daily, carvedilol 12.5mg BID. F/U hematology in 2 weeks.","A 71-year-old woman with a history of heart failure with stiff heart muscle, and acid reflux was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) omeprazole 20mg before breakfast [acid-reducing medicine]; (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (5) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Psychiatry,Discharge Summary,high
4427,"Rx: Tab amlodipine 10mg daily. Tab ibuprofen 400mg Q6H PRN with food. Tab carvedilol 12.5mg BID. Tab ciprofloxacin 500mg BID x 5 days. Lantus 20U QHS. Adv: low potassium diet. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (3) carvedilol 12.5mg twice daily [heart medicine]. (4) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (5) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,high
4428,"80 y/o F with PMH of HFpEF, CKD Stage 3, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on Augmentin 875/125 BID x 7 days, amlodipine 10mg daily. F/U hematology in 2 weeks.","A 80-year-old woman with a history of heart failure with stiff heart muscle, and moderate kidney disease was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",General Surgery,Discharge Summary,high
4429,"Thyroid panel: TSH 2.08 (N), Free T4 2.7.",Your thyroid test results: TSH is normal at 2.08. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
4430,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. Mild generalized cerebral atrophy appropriate for age. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There is mild brain shrinkage, which is normal for your age. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
4431,"24 y/o F presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 24-year-old woman came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
4432,CT Head without contrast: Paranasal sinuses clear. 4cm right subdural hematoma with 5mm midline shift. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: The sinuses are clear with no infection. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
4433,"Rx: Tab lisinopril 20mg daily. Tab omeprazole 20mg AC breakfast. Lantus 20U QHS. Adv: high fiber diet, adequate hydration Avoid grapefruit juice. F/U 1 month with repeat imaging.","Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. (3) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Do not drink grapefruit juice as it interferes with this medication. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
4434,"87 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 87-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4435,"65 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 65-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4436,"83 y/o F with PMH of A-fib, ICD in situ, h/o TIA, BPH, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on clopidogrel 75mg daily, ASA 81mg daily, potassium chloride 20mEq daily, timolol 0.5% OU BID. F/U surgery in 10 days.","A 83-year-old woman with a history of irregular heartbeat [atrial fibrillation], implanted heart defibrillator, history of mini-stroke, and enlarged prostate was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (4) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up with the surgeon in 10 days.",Infectious Disease,Discharge Summary,high
4437,"Rx: Tab spironolactone 25mg daily. Spiriva 18mcg daily. Tab levothyroxine 75mcg daily on empty stomach. Do not stop abruptly, taper as directed Adv: SMBG BID, diabetic diet. F/U 2 weeks with INR.",Your medicines: (1) spironolactone 25mg once daily [heart-protecting water pill]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,medium
4438,"39 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 39-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4439,"Rx: Tab entresto 49/51mg BID. Tab atorvastatin 80mg QHS. Tab spironolactone 25mg daily. Do not stop abruptly, taper as directed. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (3) spironolactone 25mg once daily [heart-protecting water pill]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
4440,"77 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 77-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4441,"53 y/o F with PMH of SLE, s/p TKR, h/o CVA, HLD, CHF, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Compression stockings when ambulating. D/C on atorvastatin 80mg QHS, pantoprazole 40mg AC breakfast, glipizide 5mg BID AC, tramadol 50mg Q6H PRN pain, timolol 0.5% OU BID. F/U nephrology in 1 week.","A 53-year-old woman with a history of lupus, prior knee replacement, history of stroke, high cholesterol, and heart failure was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (5) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
4442,"76 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 76-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4443,CXR PA: Compression fracture T12. Clear lung fields bilaterally. Increased interstitial markings suggesting pulmonary edema. Cardiomegaly with CTR >0.5.,"Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. Both lungs look clear with no problems. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. The heart appears larger than normal.",Pulmonology,Radiology Report,high
4444,HbA1c: 12.0% (H). FBS: 309 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.0%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 309, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4445,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
4446,"BMP: Na 138 (N), K 3.9 (N), BUN 90, Cr 5.8 (H), Glucose 265.","Your blood chemistry results: Sodium is normal at 138. Potassium is normal at 3.9. Creatinine is elevated at 5.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 265 (high).",Nephrology,Lab Result,high
4447,"US Abdomen: Ascites moderate amount. Left kidney 8cm, cortical thinning consistent with CKD. CBD 5mm, not dilated. GB wall thickening with stones, positive Murphy's sign. Pancreas unremarkable.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. Left kidney is small with thin outer layer, consistent with chronic kidney disease. The bile duct is normal size [not blocked]. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The pancreas looks normal.",Gastroenterology,Radiology Report,high
4448,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
4449,"87 y/o F with PMH of ESRD on HD, s/p CABG, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on carvedilol 12.5mg BID, amlodipine 5mg daily. F/U hematology in 2 weeks.","A 87-year-old woman with a history of kidney failure requiring dialysis, and prior heart bypass surgery was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Cardiology,Discharge Summary,high
4450,"58 y/o F with PMH of PPM in situ, A-fib, gout, OSA on CPAP, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Compression stockings when ambulating. D/C on Xarelto 20mg daily with dinner, warfarin 5mg daily, carvedilol 12.5mg BID, atorvastatin 40mg QHS, amlodipine 10mg daily. F/U cardiology in 2 weeks.","A 58-year-old woman with a history of implanted pacemaker, irregular heartbeat [atrial fibrillation], gout, and sleep apnea [uses a breathing machine at night] was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) atorvastatin 40mg at bedtime [cholesterol medicine]; (5) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the heart doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4451,"CBC: WBC 11.7 (H), Hgb 12.3 (N), Plt 222 (N).","Your blood count results: White blood cells are 11.7 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 12.3. Platelets are 222, which is normal.",Hematology,Lab Result,high
4452,CXR PA: Right middle lobe atelectasis. Osseous structures intact. Right lower lobe consolidation. Bilateral hilar lymphadenopathy.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The bones look normal with no fractures. There is an area in the lower right lung that appears infected, suggesting pneumonia. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
4453,"49 y/o M with PMH of seizure disorder on Keppra, anemia, hypothyroidism, obesity (BMI 38), OSA on CPAP, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on Xarelto 20mg daily with dinner, metoprolol 25mg BID. F/U PCP in 2 weeks.","A 49-year-old man with a history of seizure disorder [on Keppra], low blood count [anemia], underactive thyroid, obesity, and sleep apnea [uses a breathing machine at night] was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
4454,"51 y/o F with PMH of anemia, osteoporosis, obesity (BMI 38), gout, cirrhosis, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on ibuprofen 400mg Q6H PRN with food, atorvastatin 40mg QHS, albuterol MDI 2 puffs Q4-6H PRN, metoprolol 25mg BID, tramadol 50mg Q6H PRN pain. F/U PCP in 2 weeks.","A 51-year-old woman with a history of low blood count [anemia], weak bones [osteoporosis], obesity, gout, and liver scarring [cirrhosis] was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (4) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
4455,"58 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 58-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4456,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4457,Delivery Note: G?P? at 38+2 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4458,"BMP: Na 147 (H), K 6.8 (H), BUN 29, Cr 6.1 (H), Glucose 60.","Your blood chemistry results: Sodium is high at 147, meaning you may be dehydrated. Potassium is dangerously high at 6.8 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 6.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 60 (low).",Nephrology,Lab Result,high
4459,"US Abdomen: Left kidney 8cm, cortical thinning consistent with CKD. Pancreas unremarkable. Ascites moderate amount.","Abdominal ultrasound results: Left kidney is small with thin outer layer, consistent with chronic kidney disease. The pancreas looks normal. There is a moderate amount of fluid in the belly [ascites].",Gastroenterology,Radiology Report,high
4460,"BMP: Na 144 (N), K 5.3 (H), BUN 12, Cr 3.9 (H), Glucose 333.","Your blood chemistry results: Sodium is normal at 144. Potassium is high at 5.3 — needs monitoring. Creatinine is elevated at 3.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 333 (high).",Nephrology,Lab Result,high
4461,"BMP: Na 136 (N), K 4.6 (N), BUN 7, Cr 3.5 (H), Glucose 306.","Your blood chemistry results: Sodium is normal at 136. Potassium is normal at 4.6. Creatinine is elevated at 3.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 306 (high).",Nephrology,Lab Result,high
4462,"Rx: Tab clopidogrel 75mg daily. Tab latanoprost 0.005% OU QHS. Tab sertraline 50mg daily. Adv: avoid alcohol, hepatotoxic drugs. F/U PCP in 1 week for BP recheck.",Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
4463,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4464,CXR PA: Hyperinflated lungs consistent with COPD. Cardiomegaly with CTR >0.5. No cardiomegaly. Mild cardiomegaly. Right middle lobe atelectasis.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The heart appears larger than normal. The heart is a normal size. The heart is slightly larger than normal. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging.",Pulmonology,Radiology Report,high
4465,Procedure: Colonoscopy with polypectomy. Pt 56 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 56-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4466,Delivery Note: G?P? at 40+0 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4467,Procedure: Colonoscopy with polypectomy. Pt 36 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 36-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4468,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
4469,"Rx: Tab lisinopril 10mg daily. Tab empagliflozin 10mg daily. Tab potassium chloride 20mEq daily. Adv: elevate affected limb, compression stockings Avoid NSAIDs. F/U 2 weeks.",Your medicines: (1) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: keep the affected leg elevated when resting and wear compression stockings Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
4470,"BMP: Na 123 (L), K 2.8 (L), BUN 57, Cr 2.1 (H), Glucose 137.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is low at 2.8 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 2.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 137 (high).",Nephrology,Lab Result,high
4471,"Rx: Tab losartan 50mg daily. Tab glipizide 5mg BID AC. Do not stop abruptly, taper as directed Adv: smoking cessation, pulmonary rehab. F/U 2 weeks.",Your medicines: (1) losartan 50mg once daily [blood pressure medicine]. (2) glipizide 5mg twice daily before meals [helps release insulin]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
4472,"Lipid panel: TC 260, LDL 172, HDL 44, TG 177.","Your cholesterol results: Total cholesterol is 260. LDL (bad cholesterol) is very high at 172 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 44. Triglycerides are high at 177.",Cardiology,Lab Result,high
4473,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4474,"Rx: Tab clopidogrel 75mg daily. Tab spironolactone 25mg daily. Do not stop abruptly, taper as directed Adv: DASH diet, daily BP monitoring. F/U 6 weeks with LFTs.","Your medicines: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]. (2) spironolactone 25mg once daily [heart-protecting water pill]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,low
4475,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. No mass effect. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain.",Neurology,Radiology Report,high
4476,Delivery Note: G?P? at 37+3 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4477,"Rx: Tab omeprazole 20mg AC breakfast. Tab amoxicillin 500mg TID x 10 days. Tab Augmentin 875/125 BID x 7 days. Tab ASA 81mg daily. Adv: high fiber diet, adequate hydration Do not stop abruptly, taper as directed. F/U 1 week with CBC, CMP.","Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. (4) baby aspirin 81mg once daily [prevents blood clots]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Infectious Disease,Prescription,high
4478,"BMP: Na 143 (N), K 3.6 (N), BUN 49, Cr 4.7 (H), Glucose 224.","Your blood chemistry results: Sodium is normal at 143. Potassium is normal at 3.6. Creatinine is elevated at 4.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 224 (high).",Nephrology,Lab Result,high
4479,"68 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 68-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4480,"Rx: Tab amlodipine 5mg daily. Tab metformin 1000mg BID. Adv: avoid alcohol, hepatotoxic drugs. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) metformin 1000mg twice daily with meals [blood sugar medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
4481,"MRI Lumbar Spine: Conus medullaris at L1, normal. L4-L5 disc herniation with moderate bilateral foraminal stenosis.","MRI of the lower back results: The spinal cord ends at a normal level. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
4482,"23 y/o M with PMH of ESRD on HD, h/o TIA, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on metformin 500mg BID, Xarelto 20mg daily with dinner, atorvastatin 80mg QHS, Dulcolax 10mg QHS PRN. F/U pulmonology in 2 weeks.","A 23-year-old man with a history of kidney failure requiring dialysis, and history of mini-stroke was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (4) Dulcolax 10mg at bedtime as needed [for constipation]. Follow-up with the lung doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4483,"BMP: Na 122 (L), K 6.8 (H), BUN 29, Cr 6.5 (H), Glucose 318.","Your blood chemistry results: Sodium is low at 122 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.8 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 6.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 318 (high).",Nephrology,Lab Result,high
4484,CXR PA: Small left pleural effusion. Compression fracture T12. Port-a-cath in appropriate position. Mild cardiomegaly. Right lower lobe consolidation.,"Chest X-ray results: There is a small amount of fluid around the left lung. There is a compression fracture [collapsed bone] in the lower spine at T12. The implanted medication port is in the correct position. The heart is slightly larger than normal. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
4485,"Rx: Tab Xarelto 20mg daily with dinner. Tab methotrexate 15mg weekly. Tab gabapentin 300mg TID. Tab Dulcolax 10mg QHS PRN. Adv: SMBG BID, diabetic diet. F/U 1 week with wound check.",Your medicines: (1) Xarelto 20mg once daily with dinner [blood thinner]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week to have the wound checked.,Neurology,Prescription,high
4486,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab ondansetron 4mg Q8H PRN N/V. Do not stop abruptly, taper as directed Avoid grapefruit juice. F/U INR in 3 days.",Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Do not drink grapefruit juice as it interferes with this medication. Come back in 3 days for a blood thinner level check [INR].,Infectious Disease,Prescription,medium
4487,"78 y/o M with PMH of SLE, hypothyroidism, depression, PAD, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on atorvastatin 40mg QHS, glipizide 5mg BID AC, levothyroxine 75mcg daily on empty stomach, Eliquis 5mg BID, hydroxychloroquine 200mg BID. F/U wound care in 3 days.","A 78-year-old man with a history of lupus, underactive thyroid, depression, and poor blood flow in the legs [peripheral artery disease] was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) glipizide 5mg twice daily before meals [helps release insulin]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (4) Eliquis 5mg twice daily [blood thinner]; (5) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up at the wound care clinic in 3 days.",Hematology,Discharge Summary,high
4488,"53 y/o F with PMH of hypothyroidism, PAD, PPM in situ, seizure disorder on Keppra, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on tramadol 50mg Q6H PRN pain, metoprolol 25mg BID, Augmentin 875/125 BID x 7 days. F/U INR check in 3 days.","A 53-year-old woman with a history of underactive thyroid, poor blood flow in the legs [peripheral artery disease], implanted pacemaker, and seizure disorder [on Keppra] was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
4489,"Rx: Tab entresto 49/51mg BID. Tab sertraline 50mg daily. Avoid NSAIDs. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,low
4490,"CBC: WBC 4.5 (N), Hgb 15.1 (N), Plt 124 (L).","Your blood count results: White blood cells are 4.5 (normal). Hemoglobin is normal at 15.1. Platelets are 124, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
4491,Procedure: ERCP with sphincterotomy. Pt 63 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 63-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4492,CXR PA: No cardiomegaly. Elevated left hemidiaphragm. Widened mediastinum. Sternotomy wires intact.,"Chest X-ray results: The heart is a normal size. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The space between the lungs appears wider than normal, which needs further evaluation. The wires from prior heart surgery are intact.",Pulmonology,Radiology Report,high
4493,CXR PA: Right-sided pneumothorax. Pacemaker leads in appropriate position. No cardiomegaly.,Chest X-ray results: The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The pacemaker wires are in the correct position. The heart is a normal size.,Pulmonology,Radiology Report,high
4494,CT Head without contrast: Paranasal sinuses clear. Acute ischemic infarct in R MCA territory. 4cm right subdural hematoma with 5mm midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease.,"CT scan of the head results: The sinuses are clear with no infection. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time.",Neurology,Radiology Report,high
4495,"22 y/o F presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 22-year-old woman came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
4496,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Tab atorvastatin 40mg QHS. Tab gabapentin 300mg TID. Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with INR.",Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks for a blood thinner level check [INR].,Cardiology,Prescription,low
4497,"75 y/o F with PMH of ESRD on HD, gout, SLE, CKD Stage 3, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on rosuvastatin 10mg QHS, Lantus 20U QHS. F/U endocrine in 1 week.","A 75-year-old woman with a history of kidney failure requiring dialysis, gout, lupus, and moderate kidney disease was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the hormone/diabetes doctor in 1 week.",Cardiology,Discharge Summary,high
4498,CXR PA: Right middle lobe atelectasis. Increased interstitial markings suggesting pulmonary edema. No pneumothorax.,"Chest X-ray results: Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There is no collapsed lung.",Pulmonology,Radiology Report,high
4499,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4500,CXR PA: Sternotomy wires intact. Bilateral pleural effusions. No pneumothorax. Port-a-cath in appropriate position. Mild cardiomegaly.,Chest X-ray results: The wires from prior heart surgery are intact. There is fluid collecting around both lungs. There is no collapsed lung. The implanted medication port is in the correct position. The heart is slightly larger than normal.,Pulmonology,Radiology Report,high
4501,HbA1c: 8.1% (H). FBS: 348 mg/dL (H).,"Your diabetes blood test results: HbA1c is 8.1%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 348, which is high (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
4502,"91 y/o F with PMH of h/o CVA, GERD, s/p CABG, CKD Stage 4, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on glipizide 5mg BID AC, pantoprazole 40mg AC breakfast, Spiriva 18mcg daily. F/U pulmonology in 2 weeks.","A 91-year-old woman with a history of history of stroke, acid reflux, prior heart bypass surgery, and advanced kidney disease was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) glipizide 5mg twice daily before meals [helps release insulin]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the lung doctor in 2 weeks.",Cardiology,Discharge Summary,high
4503,"Rx: Tab entresto 49/51mg BID. Tab metoprolol succinate 50mg daily. Tab sertraline 50mg daily. Tab escitalopram 10mg daily. Avoid grapefruit juice Adv: smoking cessation, pulmonary rehab. F/U PCP in 1 week for BP recheck.",Your medicines: (1) Entresto 49/51mg twice daily [heart failure medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Do not drink grapefruit juice as it interferes with this medication Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,high
4504,"28 y/o M with PMH of CKD Stage 3, depression, CAD, CKD Stage 4, HTN, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Compression stockings when ambulating. D/C on Xarelto 20mg daily with dinner, lisinopril 20mg daily, ciprofloxacin 500mg BID x 5 days, azithromycin 500mg day 1 then 250mg x 4 days, acetaminophen 650mg Q6H PRN. F/U INR check in 3 days.","A 28-year-old man with a history of moderate kidney disease, depression, coronary artery disease [heart artery blockages], advanced kidney disease, and high blood pressure was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up for a blood thinner level check in 3 days.",Infectious Disease,Discharge Summary,high
4505,"BMP: Na 130 (L), K 6.1 (H), BUN 25, Cr 7.3 (H), Glucose 350.","Your blood chemistry results: Sodium is low at 130 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.1 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 7.3 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 350 (high).",Nephrology,Lab Result,high
4506,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. Pancreas unremarkable. No focal hepatic lesion. Moderate right hydronephrosis. CBD 5mm, not dilated. Ascites moderate amount.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The pancreas looks normal. No tumors or masses were found in the liver. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The bile duct is normal size [not blocked]. There is a moderate amount of fluid in the belly [ascites].",Gastroenterology,Radiology Report,high
4507,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
4508,"Rx: Tab potassium chloride 20mEq daily. Tab timolol 0.5% OU BID. Tab lisinopril 20mg daily. Adv: weight bearing exercise, calcium/vit D supplementation Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with INR.","Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (3) lisinopril 20mg once daily [blood pressure medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
4509,"52 y/o M with PMH of osteoporosis, s/p THR, CHF, h/o TIA, cirrhosis, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Dulcolax 10mg QHS PRN, tramadol 50mg Q6H PRN pain, metoprolol succinate 50mg daily, amlodipine 10mg daily, clopidogrel 75mg daily. F/U orthopedics in 6 weeks with X-ray.","A 52-year-old man with a history of weak bones [osteoporosis], prior hip replacement, heart failure, history of mini-stroke, and liver scarring [cirrhosis] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (4) amlodipine 10mg once daily [blood pressure medicine]; (5) Plavix (clopidogrel) 75mg once daily [blood thinner]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Pulmonology,Discharge Summary,high
4510,"BMP: Na 139 (N), K 5.8 (H), BUN 38, Cr 6.8 (H), Glucose 114.","Your blood chemistry results: Sodium is normal at 139. Potassium is dangerously high at 5.8 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 6.8 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 114 (high).",Nephrology,Lab Result,high
4511,"Rx: Tab amlodipine 5mg daily. Tab amoxicillin 500mg TID x 10 days. Tab metoprolol 25mg BID. Adv: fall precautions, home safety evaluation. F/U 1 month with repeat imaging.","Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 month — a repeat scan will be ordered.",Pediatrics,Prescription,low
4512,"BMP: Na 142 (N), K 4.3 (N), BUN 52, Cr 5.7 (H), Glucose 264.","Your blood chemistry results: Sodium is normal at 142. Potassium is normal at 4.3. Creatinine is elevated at 5.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 264 (high).",Nephrology,Lab Result,high
4513,"CBC: WBC 20.2 (H), Hgb 5.1 (L), Plt 28 (L).","Your blood count results: White blood cells are 20.2 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 5.1, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 28, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
4514,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Tab ciprofloxacin 500mg BID x 5 days. Tab metformin 500mg BID. Tab Eliquis 5mg BID. Tab tramadol 50mg Q6H PRN pain. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 1 month with repeat imaging.","Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (3) metformin 500mg twice daily with meals [blood sugar medicine]. (4) Eliquis 5mg twice daily [blood thinner]. (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 1 month — a repeat scan will be ordered.",Endocrinology,Prescription,high
4515,"90 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 90-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4516,"36 y/o M with PMH of CKD Stage 4, hypothyroidism, HFpEF, DM2, RA on MTX, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on levothyroxine 75mcg daily on empty stomach, Eliquis 5mg BID, pantoprazole 40mg AC breakfast. F/U wound care in 3 days.","A 36-year-old man with a history of advanced kidney disease, underactive thyroid, heart failure with stiff heart muscle, type 2 diabetes, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) Eliquis 5mg twice daily [blood thinner]; (3) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up at the wound care clinic in 3 days.",Endocrinology,Discharge Summary,high
4517,"88 y/o M with PMH of RA on MTX, HLD, anxiety, h/o TIA, anemia, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on sertraline 50mg daily, azithromycin 500mg day 1 then 250mg x 4 days, Augmentin 875/125 BID x 7 days. F/U PCP in 2 weeks.","A 88-year-old man with a history of rheumatoid arthritis [on immune-suppressing medicine], high cholesterol, anxiety, history of mini-stroke, and low blood count [anemia] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the primary care doctor in 2 weeks.",Pulmonology,Discharge Summary,high
4518,CXR PA: Hyperinflated lungs consistent with COPD. Right lower lobe consolidation. Bilateral hilar lymphadenopathy.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There is an area in the lower right lung that appears infected, suggesting pneumonia. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
4519,"53 y/o M with PMH of A-fib, gout, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on timolol 0.5% OU BID, potassium chloride 20mEq daily, montelukast 10mg QHS. F/U wound care in 3 days.","A 53-year-old man with a history of irregular heartbeat [atrial fibrillation], and gout was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up at the wound care clinic in 3 days.",Nephrology,Discharge Summary,high
4520,"BMP: Na 142 (N), K 4.2 (N), BUN 24, Cr 7.0 (H), Glucose 338.","Your blood chemistry results: Sodium is normal at 142. Potassium is normal at 4.2. Creatinine is elevated at 7.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 338 (high).",Nephrology,Lab Result,high
4521,MRI Lumbar Spine: No compression fracture. C5-C6 disc herniation with cord compression. L4-L5 disc herniation with moderate bilateral foraminal stenosis.,"MRI of the lower back results: No bones are broken or collapsed. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides.",Orthopedics,Radiology Report,high
4522,HbA1c: 6.7% (H). FBS: 400 mg/dL (H).,"Your diabetes blood test results: HbA1c is 6.7%, which is at the diabetes target. Your diabetes is reasonably well controlled. Fasting blood sugar was 400, which is high (normal is 70-100). Continue current diabetes treatment plan.",Endocrinology,Lab Result,high
4523,"Rx: Tab atorvastatin 80mg QHS. Tab Dulcolax 10mg QHS PRN. Tab losartan 50mg daily. Tab entresto 49/51mg BID. Tab methotrexate 15mg weekly. Avoid grapefruit juice Adv: SMBG BID, diabetic diet. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (2) Dulcolax 10mg at bedtime as needed [for constipation]. (3) losartan 50mg once daily [blood pressure medicine]. (4) Entresto 49/51mg twice daily [heart failure medicine]. (5) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Do not drink grapefruit juice as it interferes with this medication Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,high
4524,Procedure: Colonoscopy with polypectomy. Pt 69 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 69-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4525,CXR PA: No cardiomegaly. Small left pleural effusion. Elevated left hemidiaphragm. Bilateral pleural effusions.,Chest X-ray results: The heart is a normal size. There is a small amount of fluid around the left lung. The left side of the breathing muscle [diaphragm] is sitting higher than normal. There is fluid collecting around both lungs.,Pulmonology,Radiology Report,high
4526,"90 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 90-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4527,"84 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 84-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4528,"44 y/o F with PMH of HFpEF, PAD, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on metoprolol 25mg BID, ibuprofen 400mg Q6H PRN with food. F/U nephrology in 5 days.","A 44-year-old woman with a history of heart failure with stiff heart muscle, and poor blood flow in the legs [peripheral artery disease] was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the kidney doctor in 5 days.",Gastroenterology,Discharge Summary,high
4529,"Rx: Tab pantoprazole 40mg AC breakfast. Tab metformin 500mg BID. Tab omeprazole 20mg AC breakfast. Lantus 20U QHS. Adv: low potassium diet. F/U 1 week with CBC, CMP.","Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) metformin 500mg twice daily with meals [blood sugar medicine]. (3) omeprazole 20mg before breakfast [acid-reducing medicine]. (4) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Gastroenterology,Prescription,high
4530,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab furosemide 40mg daily. Adv: high fiber diet, adequate hydration. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Cardiology,Prescription,medium
4531,"MRI Lumbar Spine: Conus medullaris at L1, normal. Multilevel degenerative disc disease. C5-C6 disc herniation with cord compression. Central canal stenosis at L3-L4.","MRI of the lower back results: The spinal cord ends at a normal level. Multiple discs in the spine are showing wear and aging. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
4532,"Rx: Tab warfarin 5mg daily. Tab ASA 81mg daily. Adv: low salt low sugar diet, regular exercise Avoid NSAIDs. F/U 1 month with repeat imaging.","Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) baby aspirin 81mg once daily [prevents blood clots]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
4533,"88 y/o F presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 88-year-old woman came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4534,"72 y/o M with PMH of anxiety, CAD, OA, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on entresto 49/51mg BID, ibuprofen 400mg Q6H PRN with food, prednisone taper, amlodipine 5mg daily, atorvastatin 40mg QHS. F/U orthopedics in 6 weeks with X-ray.","A 72-year-old man with a history of anxiety, coronary artery disease [heart artery blockages], and arthritis [osteoarthritis] was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) Entresto 49/51mg twice daily [heart failure medicine]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (4) amlodipine 5mg once daily [blood pressure medicine]; (5) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",General Surgery,Discharge Summary,high
4535,"27 y/o M with PMH of HFpEF, osteoporosis, OA, OSA on CPAP, ICD in situ, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Compression stockings when ambulating. D/C on amlodipine 5mg daily, levothyroxine 75mcg daily on empty stomach, Eliquis 5mg BID, pantoprazole 40mg AC breakfast, warfarin 5mg daily. F/U neurology in 2 weeks.","A 27-year-old man with a history of heart failure with stiff heart muscle, weak bones [osteoporosis], arthritis [osteoarthritis], sleep apnea [uses a breathing machine at night], and implanted heart defibrillator was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) Eliquis 5mg twice daily [blood thinner]; (4) pantoprazole 40mg before breakfast [acid-reducing medicine]; (5) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Follow-up with the brain/nerve doctor in 2 weeks.",Endocrinology,Discharge Summary,high
4536,"Rx: Tab carvedilol 12.5mg BID. Tab ASA 81mg daily. Do not stop abruptly, taper as directed. F/U 2 weeks.",Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) baby aspirin 81mg once daily [prevents blood clots]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back for a check-up in 2 weeks.,Cardiology,Prescription,medium
4537,"83 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 83-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
4538,"58 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 58-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4539,MRI Lumbar Spine: No compression fracture. C5-C6 disc herniation with cord compression.,"MRI of the lower back results: No bones are broken or collapsed. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
4540,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
4541,"Rx: Tab metoprolol 25mg BID. Tab atorvastatin 40mg QHS. Tab amlodipine 5mg daily. Adv: smoking cessation, pulmonary rehab. F/U PCP in 1 week for BP recheck.",Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) amlodipine 5mg once daily [blood pressure medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,medium
4542,"50 y/o M with PMH of HTN, seizure disorder on Keppra, GERD, CKD Stage 3, OSA on CPAP, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on lisinopril 20mg daily, metoprolol succinate 50mg daily, rosuvastatin 10mg QHS, amoxicillin 500mg TID x 10 days. F/U surgery in 2 weeks for drain removal.","A 50-year-old man with a history of high blood pressure, seizure disorder [on Keppra], acid reflux, moderate kidney disease, and sleep apnea [uses a breathing machine at night] was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the surgeon in 2 weeks to remove the drain.",Orthopedics,Discharge Summary,high
4543,"LFTs: AST 319 (H), ALT 599 (H), ALP 161, T.Bili 7.1 (H), Albumin 3.7.","Your liver blood test results: Liver enzymes (AST 319, ALT 599) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 7.1 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.7.",Gastroenterology,Lab Result,high
4544,"84 y/o M with PMH of OSA on CPAP, h/o TIA, A-fib, CKD Stage 4, s/p CABG, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. Strict I&O, daily weights. D/C on Lantus 20U QHS, ciprofloxacin 500mg BID x 5 days, tramadol 50mg Q6H PRN pain, amlodipine 10mg daily, gabapentin 300mg TID. F/U pulmonology in 2 weeks.","A 84-year-old man with a history of sleep apnea [uses a breathing machine at night], history of mini-stroke, irregular heartbeat [atrial fibrillation], advanced kidney disease, and prior heart bypass surgery was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (4) amlodipine 10mg once daily [blood pressure medicine]; (5) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the lung doctor in 2 weeks.",General Surgery,Discharge Summary,high
4545,HbA1c: 9.2% (H). FBS: 65 mg/dL (L).,"Your diabetes blood test results: HbA1c is 9.2%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 65, which is low — risk of hypoglycemia (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
4546,HbA1c: 12.3% (H). FBS: 339 mg/dL (H).,"Your diabetes blood test results: HbA1c is 12.3%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 339, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4547,"49 y/o F with PMH of DM1, CAD, OA, s/p CABG, admitted for syncope. Cardiac workup and neurologic evaluation performed. Managed per protocol with improvement. Low potassium diet. D/C on metformin 1000mg BID, entresto 49/51mg BID. F/U cardiology in 2 weeks.","A 49-year-old woman with a history of type 1 diabetes, coronary artery disease [heart artery blockages], arthritis [osteoarthritis], and prior heart bypass surgery was admitted for fainting [loss of consciousness]. Cardiac workup and neurologic evaluation performed. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
4548,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,high
4549,"90 y/o M with PMH of s/p THR, anemia, Parkinson's disease, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on metformin 1000mg BID, empagliflozin 10mg daily, amoxicillin 500mg TID x 10 days. F/U neurology in 2 weeks.","A 90-year-old man with a history of prior hip replacement, low blood count [anemia], and Parkinson's disease was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) metformin 1000mg twice daily with meals [blood sugar medicine]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the brain/nerve doctor in 2 weeks.",Orthopedics,Discharge Summary,high
4550,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
4551,"CBC: WBC 20.6 (H), Hgb 15.4 (N), Plt 489 (H).","Your blood count results: White blood cells are 20.6 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 15.4. Platelets are 489, which is high — your blood may clot too easily.",Hematology,Lab Result,high
4552,"75 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 75-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4553,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
4554,"US Abdomen: Left kidney 8cm, cortical thinning consistent with CKD. Right kidney 10.5cm, no hydronephrosis. Simple renal cysts bilaterally.","Abdominal ultrasound results: Left kidney is small with thin outer layer, consistent with chronic kidney disease. Right kidney is normal size with no blockage. Both kidneys have harmless fluid-filled cysts.",Gastroenterology,Radiology Report,high
4555,CT Head without contrast: Acute ischemic infarct in R MCA territory. Chronic lacunar infarcts in bilateral basal ganglia. No mass effect.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There are signs of small old strokes in the deep parts of the brain. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
4556,CXR PA: Port-a-cath in appropriate position. Patchy bilateral infiltrates. Bilateral hilar lymphadenopathy.,"Chest X-ray results: The implanted medication port is in the correct position. There are scattered cloudy patches in both lungs suggesting infection or inflammation. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
4557,"78 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 78-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4558,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab metoprolol 25mg BID. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab potassium chloride 20mEq daily. Adv: low salt diet, fluid restriction 1.5L/day Adv: wound care with daily dressing changes. F/U 2 weeks.","Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back for a check-up in 2 weeks.",Infectious Disease,Prescription,high
4559,CXR PA: Increased interstitial markings suggesting pulmonary edema. Small left pleural effusion. Cardiomegaly with CTR >0.5. Compression fracture T12.,"Chest X-ray results: There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. There is a small amount of fluid around the left lung. The heart appears larger than normal. There is a compression fracture [collapsed bone] in the lower spine at T12.",Pulmonology,Radiology Report,high
4560,"US Abdomen: Pancreas unremarkable. No focal hepatic lesion. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Moderate right hydronephrosis. Ascites moderate amount.","Abdominal ultrasound results: The pancreas looks normal. No tumors or masses were found in the liver. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. There is a moderate amount of fluid in the belly [ascites].",Gastroenterology,Radiology Report,high
4561,Procedure: PCI with DES to LAD. Pt 79 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 79-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4562,"43 y/o M with PMH of HFrEF (EF 30%), seizure disorder on Keppra, CHF, anxiety, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on Humalog per SSI, timolol 0.5% OU BID, glipizide 5mg BID AC, rosuvastatin 10mg QHS. F/U cardiology in 2 weeks.","A 43-year-old man with a history of heart failure with weak pumping (30%), seizure disorder [on Keppra], heart failure, and anxiety was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) Humalog insulin before meals as directed [fast-acting insulin]; (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the heart doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
4563,"90 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 90-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4564,Procedure: PCI with DES to LAD. Pt 58 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 58-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4565,"LFTs: AST 228 (H), ALT 53 (H), ALP 60, T.Bili 5.6 (H), Albumin 2.6.","Your liver blood test results: Liver enzymes (AST 228, ALT 53) are mildly elevated (normal is under 40). Bilirubin is high at 5.6 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.6 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4566,"68 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 68-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4567,"31 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 31-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4568,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,low
4569,"Rx: Tab Eliquis 5mg BID. Tab levothyroxine 75mcg daily on empty stomach. Adv: low salt low sugar diet, regular exercise. F/U 1 week with wound check.","Your medicines: (1) Eliquis 5mg twice daily [blood thinner]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 1 week to have the wound checked.",Endocrinology,Prescription,medium
4570,CXR PA: NG tube tip in stomach. Osseous structures intact. Clear lung fields bilaterally.,Chest X-ray results: The feeding/drainage tube tip is correctly positioned in the stomach. The bones look normal with no fractures. Both lungs look clear with no problems.,Pulmonology,Radiology Report,high
4571,HbA1c: 13.8% (H). FBS: 143 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.8%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 143, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4572,Procedure: Colonoscopy with polypectomy. Pt 54 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 54-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4573,"US Abdomen: Spleen 11cm, normal. GB sludge, no stones. GB wall thickening with stones, positive Murphy's sign. Moderate right hydronephrosis.","Abdominal ultrasound results: The spleen is a normal size. The gallbladder contains thickened bile [sludge] but no stones. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage.",Gastroenterology,Radiology Report,high
4574,"74 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 74-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4575,"33 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 33-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4576,CXR PA: NG tube tip in stomach. Pacemaker leads in appropriate position. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: The feeding/drainage tube tip is correctly positioned in the stomach. The pacemaker wires are in the correct position. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
4577,Procedure: Laparoscopic cholecystectomy. Pt 49 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 49-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
4578,"57 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 57-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4579,"Rx: Tab metformin 1000mg BID. Tab amlodipine 5mg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab potassium chloride 20mEq daily. Tab timolol 0.5% OU BID. Adv: high fiber diet, adequate hydration. F/U 6 weeks with LFTs.","Your medicines: (1) metformin 1000mg twice daily with meals [blood sugar medicine]. (2) amlodipine 5mg once daily [blood pressure medicine]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (5) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 6 weeks for liver function blood tests.",General,Prescription,high
4580,"69 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 69-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4581,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
4582,"BMP: Na 130 (L), K 2.5 (L), BUN 82, Cr 1.7 (H), Glucose 387.","Your blood chemistry results: Sodium is low at 130 (normal 136-145), meaning too much water in your body. Potassium is low at 2.5 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 1.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 387 (high).",Nephrology,Lab Result,high
4583,CXR PA: Compression fracture T12. Osseous structures intact. Pacemaker leads in appropriate position. Port-a-cath in appropriate position. Widened mediastinum.,"Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. The bones look normal with no fractures. The pacemaker wires are in the correct position. The implanted medication port is in the correct position. The space between the lungs appears wider than normal, which needs further evaluation.",Pulmonology,Radiology Report,high
4584,"US Abdomen: Liver 18cm, diffusely echogenic consistent with hepatic steatosis. CBD 5mm, not dilated. Moderate right hydronephrosis. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The bile duct is normal size [not blocked]. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
4585,"Rx: Tab pantoprazole 40mg AC breakfast. Tab metoprolol succinate 50mg daily. Tab spironolactone 25mg daily. Tab entresto 49/51mg BID. Adv: wound care with daily dressing changes. F/U 1 week with CBC, CMP.","Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (3) spironolactone 25mg once daily [heart-protecting water pill]. (4) Entresto 49/51mg twice daily [heart failure medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
4586,Procedure: ERCP with sphincterotomy. Pt 27 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 27-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4587,CT Head without contrast: Paranasal sinuses clear. Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage. Mild generalized cerebral atrophy appropriate for age.,"CT scan of the head results: The sinuses are clear with no infection. There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain. There is mild brain shrinkage, which is normal for your age.",Neurology,Radiology Report,high
4588,Rx: Tab lisinopril 20mg daily. Tab furosemide 40mg BID. Tab carvedilol 12.5mg BID. Avoid NSAIDs. F/U 1 month with repeat imaging.,Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) carvedilol 12.5mg twice daily [heart medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,medium
4589,Procedure: ORIF L distal radius. Pt 48 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 48-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
4590,"BMP: Na 144 (N), K 3.5 (N), BUN 76, Cr 7.1 (H), Glucose 353.","Your blood chemistry results: Sodium is normal at 144. Potassium is normal at 3.5. Creatinine is elevated at 7.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 353 (high).",Nephrology,Lab Result,high
4591,"85 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 85-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4592,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4593,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,high
4594,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
4595,"Lipid panel: TC 316, LDL 185, HDL 25, TG 112.","Your cholesterol results: Total cholesterol is 316. LDL (bad cholesterol) is very high at 185 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is too low at 25 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are normal at 112.",Cardiology,Lab Result,high
4596,MRI Lumbar Spine: Multilevel degenerative disc disease. No compression fracture.,MRI of the lower back results: Multiple discs in the spine are showing wear and aging. No bones are broken or collapsed.,Orthopedics,Radiology Report,high
4597,"34 y/o M with PMH of cirrhosis, DVT/PE on warfarin, OA, BPH, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on latanoprost 0.005% OU QHS, rosuvastatin 10mg QHS, metoprolol 25mg BID, atorvastatin 80mg QHS. F/U endocrine in 1 week.","A 34-year-old man with a history of liver scarring [cirrhosis], blood clots [on blood thinner warfarin], arthritis [osteoarthritis], and enlarged prostate was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (4) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Follow-up with the hormone/diabetes doctor in 1 week.",Pulmonology,Discharge Summary,high
4598,"CBC: WBC 23.4 (H), Hgb 6.9 (L), Plt 332 (N).","Your blood count results: White blood cells are 23.4 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 6.9, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 332, which is normal.",Hematology,Lab Result,high
4599,CT Head without contrast: Acute ischemic infarct in R MCA territory. Subarachnoid hemorrhage in bilateral sylvian fissures. No midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage.,"CT scan of the head results: There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. There is bleeding around the brain surface, particularly in the grooves on both sides. The brain is centered normally. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain.",Neurology,Radiology Report,high
4600,CXR PA: Compression fracture T12. NG tube tip in stomach. Mild cardiomegaly. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. The feeding/drainage tube tip is correctly positioned in the stomach. The heart is slightly larger than normal. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
4601,"Lipid panel: TC 142, LDL 88, HDL 68, TG 448.",Your cholesterol results: Total cholesterol is 142. LDL (bad cholesterol) is at goal (88). HDL (good cholesterol) is good at 68. Triglycerides are very high at 448 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
4602,CT Head without contrast: Paranasal sinuses clear. 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures.,"CT scan of the head results: The sinuses are clear with no infection. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides.",Neurology,Radiology Report,high
4603,"US Abdomen: Spleen 16cm, splenomegaly. Left kidney 8cm, cortical thinning consistent with CKD. Simple renal cysts bilaterally.","Abdominal ultrasound results: The spleen is enlarged [splenomegaly]. Left kidney is small with thin outer layer, consistent with chronic kidney disease. Both kidneys have harmless fluid-filled cysts.",Gastroenterology,Radiology Report,high
4604,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,high
4605,CXR PA: Small left pleural effusion. Widened mediastinum. Right lower lobe consolidation.,"Chest X-ray results: There is a small amount of fluid around the left lung. The space between the lungs appears wider than normal, which needs further evaluation. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
4606,Procedure: Colonoscopy with polypectomy. Pt 70 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 70-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4607,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4608,"Lipid panel: TC 194, LDL 143, HDL 49, TG 172.",Your cholesterol results: Total cholesterol is 194. LDL (bad cholesterol) is high at 143 (goal under 100). HDL (good cholesterol) is good at 49. Triglycerides are high at 172.,Cardiology,Lab Result,high
4609,Delivery Note: G?P? at 40+0 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4610,CT Head without contrast: No mass effect. Mild generalized cerebral atrophy appropriate for age. 4cm right subdural hematoma with 5mm midline shift. Chronic lacunar infarcts in bilateral basal ganglia. No midline shift.,"CT scan of the head results: There are no tumors or masses pushing on the brain. There is mild brain shrinkage, which is normal for your age. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are signs of small old strokes in the deep parts of the brain. The brain is centered normally.",Neurology,Radiology Report,high
4611,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
4612,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4613,"LFTs: AST 10 (N), ALT 148 (H), ALP 281, T.Bili 7.8 (H), Albumin 1.5.","Your liver blood test results: Liver enzymes (AST 10, ALT 148) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is high at 7.8 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 1.5 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4614,"52 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 52-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4615,"US Abdomen: GB sludge, no stones. Ascites moderate amount. Spleen 11cm, normal. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. No focal hepatic lesion. CBD 5mm, not dilated.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. There is a moderate amount of fluid in the belly [ascites]. The spleen is a normal size. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. No tumors or masses were found in the liver. The bile duct is normal size [not blocked].",Gastroenterology,Radiology Report,high
4616,MRI Lumbar Spine: L4-L5 disc herniation with moderate bilateral foraminal stenosis. Central canal stenosis at L3-L4.,"MRI of the lower back results: At the L4-L5 level, a disc has pushed outward [herniated] and is narrowing the nerve tunnels on both sides. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
4617,"22 y/o F with PMH of anxiety, HFpEF, PPM in situ, DM1, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Strict I&O, daily weights. D/C on metformin 500mg BID, ibuprofen 400mg Q6H PRN with food, ondansetron 4mg Q8H PRN N/V, montelukast 10mg QHS, Humalog per SSI. F/U GI in 1 week.","A 22-year-old woman with a history of anxiety, heart failure with stiff heart muscle, implanted pacemaker, and type 1 diabetes was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (4) montelukast 10mg at bedtime [asthma/allergy medicine]; (5) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
4618,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,high
4619,"CBC: WBC 14.1 (H), Hgb 16.0 (N), Plt 450 (H).","Your blood count results: White blood cells are 14.1 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 16.0. Platelets are 450, which is high — your blood may clot too easily.",Hematology,Lab Result,high
4620,"22 y/o F with PMH of anemia, seizure disorder on Keppra, osteoporosis, gout, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on carvedilol 12.5mg BID, entresto 49/51mg BID, Augmentin 875/125 BID x 7 days. F/U nephrology in 5 days.","A 22-year-old woman with a history of low blood count [anemia], seizure disorder [on Keppra], weak bones [osteoporosis], and gout was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]. Follow-up with the kidney doctor in 5 days.",Cardiology,Discharge Summary,high
4621,"US Abdomen: GB sludge, no stones. CBD 12mm, dilated. CBD 5mm, not dilated. No focal hepatic lesion. GB wall thickening with stones, positive Murphy's sign.","Abdominal ultrasound results: The gallbladder contains thickened bile [sludge] but no stones. The bile duct is wider than normal [dilated], which may indicate a blockage. The bile duct is normal size [not blocked]. No tumors or masses were found in the liver. The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection.",Gastroenterology,Radiology Report,high
4622,"57 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 57-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4623,CXR PA: Hyperinflated lungs consistent with COPD. Right-sided pneumothorax. No cardiomegaly. No pneumothorax.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. The heart is a normal size. There is no collapsed lung.",Pulmonology,Radiology Report,high
4624,"LFTs: AST 232 (H), ALT 559 (H), ALP 88, T.Bili 6.2 (H), Albumin 3.5.","Your liver blood test results: Liver enzymes (AST 232, ALT 559) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.2 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 3.5.",Gastroenterology,Lab Result,high
4625,"42 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 42-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4626,CT Head without contrast: Paranasal sinuses clear. No midline shift. Chronic lacunar infarcts in bilateral basal ganglia. 4cm right subdural hematoma with 5mm midline shift. Acute ischemic infarct in R MCA territory.,"CT scan of the head results: The sinuses are clear with no infection. The brain is centered normally. There are signs of small old strokes in the deep parts of the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery.",Neurology,Radiology Report,high
4627,"Rx: Spiriva 18mcg daily. Tab furosemide 40mg BID. Tab amlodipine 5mg daily. Tab Dulcolax 10mg QHS PRN. Adv: wound care with daily dressing changes. F/U 1 week with CBC, CMP.","Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) amlodipine 5mg once daily [blood pressure medicine]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
4628,"79 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 79-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4629,"Thyroid panel: TSH 10.56 (H), Free T4 2.6.","Your thyroid test results: TSH is elevated at 10.56 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
4630,"Rx: Lantus 20U QHS. Humalog per SSI. Adv: low salt diet, fluid restriction 1.5L/day Adv: low potassium diet. F/U 1 week with CBC, CMP.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) Humalog insulin before meals as directed [fast-acting insulin]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,medium
4631,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
4632,"Rx: Tab calcium + vitamin D 600/400 daily. Tab losartan 50mg daily. Tab metoprolol 25mg BID. Tab Dulcolax 10mg QHS PRN. Tab lisinopril 10mg daily. Avoid grapefruit juice Adv: DASH diet, daily BP monitoring. F/U 2 weeks.","Your medicines: (1) calcium plus vitamin D once daily [bone strengthening]. (2) losartan 50mg once daily [blood pressure medicine]. (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. (5) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Do not drink grapefruit juice as it interferes with this medication Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
4633,"82 y/o M with PMH of HTN, s/p TKR, ESRD on HD, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on levothyroxine 75mcg daily on empty stomach, tramadol 50mg Q6H PRN pain, glipizide 5mg BID AC, ondansetron 4mg Q8H PRN N/V, spironolactone 25mg daily. F/U neurology in 2 weeks.","A 82-year-old man with a history of high blood pressure, prior knee replacement, and kidney failure requiring dialysis was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (5) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up with the brain/nerve doctor in 2 weeks.",Endocrinology,Discharge Summary,high
4634,"Rx: Tab sertraline 50mg daily. Tab amoxicillin 500mg TID x 10 days. Adv: DASH diet, daily BP monitoring. F/U 1 month with repeat imaging.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 month — a repeat scan will be ordered.",Psychiatry,Prescription,medium
4635,Procedure: Port-a-cath placement. Pt 86 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 86-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
4636,"79 y/o F with PMH of CKD Stage 4, osteoporosis, CAD, h/o CVA, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on hydroxychloroquine 200mg BID, furosemide 40mg BID, amoxicillin 500mg TID x 10 days, lisinopril 20mg daily. F/U oncology in 1 week.","A 79-year-old woman with a history of advanced kidney disease, weak bones [osteoporosis], coronary artery disease [heart artery blockages], and history of stroke was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) furosemide (Lasix) 40mg twice daily [water pill]; (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (4) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the cancer doctor in 1 week.",Neurology,Discharge Summary,high
4637,"62 y/o F with PMH of HTN, cirrhosis, anxiety, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on ferrous sulfate 325mg BID, Dulcolax 10mg QHS PRN, tramadol 50mg Q6H PRN pain. F/U orthopedics in 6 weeks with X-ray.","A 62-year-old woman with a history of high blood pressure, liver scarring [cirrhosis], and anxiety was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",General Surgery,Discharge Summary,high
4638,"Rx: Tab metoprolol succinate 50mg daily. Tab atorvastatin 80mg QHS. Tab hydroxychloroquine 200mg BID. Tab entresto 49/51mg BID. Tab ASA 81mg daily. Adv: fall precautions, home safety evaluation. F/U 1 week with wound check.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (4) Entresto 49/51mg twice daily [heart failure medicine]. (5) baby aspirin 81mg once daily [prevents blood clots]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
4639,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,low
4640,"68 y/o M with PMH of anemia, h/o CVA, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on Xarelto 20mg daily with dinner, furosemide 40mg daily, Dulcolax 10mg QHS PRN, metoprolol succinate 50mg daily, Eliquis 5mg BID. F/U PCP in 2 weeks.","A 68-year-old man with a history of low blood count [anemia], and history of stroke was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) Xarelto 20mg once daily with dinner [blood thinner]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]; (3) Dulcolax 10mg at bedtime as needed [for constipation]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (5) Eliquis 5mg twice daily [blood thinner]. Follow-up with the primary care doctor in 2 weeks.",Cardiology,Discharge Summary,high
4641,Delivery Note: G?P? at 40+0 weeks. Primary low-transverse C-section. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4642,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab pantoprazole 40mg AC breakfast. Tab ibuprofen 400mg Q6H PRN with food. Tab empagliflozin 10mg daily. Tab metoprolol succinate 50mg daily. Adv: avoid alcohol, hepatotoxic drugs Adv: DASH diet, daily BP monitoring. F/U 2 weeks with INR.","Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) pantoprazole 40mg before breakfast [acid-reducing medicine]. (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (5) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
4643,CXR PA: Port-a-cath in appropriate position. Right middle lobe atelectasis. Left lower lobe consolidation. Patchy bilateral infiltrates.,"Chest X-ray results: The implanted medication port is in the correct position. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. There is an area in the lower left lung that appears infected. There are scattered cloudy patches in both lungs suggesting infection or inflammation.",Pulmonology,Radiology Report,high
4644,"83 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 83-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4645,"Rx: Tab metoprolol 25mg BID. Tab amlodipine 10mg daily. Tab rosuvastatin 10mg QHS. Adv: low salt diet, fluid restriction 1.5L/day Do not stop abruptly, taper as directed. F/U 1 month with repeat imaging.",Your medicines: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) rosuvastatin 10mg at bedtime [cholesterol medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 month — a repeat scan will be ordered.,Cardiology,Prescription,medium
4646,CXR PA: Clear lung fields bilaterally. Widened mediastinum. Moderate right pleural effusion.,"Chest X-ray results: Both lungs look clear with no problems. The space between the lungs appears wider than normal, which needs further evaluation. There is a moderate amount of fluid around the right lung.",Pulmonology,Radiology Report,high
4647,Rx: Tab warfarin 5mg daily. Tab entresto 49/51mg BID. Tab acetaminophen 650mg Q6H PRN. Tab clopidogrel 75mg daily. Adv: wound care with daily dressing changes. F/U 1 month with repeat imaging.,"Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
4648,"Rx: Tab lisinopril 20mg daily. Tab ondansetron 4mg Q8H PRN N/V. Tab omeprazole 20mg AC breakfast. Tab lisinopril 10mg daily. Tab entresto 49/51mg BID. Adv: low salt diet, fluid restriction 1.5L/day Adv: high fiber diet, adequate hydration. F/U 1 week with wound check.","Your medicines: (1) lisinopril 20mg once daily [blood pressure medicine]. (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (3) omeprazole 20mg before breakfast [acid-reducing medicine]. (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (5) Entresto 49/51mg twice daily [heart failure medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
4649,"Rx: Lantus 20U QHS. Tab calcium + vitamin D 600/400 daily. Tab ciprofloxacin 500mg BID x 5 days. Tab Augmentin 875/125 BID x 7 days. Adv: low salt diet, fluid restriction 1.5L/day. F/U 6 weeks with LFTs.",Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) calcium plus vitamin D once daily [bone strengthening]. (3) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]. (4) Augmentin 875mg twice daily for 7 days [antibiotic]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 6 weeks for liver function blood tests.,Infectious Disease,Prescription,high
4650,"BMP: Na 141 (N), K 5.0 (N), BUN 17, Cr 2.0 (H), Glucose 114.","Your blood chemistry results: Sodium is normal at 141. Potassium is normal at 5.0. Creatinine is elevated at 2.0 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 114 (high).",Nephrology,Lab Result,high
4651,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,high
4652,"84 y/o F with PMH of ESRD on HD, Parkinson's disease, CKD Stage 3, s/p CABG, h/o TIA, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on montelukast 10mg QHS, lisinopril 10mg daily. F/U PCP in 2 weeks.","A 84-year-old woman with a history of kidney failure requiring dialysis, Parkinson's disease, moderate kidney disease, prior heart bypass surgery, and history of mini-stroke was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the primary care doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
4653,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab gabapentin 300mg TID. Tab ondansetron 4mg Q8H PRN N/V. Adv: low salt low sugar diet, regular exercise Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks.","Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (3) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back for a check-up in 2 weeks.",Neurology,Prescription,medium
4654,MRI Lumbar Spine: Central canal stenosis at L3-L4. L5-S1 disc desiccation with mild bulge. Facet joint hypertrophy at L4-L5.,"MRI of the lower back results: The spinal canal is narrowed at L3-L4, which may be pressing on the nerves. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. The small joints in the spine at L4-L5 are enlarged from arthritis.",Orthopedics,Radiology Report,high
4655,Procedure: TURP for BPH. Pt 55 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 55-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
4656,"37 y/o F with PMH of ICD in situ, CAD, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on escitalopram 10mg daily, atorvastatin 40mg QHS, ibuprofen 400mg Q6H PRN with food. F/U hematology in 2 weeks.","A 37-year-old woman with a history of implanted heart defibrillator, and coronary artery disease [heart artery blockages] was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the blood disorder doctor in 2 weeks.",Neurology,Discharge Summary,high
4657,"55 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 55-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4658,Procedure: EGD with biopsy. Pt 35 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes upper endoscopy with small tissue samples taken for a 35-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4659,"80 y/o M with PMH of s/p CABG, RA on MTX, OSA on CPAP, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Elevate R leg above heart level when resting. D/C on metformin 500mg BID, empagliflozin 10mg daily, atorvastatin 40mg QHS. F/U PCP in 1 week.","A 80-year-old man with a history of prior heart bypass surgery, rheumatoid arthritis [on immune-suppressing medicine], and sleep apnea [uses a breathing machine at night] was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. When resting, prop your right leg up on pillows so it is higher than your heart.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the primary care doctor in 1 week.",Infectious Disease,Discharge Summary,high
4660,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
4661,"CBC: WBC 19.7 (H), Hgb 6.0 (L), Plt 115 (L).","Your blood count results: White blood cells are 19.7 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 6.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 115, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
4662,"Rx: Tab montelukast 10mg QHS. Tab amlodipine 10mg daily. Tab methotrexate 15mg weekly. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: high fiber diet, adequate hydration Adv: elevate affected limb, compression stockings. F/U 2 weeks.","Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: keep the affected leg elevated when resting and wear compression stockings. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
4663,"48 y/o F with PMH of h/o TIA, DM2, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Low potassium diet. D/C on sertraline 50mg daily, azithromycin 500mg day 1 then 250mg x 4 days. F/U PCP in 2 weeks.","A 48-year-old woman with a history of history of mini-stroke, and type 2 diabetes was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the primary care doctor in 2 weeks.",Endocrinology,Discharge Summary,high
4664,"Rx: Tab furosemide 40mg BID. Tab spironolactone 25mg daily. Tab latanoprost 0.005% OU QHS. Adv: weight bearing exercise, calcium/vit D supplementation Adv: wound care with daily dressing changes. F/U INR in 3 days.","Your medicines: (1) furosemide (Lasix) 40mg twice daily [water pill]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
4665,"52 y/o F with PMH of OA, osteoporosis, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on amlodipine 10mg daily, lisinopril 20mg daily, spironolactone 25mg daily. F/U hematology in 2 weeks.","A 52-year-old woman with a history of arthritis [osteoarthritis], and weak bones [osteoporosis] was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up with the blood disorder doctor in 2 weeks.",Nephrology,Discharge Summary,high
4666,"Rx: Tab carvedilol 12.5mg BID. albuterol MDI 2 puffs Q4-6H PRN. Tab potassium chloride 20mEq daily. Spiriva 18mcg daily. Adv: low salt low sugar diet, regular exercise. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (3) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (4) Spiriva inhaler once daily [long-acting lung medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Pulmonology,Prescription,high
4667,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,high
4668,"79 y/o F with PMH of osteoporosis, CAD, s/p THR, CKD Stage 3, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Strict I&O, daily weights. D/C on clopidogrel 75mg daily, entresto 49/51mg BID, tramadol 50mg Q6H PRN pain, furosemide 40mg BID. F/U nephrology in 1 week.","A 79-year-old woman with a history of weak bones [osteoporosis], coronary artery disease [heart artery blockages], prior hip replacement, and moderate kidney disease was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]; (4) furosemide (Lasix) 40mg twice daily [water pill]. Follow-up with the kidney doctor in 1 week.",Pulmonology,Discharge Summary,high
4669,CXR PA: Patchy bilateral infiltrates. Sternotomy wires intact. Right middle lobe atelectasis. Pacemaker leads in appropriate position. Bilateral hilar lymphadenopathy.,"Chest X-ray results: There are scattered cloudy patches in both lungs suggesting infection or inflammation. The wires from prior heart surgery are intact. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The pacemaker wires are in the correct position. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
4670,"53 y/o M with PMH of A-fib, s/p THR, Parkinson's disease, PAD, gout, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on metformin 500mg BID, hydroxychloroquine 200mg BID. F/U GI in 1 week.","A 53-year-old man with a history of irregular heartbeat [atrial fibrillation], prior hip replacement, Parkinson's disease, poor blood flow in the legs [peripheral artery disease], and gout was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) metformin 500mg twice daily with meals [blood sugar medicine]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the stomach doctor in 1 week.",Psychiatry,Discharge Summary,high
4671,"63 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 63-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4672,"BMP: Na 120 (L), K 6.9 (H), BUN 29, Cr 1.7 (H), Glucose 318.","Your blood chemistry results: Sodium is low at 120 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 6.9 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is elevated at 1.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 318 (high).",Nephrology,Lab Result,high
4673,Procedure: PCI with DES to LAD. Pt 71 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 71-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4674,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4675,"50 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 50-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4676,Procedure: Colonoscopy with polypectomy. Pt 39 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 39-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4677,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab losartan 50mg daily. Tab levothyroxine 75mcg daily on empty stomach. Adv: weight bearing exercise, calcium/vit D supplementation. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) losartan 50mg once daily [blood pressure medicine]. (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: do weight-bearing exercises (walking, light weights) and take calcium and vitamin D for bone strength. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
4678,MRI Lumbar Spine: Multilevel degenerative disc disease. Facet joint hypertrophy at L4-L5. C5-C6 disc herniation with cord compression.,"MRI of the lower back results: Multiple discs in the spine are showing wear and aging. The small joints in the spine at L4-L5 are enlarged from arthritis. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant.",Orthopedics,Radiology Report,high
4679,CT Head without contrast: Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No mass effect. No acute intracranial hemorrhage. 4cm right subdural hematoma with 5mm midline shift. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There are no tumors or masses pushing on the brain. There is no bleeding in the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
4680,"Rx: Tab amlodipine 10mg daily. Spiriva 18mcg daily. albuterol MDI 2 puffs Q4-6H PRN. Tab furosemide 40mg BID. Avoid NSAIDs. F/U 1 week with CBC, CMP.",Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) Spiriva inhaler once daily [long-acting lung medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) furosemide (Lasix) 40mg twice daily [water pill]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,high
4681,"62 y/o M with PMH of HFrEF (EF 30%), DVT/PE on warfarin, SLE, cirrhosis, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Compression stockings when ambulating. D/C on Spiriva 18mcg daily, atorvastatin 80mg QHS, glipizide 5mg BID AC, pantoprazole 40mg AC breakfast. F/U hematology in 2 weeks.","A 62-year-old man with a history of heart failure with weak pumping (30%), blood clots [on blood thinner warfarin], lupus, and liver scarring [cirrhosis] was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Endocrinology,Discharge Summary,high
4682,"75 y/o F with PMH of HFpEF, gout, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on hydroxychloroquine 200mg BID, methotrexate 15mg weekly, ASA 81mg daily, Eliquis 5mg BID, amoxicillin 500mg TID x 10 days. F/U surgery in 10 days.","A 75-year-old woman with a history of heart failure with stiff heart muscle, and gout was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (3) baby aspirin 81mg once daily [prevents blood clots]; (4) Eliquis 5mg twice daily [blood thinner]; (5) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the surgeon in 10 days.",Nephrology,Discharge Summary,high
4683,"LFTs: AST 168 (H), ALT 239 (H), ALP 137, T.Bili 6.5 (H), Albumin 2.0.","Your liver blood test results: Liver enzymes (AST 168, ALT 239) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 6.5 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.0 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4684,"31 y/o F with PMH of s/p CABG, osteoporosis, HLD, CKD Stage 3, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on ibuprofen 400mg Q6H PRN with food, lisinopril 20mg daily, amlodipine 10mg daily, ASA 81mg daily, amlodipine 5mg daily. F/U orthopedics in 6 weeks with X-ray.","A 31-year-old woman with a history of prior heart bypass surgery, weak bones [osteoporosis], high cholesterol, and moderate kidney disease was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (2) lisinopril 20mg once daily [blood pressure medicine]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) baby aspirin 81mg once daily [prevents blood clots]; (5) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Cardiology,Discharge Summary,high
4685,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,high
4686,"87 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 87-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4687,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4688,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,medium
4689,"Rx: Humalog per SSI. prednisone taper. Adv: DASH diet, daily BP monitoring Adv: wound care with daily dressing changes. F/U 1 week with CBC, CMP.","Your medicines: (1) Humalog insulin before meals as directed [fast-acting insulin]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Endocrinology,Prescription,medium
4690,"88 y/o F with PMH of A-fib, HTN, PPM in situ, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on amoxicillin 500mg TID x 10 days, hydroxychloroquine 200mg BID. F/U nephrology in 5 days.","A 88-year-old woman with a history of irregular heartbeat [atrial fibrillation], high blood pressure, and implanted pacemaker was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the kidney doctor in 5 days.",Urology,Discharge Summary,high
4691,"53 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 53-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4692,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
4693,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4694,"72 y/o F with PMH of DM1, ESRD on HD, GERD, h/o CVA, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on atorvastatin 40mg QHS, pantoprazole 40mg AC breakfast, sertraline 50mg daily, Spiriva 18mcg daily. F/U INR check in 3 days.","A 72-year-old woman with a history of type 1 diabetes, kidney failure requiring dialysis, acid reflux, and history of stroke was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up for a blood thinner level check in 3 days.",Infectious Disease,Discharge Summary,high
4695,"BMP: Na 140 (N), K 3.6 (N), BUN 43, Cr 3.1 (H), Glucose 314.","Your blood chemistry results: Sodium is normal at 140. Potassium is normal at 3.6. Creatinine is elevated at 3.1 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 314 (high).",Nephrology,Lab Result,high
4696,"47 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 47-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4697,"BMP: Na 141 (N), K 5.3 (H), BUN 78, Cr 2.6 (H), Glucose 201.","Your blood chemistry results: Sodium is normal at 141. Potassium is high at 5.3 — needs monitoring. Creatinine is elevated at 2.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 201 (high).",Nephrology,Lab Result,high
4698,"Rx: Tab pregabalin 75mg BID. Tab amlodipine 10mg daily. albuterol MDI 2 puffs Q4-6H PRN. Tab hydroxychloroquine 200mg BID. Tab lisinopril 20mg daily. Avoid NSAIDs Adv: elevate affected limb, compression stockings. F/U 1 week with CBC, CMP.",Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]. (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. (5) lisinopril 20mg once daily [blood pressure medicine]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,high
4699,"53 y/o F with PMH of BPH, h/o CVA, DVT/PE on warfarin, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on Dulcolax 10mg QHS PRN, acetaminophen 650mg Q6H PRN. F/U PCP in 1 week.","A 53-year-old woman with a history of enlarged prostate, history of stroke, and blood clots [on blood thinner warfarin] was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) Dulcolax 10mg at bedtime as needed [for constipation]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the primary care doctor in 1 week.",Cardiology,Discharge Summary,high
4700,Delivery Note: G?P? at 37+3 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4701,"Rx: Tab gabapentin 300mg TID. Tab furosemide 40mg daily. Tab sertraline 50mg daily. Adv: smoking cessation, pulmonary rehab Adv: wound care with daily dressing changes. F/U 2 weeks.","Your medicines: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back for a check-up in 2 weeks.",Cardiology,Prescription,medium
4702,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
4703,"71 y/o M presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 71-year-old man came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4704,"CBC: WBC 8.6 (N), Hgb 14.2 (N), Plt 231 (N).","Your blood count results: White blood cells are 8.6 (normal). Hemoglobin is normal at 14.2. Platelets are 231, which is normal.",Hematology,Lab Result,medium
4705,"Thyroid panel: TSH 14.26 (H), Free T4 1.8.","Your thyroid test results: TSH is elevated at 14.26 (normal 0.4-4.5), meaning your thyroid is underactive [hypothyroidism]. Free T4 is borderline — confirming the thyroid is not producing enough hormone.",Endocrinology,Lab Result,high
4706,"47 y/o F with PMH of CKD Stage 3, hypothyroidism, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Strict I&O, daily weights. D/C on ondansetron 4mg Q8H PRN N/V, acetaminophen 650mg Q6H PRN, lisinopril 20mg daily, empagliflozin 10mg daily. F/U INR check in 3 days.","A 47-year-old woman with a history of moderate kidney disease, and underactive thyroid was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (3) lisinopril 20mg once daily [blood pressure medicine]; (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up for a blood thinner level check in 3 days.",Hematology,Discharge Summary,high
4707,"71 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 71-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4708,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,medium
4709,"US Abdomen: Ascites moderate amount. Spleen 16cm, splenomegaly. Liver 18cm, diffusely echogenic consistent with hepatic steatosis. No focal hepatic lesion. Simple renal cysts bilaterally. Pancreas unremarkable.","Abdominal ultrasound results: There is a moderate amount of fluid in the belly [ascites]. The spleen is enlarged [splenomegaly]. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. No tumors or masses were found in the liver. Both kidneys have harmless fluid-filled cysts. The pancreas looks normal.",Gastroenterology,Radiology Report,high
4710,"28 y/o F with PMH of HLD, CAD, s/p TKR, PPM in situ, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Low potassium diet. D/C on clopidogrel 75mg daily, furosemide 40mg daily. F/U GI in 1 week.","A 28-year-old woman with a history of high cholesterol, coronary artery disease [heart artery blockages], prior knee replacement, and implanted pacemaker was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Follow-up with the stomach doctor in 1 week.",Endocrinology,Discharge Summary,high
4711,"37 y/o M with PMH of gout, OA, HFpEF, CAD, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on sertraline 50mg daily, pregabalin 75mg BID. F/U oncology in 1 week.","A 37-year-old man with a history of gout, arthritis [osteoarthritis], heart failure with stiff heart muscle, and coronary artery disease [heart artery blockages] was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) pregabalin 75mg twice daily [nerve pain medicine]. Follow-up with the cancer doctor in 1 week.",Gastroenterology,Discharge Summary,high
4712,HbA1c: 10.8% (H). FBS: 262 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.8%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 262, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4713,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,low
4714,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4715,"LFTs: AST 272 (H), ALT 237 (H), ALP 149, T.Bili 1.9 (H), Albumin 2.5.","Your liver blood test results: Liver enzymes (AST 272, ALT 237) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is mildly elevated at 1.9. Albumin is low at 2.5 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4716,Delivery Note: G?P? at 38+2 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4717,"Rx: Tab carvedilol 12.5mg BID. Tab atorvastatin 40mg QHS. Tab Augmentin 875/125 BID x 7 days. Tab pantoprazole 40mg AC breakfast. Adv: fall precautions, home safety evaluation Adv: avoid alcohol, hepatotoxic drugs. F/U 1 week with wound check.","Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) atorvastatin 40mg at bedtime [cholesterol medicine]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 1 week to have the wound checked.",Cardiology,Prescription,high
4718,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4719,"62 y/o M with PMH of cirrhosis, RA on MTX, h/o TIA, s/p THR, anxiety, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on furosemide 40mg BID, latanoprost 0.005% OU QHS, hydroxychloroquine 200mg BID, clopidogrel 75mg daily, Xarelto 20mg daily with dinner. F/U surgery in 10 days.","A 62-year-old man with a history of liver scarring [cirrhosis], rheumatoid arthritis [on immune-suppressing medicine], history of mini-stroke, prior hip replacement, and anxiety was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (4) Plavix (clopidogrel) 75mg once daily [blood thinner]; (5) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the surgeon in 10 days.",Gastroenterology,Discharge Summary,high
4720,"US Abdomen: No focal hepatic lesion. Pancreas unremarkable. CBD 12mm, dilated.","Abdominal ultrasound results: No tumors or masses were found in the liver. The pancreas looks normal. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
4721,"Lipid panel: TC 120, LDL 55, HDL 21, TG 59.","Your cholesterol results: Total cholesterol is 120. LDL (bad cholesterol) is at goal (55). HDL (good cholesterol) is too low at 21 (should be above 40 for men, 50 for women) — this is a risk factor for heart disease. Triglycerides are normal at 59.",Cardiology,Lab Result,high
4722,Procedure: R TKA. Pt 62 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes total knee replacement on the right for a 62-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
4723,HbA1c: 5.6% (N). FBS: 260 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.6%, which is normal — you do not have diabetes. Fasting blood sugar was 260, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
4724,"36 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 36-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4725,"Rx: Tab warfarin 5mg daily. Tab timolol 0.5% OU BID. Tab gabapentin 300mg TID. Tab Xarelto 20mg daily with dinner. Adv: SMBG BID, diabetic diet. F/U 1 week with wound check.",Your medicines: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. (4) Xarelto 20mg once daily with dinner [blood thinner]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 1 week to have the wound checked.,Hematology,Prescription,high
4726,"28 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 28-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4727,"39 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 39-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4728,"51 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 51-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4729,"CBC: WBC 18.9 (H), Hgb 16.7 (N), Plt 76 (L).","Your blood count results: White blood cells are 18.9 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 16.7. Platelets are 76, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
4730,HbA1c: 5.2% (N). FBS: 126 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.2%, which is normal — you do not have diabetes. Fasting blood sugar was 126, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
4731,"Rx: Tab pregabalin 75mg BID. Tab Xarelto 20mg daily with dinner. Tab calcium + vitamin D 600/400 daily. Adv: SMBG BID, diabetic diet. F/U 2 weeks.",Your medicines: (1) pregabalin 75mg twice daily [nerve pain medicine]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) calcium plus vitamin D once daily [bone strengthening]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back for a check-up in 2 weeks.,Neurology,Prescription,medium
4732,"42 y/o F with PMH of RA on MTX, CAD, HTN, PAD, DM1, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on latanoprost 0.005% OU QHS, amoxicillin 500mg TID x 10 days, atorvastatin 40mg QHS, lisinopril 20mg daily. F/U INR check in 3 days.","A 42-year-old woman with a history of rheumatoid arthritis [on immune-suppressing medicine], coronary artery disease [heart artery blockages], high blood pressure, poor blood flow in the legs [peripheral artery disease], and type 1 diabetes was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]; (4) lisinopril 20mg once daily [blood pressure medicine]. Follow-up for a blood thinner level check in 3 days.",Infectious Disease,Discharge Summary,high
4733,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4734,Delivery Note: G?P? at 40+0 weeks. SVD. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 40+0 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4735,HbA1c: 13.8% (H). FBS: 202 mg/dL (H).,"Your diabetes blood test results: HbA1c is 13.8%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 202, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4736,CXR PA: Elevated left hemidiaphragm. Right middle lobe atelectasis. ET tube 3cm above carina. Osseous structures intact. Small left pleural effusion.,"Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The breathing tube is in good position. The bones look normal with no fractures. There is a small amount of fluid around the left lung.",Pulmonology,Radiology Report,high
4737,"US Abdomen: Liver 18cm, diffusely echogenic consistent with hepatic steatosis. Pancreas unremarkable. Spleen 11cm, normal.","Abdominal ultrasound results: The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease. The pancreas looks normal. The spleen is a normal size.",Gastroenterology,Radiology Report,high
4738,"46 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 46-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4739,"68 y/o M with PMH of Parkinson's disease, hypothyroidism, OA, CAD, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on albuterol MDI 2 puffs Q4-6H PRN, calcium + vitamin D 600/400 daily, empagliflozin 10mg daily. F/U GI in 1 week.","A 68-year-old man with a history of Parkinson's disease, underactive thyroid, arthritis [osteoarthritis], and coronary artery disease [heart artery blockages] was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
4740,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
4741,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
4742,"Rx: Tab empagliflozin 10mg daily. Tab pregabalin 75mg BID. Tab metformin 1000mg BID. Tab ferrous sulfate 325mg BID. Tab atorvastatin 40mg QHS. Adv: SMBG BID, diabetic diet. F/U PCP in 1 week for BP recheck.",Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) pregabalin 75mg twice daily [nerve pain medicine]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (5) atorvastatin 40mg at bedtime [cholesterol medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. See your primary care doctor in 1 week to recheck blood pressure.,Endocrinology,Prescription,high
4743,Rx: Tab carvedilol 12.5mg BID. Tab azithromycin 500mg day 1 then 250mg x 4 days. Adv: low potassium diet. F/U INR in 3 days.,"Your medicines: (1) carvedilol 12.5mg twice daily [heart medicine]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,medium
4744,"CBC: WBC 17.9 (H), Hgb 5.4 (L), Plt 459 (H).","Your blood count results: White blood cells are 17.9 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 5.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 459, which is high — your blood may clot too easily.",Hematology,Lab Result,high
4745,"53 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 53-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4746,"53 y/o M with PMH of anxiety, depression, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Strict I&O, daily weights. D/C on montelukast 10mg QHS, entresto 49/51mg BID, metformin 1000mg BID, gabapentin 300mg TID, azithromycin 500mg day 1 then 250mg x 4 days. F/U cardiology in 2 weeks.","A 53-year-old man with a history of anxiety, and depression was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) montelukast 10mg at bedtime [asthma/allergy medicine]; (2) Entresto 49/51mg twice daily [heart failure medicine]; (3) metformin 1000mg twice daily with meals [blood sugar medicine]; (4) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (5) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
4747,"34 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 34-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4748,"40 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 40-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4749,"Rx: Tab omeprazole 20mg AC breakfast. Tab methotrexate 15mg weekly. Tab calcium + vitamin D 600/400 daily. Adv: smoking cessation, pulmonary rehab. F/U PCP in 1 week for BP recheck.",Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) calcium plus vitamin D once daily [bone strengthening]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. See your primary care doctor in 1 week to recheck blood pressure.,Gastroenterology,Prescription,medium
4750,Delivery Note: G?P? at 38+2 weeks. SVD. Live female infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4751,"48 y/o M with PMH of seizure disorder on Keppra, CKD Stage 4, PPM in situ, admitted for NSTEMI. Troponin elevated confirming heart muscle damage. Managed per protocol with improvement. Strict I&O, daily weights. D/C on rosuvastatin 10mg QHS, atorvastatin 80mg QHS, albuterol MDI 2 puffs Q4-6H PRN, furosemide 40mg daily. F/U GI in 1 week.","A 48-year-old man with a history of seizure disorder [on Keppra], advanced kidney disease, and implanted pacemaker was admitted for a type of heart attack (non-ST elevation myocardial infarction). A blood test (troponin) was elevated confirming heart muscle damage. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (4) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Follow-up with the stomach doctor in 1 week.",Cardiology,Discharge Summary,high
4752,Procedure: Colonoscopy with polypectomy. Pt 37 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 37-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4753,Procedure: ORIF L distal radius. Pt 60 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 60-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
4754,"78 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 78-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4755,"75 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 75-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4756,"24 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 24-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4757,"35 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 35-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4758,"Rx: Spiriva 18mcg daily. Tab Eliquis 5mg BID. Tab empagliflozin 10mg daily. Tab rosuvastatin 10mg QHS. Adv: DASH diet, daily BP monitoring. F/U PCP in 1 week for BP recheck.","Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) Eliquis 5mg twice daily [blood thinner]. (3) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (4) rosuvastatin 10mg at bedtime [cholesterol medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
4759,"Rx: Tab ibuprofen 400mg Q6H PRN with food. prednisone taper. Tab ferrous sulfate 325mg BID. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab carvedilol 12.5mg BID. Do not stop abruptly, taper as directed. F/U INR in 3 days.","Your medicines: (1) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (5) carvedilol 12.5mg twice daily [heart medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 3 days for a blood thinner level check [INR].",General,Prescription,high
4760,"Rx: Tab ondansetron 4mg Q8H PRN N/V. Tab losartan 50mg daily. Tab sertraline 50mg daily. Tab clopidogrel 75mg daily. Adv: DASH diet, daily BP monitoring. F/U 6 weeks with LFTs.","Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) losartan 50mg once daily [blood pressure medicine]. (3) sertraline 50mg once daily [antidepressant/anxiety medicine]. (4) Plavix (clopidogrel) 75mg once daily [blood thinner]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,high
4761,"49 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 49-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4762,"74 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 74-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4763,"Rx: Tab Eliquis 5mg BID. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab pregabalin 75mg BID. Tab levothyroxine 75mcg daily on empty stomach. Adv: smoking cessation, pulmonary rehab. F/U 1 month with repeat imaging.","Your medicines: (1) Eliquis 5mg twice daily [blood thinner]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (3) pregabalin 75mg twice daily [nerve pain medicine]. (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 month — a repeat scan will be ordered.",Neurology,Prescription,high
4764,"45 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 45-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
4765,"29 y/o F with PMH of A-fib, HTN, PAD, obesity (BMI 38), admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on metoprolol succinate 50mg daily, Augmentin 875/125 BID x 7 days, atorvastatin 40mg QHS. F/U pulmonology in 2 weeks.","A 29-year-old woman with a history of irregular heartbeat [atrial fibrillation], high blood pressure, poor blood flow in the legs [peripheral artery disease], and obesity was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) atorvastatin 40mg at bedtime [cholesterol medicine]. Follow-up with the lung doctor in 2 weeks.",General Surgery,Discharge Summary,high
4766,"32 y/o M with PMH of anemia, ESRD on HD, CKD Stage 3, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on furosemide 40mg BID, sertraline 50mg daily, rosuvastatin 10mg QHS, losartan 50mg daily. F/U GI in 1 week.","A 32-year-old man with a history of low blood count [anemia], kidney failure requiring dialysis, and moderate kidney disease was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) furosemide (Lasix) 40mg twice daily [water pill]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]; (3) rosuvastatin 10mg at bedtime [cholesterol medicine]; (4) losartan 50mg once daily [blood pressure medicine]. Follow-up with the stomach doctor in 1 week.",Gastroenterology,Discharge Summary,high
4767,"BMP: Na 121 (L), K 2.5 (L), BUN 36, Cr 3.5 (H), Glucose 397.","Your blood chemistry results: Sodium is low at 121 (normal 136-145), meaning too much water in your body. Potassium is low at 2.5 — may cause muscle weakness and heart rhythm issues. Creatinine is elevated at 3.5 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 397 (high).",Nephrology,Lab Result,high
4768,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4769,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4770,"84 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 84-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4771,CXR PA: Hyperinflated lungs consistent with COPD. Bilateral pleural effusions. Clear lung fields bilaterally.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There is fluid collecting around both lungs. Both lungs look clear with no problems.",Pulmonology,Radiology Report,high
4772,"72 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 72-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4773,CXR PA: No pneumothorax. Bilateral pleural effusions. Patchy bilateral infiltrates.,Chest X-ray results: There is no collapsed lung. There is fluid collecting around both lungs. There are scattered cloudy patches in both lungs suggesting infection or inflammation.,Pulmonology,Radiology Report,high
4774,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4775,"PATH: Skin excision: melanoma in situ, Breslow not applicable, peripheral margins clear.","Pathology results in plain language: Early melanoma confined to the top skin layer, removed with clear edges.",Dermatology,Pathology Report,high
4776,"Rx: Tab escitalopram 10mg daily. Tab metoprolol 25mg BID. Tab Augmentin 875/125 BID x 7 days. Tab furosemide 40mg BID. Adv: elevate affected limb, compression stockings. F/U INR in 3 days.",Your medicines: (1) escitalopram 10mg once daily [antidepressant/anxiety medicine]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) Augmentin 875mg twice daily for 7 days [antibiotic]. (4) furosemide (Lasix) 40mg twice daily [water pill]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 3 days for a blood thinner level check [INR].,Cardiology,Prescription,high
4777,"75 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 75-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4778,"71 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 71-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4779,Procedure: Port-a-cath placement. Pt 82 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 82-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
4780,Procedure: ERCP with sphincterotomy. Pt 67 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 67-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4781,"70 y/o F with PMH of RA on MTX, ESRD on HD, admitted for pneumonia. CXR confirmed infiltrate. Started on IV antibiotics. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on amlodipine 5mg daily, azithromycin 500mg day 1 then 250mg x 4 days, ferrous sulfate 325mg BID, Humalog per SSI, Lantus 20U QHS. F/U surgery in 2 weeks for drain removal.","A 70-year-old woman with a history of rheumatoid arthritis [on immune-suppressing medicine], and kidney failure requiring dialysis was admitted for a lung infection. CXR confirmed infiltrate. Started on IV antibiotics. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) Humalog insulin before meals as directed [fast-acting insulin]; (5) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the surgeon in 2 weeks to remove the drain.",Pulmonology,Discharge Summary,high
4782,"85 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 85-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4783,"52 y/o M presenting to ED with worst headache of my life, acute onset 2hrs ago. Vitals: BP 172/94, HR 78, GCS 15. CT Head: negative. LP: xanthochromic CSF, RBC 11000. CTA: 5mm ACOM aneurysm. Dx: SAH secondary to ruptured aneurysm. Nimodipine started. Neurosurgery consulted. Transfer to neuro ICU.","A 52-year-old man came to the emergency room with the worst headache of his/her life, started suddenly 2 hours ago. Vital signs: blood pressure elevated, heart rate normal, fully alert. CT scan did not show bleeding. Spinal tap showed blood in spinal fluid confirming brain bleed. Blood vessel scan found a 5mm bulge [aneurysm] in a brain artery. Diagnosis: bleeding around the brain from a burst blood vessel [subarachnoid hemorrhage]. Medicine to prevent artery spasms started. Brain surgeon called. Transferred to neurological intensive care unit.",Emergency Medicine,Clinical Note,high
4784,"80 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 80-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4785,"86 y/o F presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 86-year-old woman came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4786,"79 y/o M with PMH of s/p THR, h/o CVA, h/o TIA, admitted for acute pancreatitis. Lipase markedly elevated. CT showed peripancreatic inflammation. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on methotrexate 15mg weekly, calcium + vitamin D 600/400 daily, levothyroxine 75mcg daily on empty stomach, Humalog per SSI. F/U PCP in 2 weeks.","A 79-year-old man with a history of prior hip replacement, history of stroke, and history of mini-stroke was admitted for severe inflammation of the pancreas. A pancreas enzyme was very high. CT scan showed peripancreatic inflammation. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (2) calcium plus vitamin D once daily [bone strengthening]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (4) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the primary care doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4787,"23 y/o F with PMH of CKD Stage 3, anemia, s/p THR, SLE, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on ondansetron 4mg Q8H PRN N/V, levothyroxine 75mcg daily on empty stomach, methotrexate 15mg weekly. F/U PCP in 2 weeks.","A 23-year-old woman with a history of moderate kidney disease, low blood count [anemia], prior hip replacement, and lupus was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the primary care doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4788,"BMP: Na 150 (H), K 4.4 (N), BUN 56, Cr 6.6 (H), Glucose 251.","Your blood chemistry results: Sodium is high at 150, meaning you may be dehydrated. Potassium is normal at 4.4. Creatinine is elevated at 6.6 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 251 (high).",Nephrology,Lab Result,high
4789,"29 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 29-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4790,"24 y/o M presenting to ED with acute onset SOB, unable to speak in full sentences. Vitals: BP 168/92, HR 118, RR 28, O2 85% on RA. CXR: bilateral pleural effusions, pulmonary edema. BNP 2400. Dx: Acute decompensated CHF. IV furosemide 80mg, BiPAP, nitroglycerin drip. Admit CCU.","A 24-year-old man came to the emergency room with sudden severe difficulty breathing, unable to finish sentences. Vital signs: blood pressure high, heart rate very fast, breathing very rapid, oxygen dangerously low at 85%. Chest X-ray showed fluid in both lungs. Heart failure blood test very high. Diagnosis: severe heart failure flare-up — fluid overloading the lungs. Strong water pills through the IV, a breathing mask to help with breathing, and blood pressure medicine through the IV. Admitted to cardiac intensive care.",Emergency Medicine,Clinical Note,high
4791,CXR PA: Port-a-cath in appropriate position. Left lower lobe consolidation. ET tube 3cm above carina. Small left pleural effusion.,Chest X-ray results: The implanted medication port is in the correct position. There is an area in the lower left lung that appears infected. The breathing tube is in good position. There is a small amount of fluid around the left lung.,Pulmonology,Radiology Report,high
4792,"72 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 72-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4793,"Rx: Tab sertraline 50mg daily. Tab metoprolol 25mg BID. Tab entresto 49/51mg BID. Adv: smoking cessation, pulmonary rehab Adv: SMBG BID, diabetic diet. F/U 4 weeks with TSH, Free T4.",Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) Entresto 49/51mg twice daily [heart failure medicine]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: check your blood sugar twice daily and follow a diabetes-friendly diet. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.,Cardiology,Prescription,medium
4794,HbA1c: 10.1% (H). FBS: 388 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.1%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 388, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4795,"Rx: Spiriva 18mcg daily. Tab omeprazole 20mg AC breakfast. Adv: SMBG BID, diabetic diet Adv: low salt diet, fluid restriction 1.5L/day. F/U 1 week with wound check.",Your medicines: (1) Spiriva inhaler once daily [long-acting lung medicine]. (2) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: check your blood sugar twice daily and follow a diabetes-friendly diet Advice: eat less salt and limit your total fluid intake to about 6 cups per day. Come back in 1 week to have the wound checked.,Pulmonology,Prescription,medium
4796,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
4797,Delivery Note: G?P? at 38+2 weeks. SVD. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4798,"49 y/o M with PMH of HFrEF (EF 30%), HFpEF, asthma, DVT/PE on warfarin, depression, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on Spiriva 18mcg daily, atorvastatin 40mg QHS, metformin 500mg BID, Humalog per SSI. F/U PCP in 1 week.","A 49-year-old man with a history of heart failure with weak pumping (30%), heart failure with stiff heart muscle, asthma, blood clots [on blood thinner warfarin], and depression was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) Spiriva inhaler once daily [long-acting lung medicine]; (2) atorvastatin 40mg at bedtime [cholesterol medicine]; (3) metformin 500mg twice daily with meals [blood sugar medicine]; (4) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the primary care doctor in 1 week.",Gastroenterology,Discharge Summary,high
4799,Rx: prednisone taper. Tab metoprolol 25mg BID. Tab amoxicillin 500mg TID x 10 days. Tab omeprazole 20mg AC breakfast. Adv: wound care with daily dressing changes. F/U 2 weeks.,"Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (4) omeprazole 20mg before breakfast [acid-reducing medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back for a check-up in 2 weeks.",Cardiology,Prescription,high
4800,"US Abdomen: No focal hepatic lesion. Ascites moderate amount. Spleen 16cm, splenomegaly. CBD 5mm, not dilated. Right kidney 10.5cm, no hydronephrosis.",Abdominal ultrasound results: No tumors or masses were found in the liver. There is a moderate amount of fluid in the belly [ascites]. The spleen is enlarged [splenomegaly]. The bile duct is normal size [not blocked]. Right kidney is normal size with no blockage.,Gastroenterology,Radiology Report,high
4801,Procedure: Laparoscopic appendectomy. Pt 91 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 91-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
4802,"27 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 27-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4803,"Rx: Tab empagliflozin 10mg daily. Tab entresto 49/51mg BID. Tab lisinopril 10mg daily. Adv: low potassium diet Adv: smoking cessation, pulmonary rehab. F/U 2 weeks with INR.","Your medicines: (1) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. (2) Entresto 49/51mg twice daily [heart failure medicine]. (3) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,medium
4804,Procedure: Port-a-cath placement. Pt 88 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 88-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
4805,"36 y/o F presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 36-year-old woman came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4806,"35 y/o M with PMH of SLE, h/o TIA, RA on MTX, obesity (BMI 38), admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on pregabalin 75mg BID, amlodipine 5mg daily. F/U neurology in 2 weeks.","A 35-year-old man with a history of lupus, history of mini-stroke, rheumatoid arthritis [on immune-suppressing medicine], and obesity was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Cardiology,Discharge Summary,high
4807,CT Head without contrast: 4cm right subdural hematoma with 5mm midline shift. Subarachnoid hemorrhage in bilateral sylvian fissures. Mild generalized cerebral atrophy appropriate for age. No midline shift. Chronic lacunar infarcts in bilateral basal ganglia.,"CT scan of the head results: There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There is bleeding around the brain surface, particularly in the grooves on both sides. There is mild brain shrinkage, which is normal for your age. The brain is centered normally. There are signs of small old strokes in the deep parts of the brain.",Neurology,Radiology Report,high
4808,CXR PA: Elevated left hemidiaphragm. Bilateral hilar lymphadenopathy. NG tube tip in stomach.,"Chest X-ray results: The left side of the breathing muscle [diaphragm] is sitting higher than normal. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation. The feeding/drainage tube tip is correctly positioned in the stomach.",Pulmonology,Radiology Report,high
4809,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
4810,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
4811,"45 y/o M with PMH of seizure disorder on Keppra, OSA on CPAP, cirrhosis, HLD, HTN, admitted for acute stroke (CVA). CT showed acute ischemic infarct. tPA administered. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on Lantus 20U QHS, ondansetron 4mg Q8H PRN N/V, methotrexate 15mg weekly, metformin 500mg BID. F/U GI in 1 week.","A 45-year-old man with a history of seizure disorder [on Keppra], sleep apnea [uses a breathing machine at night], liver scarring [cirrhosis], high cholesterol, and high blood pressure was admitted for a stroke [blocked blood vessel in the brain]. CT scan showed acute ischemic infarct. clot-dissolving medicine was given. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (3) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (4) metformin 500mg twice daily with meals [blood sugar medicine]. Follow-up with the stomach doctor in 1 week.",Neurology,Discharge Summary,high
4812,"79 y/o M with PMH of s/p CABG, anxiety, hypothyroidism, ESRD on HD, CHF, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Low potassium diet. D/C on ferrous sulfate 325mg BID, metoprolol succinate 50mg daily, metformin 500mg BID, entresto 49/51mg BID, ASA 81mg daily. F/U pulmonology in 2 weeks.","A 79-year-old man with a history of prior heart bypass surgery, anxiety, underactive thyroid, kidney failure requiring dialysis, and heart failure was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (2) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (3) metformin 500mg twice daily with meals [blood sugar medicine]; (4) Entresto 49/51mg twice daily [heart failure medicine]; (5) baby aspirin 81mg once daily [prevents blood clots]. Follow-up with the lung doctor in 2 weeks.",Pulmonology,Discharge Summary,high
4813,"68 y/o F with PMH of CHF, CKD Stage 3, HTN, GERD, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Low potassium diet. D/C on potassium chloride 20mEq daily, glipizide 5mg BID AC. F/U cardiology in 2 weeks.","A 68-year-old woman with a history of heart failure, moderate kidney disease, high blood pressure, and acid reflux was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the heart doctor in 2 weeks.",Pulmonology,Discharge Summary,high
4814,CXR PA: Increased interstitial markings suggesting pulmonary edema. Sternotomy wires intact. Right lower lobe consolidation.,"Chest X-ray results: There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema]. The wires from prior heart surgery are intact. There is an area in the lower right lung that appears infected, suggesting pneumonia.",Pulmonology,Radiology Report,high
4815,"BMP: Na 123 (L), K 5.4 (H), BUN 70, Cr 5.7 (H), Glucose 116.","Your blood chemistry results: Sodium is low at 123 (normal 136-145), meaning too much water in your body. Potassium is high at 5.4 — needs monitoring. Creatinine is elevated at 5.7 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 116 (high).",Nephrology,Lab Result,high
4816,"41 y/o M with PMH of OSA on CPAP, SLE, DM2, admitted for sepsis secondary to UTI. Blood cultures positive. Lactate elevated. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on hydroxychloroquine 200mg BID, pantoprazole 40mg AC breakfast, timolol 0.5% OU BID, acetaminophen 650mg Q6H PRN. F/U nephrology in 1 week.","A 41-year-old man with a history of sleep apnea [uses a breathing machine at night], lupus, and type 2 diabetes was admitted for a serious blood infection from a urinary tract infection. Blood test showed bacteria in the blood. A marker of infection severity was high. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) pantoprazole 40mg before breakfast [acid-reducing medicine]; (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (4) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the kidney doctor in 1 week.",Infectious Disease,Discharge Summary,high
4817,"41 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 41-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4818,CT Head without contrast: No midline shift. Chronic lacunar infarcts in bilateral basal ganglia. No acute intracranial hemorrhage.,CT scan of the head results: The brain is centered normally. There are signs of small old strokes in the deep parts of the brain. There is no bleeding in the brain.,Neurology,Radiology Report,high
4819,"84 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 84-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4820,"US Abdomen: CBD 12mm, dilated. Simple renal cysts bilaterally. Moderate right hydronephrosis. Right kidney 10.5cm, no hydronephrosis.","Abdominal ultrasound results: The bile duct is wider than normal [dilated], which may indicate a blockage. Both kidneys have harmless fluid-filled cysts. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage. Right kidney is normal size with no blockage.",Gastroenterology,Radiology Report,high
4821,Delivery Note: G?P? at 37+3 weeks. Primary low-transverse C-section. Live female infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy female. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4822,"BMP: Na 147 (H), K 3.5 (N), BUN 76, Cr 7.9 (H), Glucose 165.","Your blood chemistry results: Sodium is high at 147, meaning you may be dehydrated. Potassium is normal at 3.5. Creatinine is elevated at 7.9 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 165 (high).",Nephrology,Lab Result,high
4823,"81 y/o M with PMH of h/o TIA, BPH, RA on MTX, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Strict I&O, daily weights. D/C on amlodipine 5mg daily, entresto 49/51mg BID. F/U INR check in 3 days.","A 81-year-old man with a history of history of mini-stroke, enlarged prostate, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) amlodipine 5mg once daily [blood pressure medicine]; (2) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up for a blood thinner level check in 3 days.",Hematology,Discharge Summary,high
4824,Procedure: Laparoscopic appendectomy. Pt 74 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes keyhole surgery to remove the appendix for a 74-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
4825,"72 y/o M presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 72-year-old man came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4826,"Rx: Tab montelukast 10mg QHS. Tab spironolactone 25mg daily. Tab metoprolol succinate 50mg daily. Do not stop abruptly, taper as directed. F/U 1 week with wound check.",Your medicines: (1) montelukast 10mg at bedtime [asthma/allergy medicine]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) metoprolol 50mg once daily [heart rate and blood pressure medicine]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week to have the wound checked.,Cardiology,Prescription,medium
4827,Rx: Lantus 20U QHS. Tab carvedilol 12.5mg BID. Tab escitalopram 10mg daily. Adv: low potassium diet Avoid NSAIDs. F/U 1 month with repeat imaging.,"Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) carvedilol 12.5mg twice daily [heart medicine]. (3) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,medium
4828,"64 y/o F with PMH of OA, GERD, PPM in situ, CKD Stage 3, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on metoprolol 25mg BID, methotrexate 15mg weekly, carvedilol 12.5mg BID, spironolactone 25mg daily. F/U oncology in 1 week.","A 64-year-old woman with a history of arthritis [osteoarthritis], acid reflux, implanted pacemaker, and moderate kidney disease was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (3) carvedilol 12.5mg twice daily [heart medicine]; (4) spironolactone 25mg once daily [heart-protecting water pill]. Follow-up with the cancer doctor in 1 week.",Cardiology,Discharge Summary,high
4829,Procedure: Colonoscopy with polypectomy. Pt 51 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 51-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4830,"57 y/o F with PMH of h/o CVA, CAD, BPH, asthma, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on Augmentin 875/125 BID x 7 days, ciprofloxacin 500mg BID x 5 days, glipizide 5mg BID AC, pregabalin 75mg BID, amlodipine 10mg daily. F/U surgery in 2 weeks for drain removal.","A 57-year-old woman with a history of history of stroke, coronary artery disease [heart artery blockages], enlarged prostate, and asthma was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) Augmentin 875mg twice daily for 7 days [antibiotic]; (2) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) pregabalin 75mg twice daily [nerve pain medicine]; (5) amlodipine 10mg once daily [blood pressure medicine]. Follow-up with the surgeon in 2 weeks to remove the drain.",Nephrology,Discharge Summary,high
4831,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4832,"Rx: Tab latanoprost 0.005% OU QHS. Tab timolol 0.5% OU BID. Tab tramadol 50mg Q6H PRN pain. Do not stop abruptly, taper as directed. F/U PCP in 1 week for BP recheck.",Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. See your primary care doctor in 1 week to recheck blood pressure.,Pediatrics,Prescription,medium
4833,"28 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 28-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4834,"37 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 37-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4835,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,high
4836,"65 y/o F with PMH of s/p TKR, gout, depression, asthma, COPD, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Seizure precautions, do not drive x 6 months. D/C on atorvastatin 40mg QHS, amlodipine 5mg daily. F/U neurology in 2 weeks.","A 65-year-old woman with a history of prior knee replacement, gout, depression, asthma, and chronic lung disease was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Take seizure safety measures (no baths alone, no heights). Do not drive for 6 months.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) amlodipine 5mg once daily [blood pressure medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4837,"90 y/o F presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 90-year-old woman came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4838,"50 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 50-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4839,"37 y/o F presenting to ED with severe epigastric pain radiating to back, N/V x 6hrs. Vitals: BP 138/82, HR 108, RR 20, T 100.4F. Lipase 1800 (H). CT abdomen: peripancreatic fat stranding, no necrosis. Dx: Acute pancreatitis. NPO, aggressive IVF, IV morphine, IV pantoprazole. Admit medicine.","A 37-year-old woman came to the emergency room with severe upper belly pain shooting to the back with nausea and vomiting for 6 hours. Vital signs: blood pressure normal, heart rate fast, mild fever. Pancreas enzyme very high. CT scan showed severe pancreas inflammation but no dead tissue. Diagnosis: severe inflammation of the pancreas. No food by mouth. Large amounts of IV fluids. Pain medicine and acid-reducer through the IV. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4840,Warfarin 5mg PO daily. INR goal 2.0-3.0. Avoid major diet changes in vitamin K. Report bleeding.,Take warfarin daily. Blood tests keep clotting in a safe range. Keep vitamin K intake steady and call your doctor for unusual bleeding.,Hematology,Medication Instruction,low
4841,CT Head without contrast: Chronic lacunar infarcts in bilateral basal ganglia. No mass effect. Subarachnoid hemorrhage in bilateral sylvian fissures. 4cm right subdural hematoma with 5mm midline shift. Paranasal sinuses clear.,"CT scan of the head results: There are signs of small old strokes in the deep parts of the brain. There are no tumors or masses pushing on the brain. There is bleeding around the brain surface, particularly in the grooves on both sides. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. The sinuses are clear with no infection.",Neurology,Radiology Report,high
4842,"84 y/o F with PMH of BPH, depression, admitted for chest pain r/o ACS. Serial troponins and cardiac monitoring performed. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on metoprolol 25mg BID, Lantus 20U QHS. F/U INR check in 3 days.","A 84-year-old woman with a history of enlarged prostate, and depression was admitted for chest pain being evaluated for a possible heart attack. Serial troponins and cardiac monitoring performed. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up for a blood thinner level check in 3 days.",Cardiology,Discharge Summary,high
4843,CXR PA: Compression fracture T12. Right middle lobe atelectasis. Elevated left hemidiaphragm. Sternotomy wires intact.,"Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The left side of the breathing muscle [diaphragm] is sitting higher than normal. The wires from prior heart surgery are intact.",Pulmonology,Radiology Report,high
4844,"77 y/o F with PMH of depression, PPM in situ, admitted for fall with hip fracture. X-ray confirmed femoral neck fracture. Orthopedics consulted. Managed per protocol with improvement. Daily weights, 1.5L fluid restriction, low sodium diet. D/C on azithromycin 500mg day 1 then 250mg x 4 days, methotrexate 15mg weekly. F/U hematology in 2 weeks.","A 77-year-old woman with a history of depression, and implanted pacemaker was admitted for broken hip after a fall. X-ray confirmed femoral neck fracture. Orthopedics consulted. They were treated according to standard guidelines and improved. Weigh yourself every morning before eating. Limit fluids to about 6 cups per day. Eat less salt.. Medications on discharge: (1) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. Follow-up with the blood disorder doctor in 2 weeks.",Orthopedics,Discharge Summary,high
4845,"Rx: Tab levothyroxine 75mcg daily on empty stomach. Tab lisinopril 10mg daily. Tab furosemide 40mg BID. Tab omeprazole 20mg AC breakfast. Spiriva 18mcg daily. Adv: low salt low sugar diet, regular exercise Do not stop abruptly, taper as directed. F/U 1 week with CBC, CMP.","Your medicines: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. (2) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. (3) furosemide (Lasix) 40mg twice daily [water pill]. (4) omeprazole 20mg before breakfast [acid-reducing medicine]. (5) Spiriva inhaler once daily [long-acting lung medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
4846,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4847,"CBC: WBC 5.1 (N), Hgb 10.2 (L), Plt 75 (L).","Your blood count results: White blood cells are 5.1 (normal). Hemoglobin is low at 10.2, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 75, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
4848,"24 y/o M with PMH of CHF, HFrEF (EF 30%), obesity (BMI 38), GERD, h/o TIA, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on acetaminophen 650mg Q6H PRN, Xarelto 20mg daily with dinner. F/U hematology in 2 weeks.","A 24-year-old man with a history of heart failure, heart failure with weak pumping (30%), obesity, acid reflux, and history of mini-stroke was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the blood disorder doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4849,MRI Lumbar Spine: Multilevel degenerative disc disease. No compression fracture. Facet joint hypertrophy at L4-L5.,MRI of the lower back results: Multiple discs in the spine are showing wear and aging. No bones are broken or collapsed. The small joints in the spine at L4-L5 are enlarged from arthritis.,Orthopedics,Radiology Report,high
4850,"CBC: WBC 12.1 (H), Hgb 10.5 (L), Plt 417 (H).","Your blood count results: White blood cells are 12.1 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 10.5, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 417, which is high — your blood may clot too easily.",Hematology,Lab Result,high
4851,CXR PA: Hyperinflated lungs consistent with COPD. No cardiomegaly. Bilateral hilar lymphadenopathy.,"Chest X-ray results: The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The heart is a normal size. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
4852,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4853,Rx: Tab ondansetron 4mg Q8H PRN N/V. prednisone taper. Tab Dulcolax 10mg QHS PRN. Avoid grapefruit juice Adv: wound care with daily dressing changes. F/U 2 weeks with INR.,"Your medicines: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]. (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (3) Dulcolax 10mg at bedtime as needed [for constipation]. Do not drink grapefruit juice as it interferes with this medication Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 2 weeks for a blood thinner level check [INR].",General,Prescription,medium
4854,"35 y/o M with PMH of seizure disorder on Keppra, COPD, HFrEF (EF 30%), asthma, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on potassium chloride 20mEq daily, gabapentin 300mg TID, ASA 81mg daily, prednisone taper. F/U INR check in 3 days.","A 35-year-old man with a history of seizure disorder [on Keppra], chronic lung disease, heart failure with weak pumping (30%), and asthma was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) baby aspirin 81mg once daily [prevents blood clots]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. Follow-up for a blood thinner level check in 3 days.",Psychiatry,Discharge Summary,high
4855,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4856,HbA1c: 4.8% (N). FBS: 251 mg/dL (H).,"Your diabetes blood test results: HbA1c is 4.8%, which is normal — you do not have diabetes. Fasting blood sugar was 251, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
4857,"61 y/o F with PMH of Parkinson's disease, hypothyroidism, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on acetaminophen 650mg Q6H PRN, amlodipine 10mg daily, Eliquis 5mg BID. F/U orthopedics in 6 weeks with X-ray.","A 61-year-old woman with a history of Parkinson's disease, and underactive thyroid was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (2) amlodipine 10mg once daily [blood pressure medicine]; (3) Eliquis 5mg twice daily [blood thinner]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Infectious Disease,Discharge Summary,high
4858,Rx: Tab amlodipine 10mg daily. Tab Augmentin 875/125 BID x 7 days. Avoid NSAIDs. F/U 1 week with wound check.,Your medicines: (1) amlodipine 10mg once daily [blood pressure medicine]. (2) Augmentin 875mg twice daily for 7 days [antibiotic]. Do not take anti-inflammatory pain medicines like ibuprofen (Advil) or naproxen (Aleve) as they can harm your kidneys. Come back in 1 week to have the wound checked.,Cardiology,Prescription,medium
4859,Procedure: PCI with DES to LAD. Pt 69 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 69-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4860,"60 y/o M presenting to ED with fall from standing, R hip pain, unable to bear weight. Vitals: BP 142/78, HR 88, RR 16, O2 97%. X-ray pelvis: displaced R femoral neck fracture. Pre-op labs WNL. ECG: NSR. Dx: R femoral neck fracture. Pain management with IV morphine. NPO for OR. Ortho consult for hemiarthroplasty vs ORIF. DVT prophylaxis with Lovenox. Admit ortho.","A 60-year-old man came to the emergency room with fell from standing, severe right hip pain, unable to put weight on the right leg. Vital signs: blood pressure slightly high (pain), heart rate normal, breathing normal, oxygen normal. X-ray showed a broken hip bone (displaced femoral neck fracture) on the right side. Pre-surgery blood tests are normal. Heart tracing is normal. Diagnosis: a broken right hip bone. Pain medicine given through IV. No food (preparing for surgery). Bone surgeon consulted to decide between a partial hip replacement or fixing the bone with screws and plates. Blood thinner to prevent leg clots. Admitted under bone surgery team.",Emergency Medicine,Clinical Note,high
4861,"PATH: Breast: IDC, Nottingham grade 2, ER/PR positive, HER2 negative, margins negative.","Pathology results in plain language: Breast biopsy shows invasive ductal carcinoma, moderately aggressive. Hormone receptors positive (often treatable with hormone therapy). HER2 negative. Edges of tissue clear of cancer.",Oncology,Pathology Report,high
4862,"88 y/o F with PMH of DVT/PE on warfarin, DM2, COPD, admitted for acute kidney injury. Creatinine rose sharply from baseline. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on potassium chloride 20mEq daily, rosuvastatin 10mg QHS, Humalog per SSI. F/U endocrine in 1 week.","A 88-year-old woman with a history of blood clots [on blood thinner warfarin], type 2 diabetes, and chronic lung disease was admitted for sudden worsening of kidney function. Kidney waste products rose sharply from baseline. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (2) rosuvastatin 10mg at bedtime [cholesterol medicine]; (3) Humalog insulin before meals as directed [fast-acting insulin]. Follow-up with the hormone/diabetes doctor in 1 week.",Nephrology,Discharge Summary,high
4863,CXR PA: Clear lung fields bilaterally. Small left pleural effusion. No pneumothorax. Osseous structures intact.,Chest X-ray results: Both lungs look clear with no problems. There is a small amount of fluid around the left lung. There is no collapsed lung. The bones look normal with no fractures.,Pulmonology,Radiology Report,high
4864,Escitalopram 10mg AM; effect builds over weeks; avoid abrupt alcohol use.,Antidepressant taken in the morning; benefits increase over several weeks; limit alcohol.,Psychiatry,Medication Instruction,medium
4865,"PATH: LN bx: reactive lymphoid hyperplasia, no evidence of lymphoma.","Pathology results in plain language: Lymph node sample shows reactive swelling from infection/inflammation, not lymphoma.",Hematology,Pathology Report,high
4866,"62 y/o M with PMH of cirrhosis, SLE, admitted for HHS. Blood sugar >800. Severe dehydration. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on gabapentin 300mg TID, Dulcolax 10mg QHS PRN, latanoprost 0.005% OU QHS, azithromycin 500mg day 1 then 250mg x 4 days. F/U pulmonology in 2 weeks.","A 62-year-old man with a history of liver scarring [cirrhosis], and lupus was admitted for hyperosmolar hyperglycemic state [extremely high blood sugar]. Blood sugar >800. Severe dehydration. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) Dulcolax 10mg at bedtime as needed [for constipation]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (4) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. Follow-up with the lung doctor in 2 weeks.",Endocrinology,Discharge Summary,high
4867,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,medium
4868,"36 y/o M with PMH of HTN, CKD Stage 3, admitted for cellulitis L lower extremity. Area was red, warm, and swollen. Marked with pen to track spread. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on warfarin 5mg daily, Eliquis 5mg BID, gabapentin 300mg TID. F/U pulmonology in 2 weeks.","A 36-year-old man with a history of high blood pressure, and moderate kidney disease was admitted for a skin infection in the left leg. Area was red, warm, and swollen. Marked with pen to track spread. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (2) Eliquis 5mg twice daily [blood thinner]; (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up with the lung doctor in 2 weeks.",Infectious Disease,Discharge Summary,high
4869,"77 y/o F with PMH of OSA on CPAP, CAD, s/p THR, admitted for atrial fibrillation with RVR. HR 150s. Diltiazem drip started for rate control. Managed per protocol with improvement. Smoking cessation counseling provided. D/C on atorvastatin 40mg QHS, amoxicillin 500mg TID x 10 days, Augmentin 875/125 BID x 7 days, pregabalin 75mg BID, entresto 49/51mg BID. F/U surgery in 10 days.","A 77-year-old woman with a history of sleep apnea [uses a breathing machine at night], coronary artery disease [heart artery blockages], and prior hip replacement was admitted for irregular heartbeat with dangerously fast rate. HR 150s. Diltiazem drip started for rate control. They were treated according to standard guidelines and improved. Strongly encouraged to quit smoking. Resources and support provided.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (3) Augmentin 875mg twice daily for 7 days [antibiotic]; (4) pregabalin 75mg twice daily [nerve pain medicine]; (5) Entresto 49/51mg twice daily [heart failure medicine]. Follow-up with the surgeon in 10 days.",Cardiology,Discharge Summary,high
4870,"59 y/o F with PMH of DM1, PPM in situ, DVT/PE on warfarin, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on lisinopril 20mg daily, azithromycin 500mg day 1 then 250mg x 4 days, levothyroxine 75mcg daily on empty stomach, amoxicillin 500mg TID x 10 days. F/U GI in 1 week.","A 59-year-old woman with a history of type 1 diabetes, implanted pacemaker, and blood clots [on blood thinner warfarin] was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) lisinopril 20mg once daily [blood pressure medicine]; (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]; (3) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. Follow-up with the stomach doctor in 1 week.",General Surgery,Discharge Summary,high
4871,"38 y/o F with PMH of DVT/PE on warfarin, PAD, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on prednisone taper, atorvastatin 80mg QHS, gabapentin 300mg TID. F/U INR check in 3 days.","A 38-year-old woman with a history of blood clots [on blood thinner warfarin], and poor blood flow in the legs [peripheral artery disease] was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]; (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]. Follow-up for a blood thinner level check in 3 days.",Infectious Disease,Discharge Summary,high
4872,"48 y/o F with PMH of CKD Stage 3, asthma, RA on MTX, admitted for upper GI bleeding. Hematemesis noted. EGD showed bleeding ulcer. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on metoprolol 25mg BID, sertraline 50mg daily. F/U orthopedics in 6 weeks with X-ray.","A 48-year-old woman with a history of moderate kidney disease, asthma, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for bleeding from the stomach or food pipe. Hematemesis noted. EGD showed bleeding ulcer. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Gastroenterology,Discharge Summary,high
4873,"Rx: Tab pantoprazole 40mg AC breakfast. Tab amlodipine 10mg daily. Adv: high fiber diet, adequate hydration Adv: smoking cessation, pulmonary rehab. F/U 4 weeks with TSH, Free T4.","Your medicines: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 4 weeks for thyroid blood tests [TSH and Free T4] to check if the dose is right.",Cardiology,Prescription,medium
4874,"Lipid panel: TC 180, LDL 75, HDL 63, TG 303.",Your cholesterol results: Total cholesterol is 180. LDL (bad cholesterol) is at goal (75). HDL (good cholesterol) is good at 63. Triglycerides are very high at 303 (normal under 150) — increases risk of pancreatitis.,Cardiology,Lab Result,high
4875,CXR PA: Mild cardiomegaly. Hyperinflated lungs consistent with COPD. Pacemaker leads in appropriate position. Bilateral pleural effusions.,"Chest X-ray results: The heart is slightly larger than normal. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The pacemaker wires are in the correct position. There is fluid collecting around both lungs.",Pulmonology,Radiology Report,high
4876,"64 y/o M presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 64-year-old man came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4877,HbA1c: 7.0% (H). FBS: 285 mg/dL (H).,"Your diabetes blood test results: HbA1c is 7.0%, which is above the target of 7.0%. Your blood sugar has been somewhat poorly controlled over the past 3 months. Fasting blood sugar was 285, which is high (normal is 70-100). Your diabetes medicines may need adjustment. Discuss with your doctor.",Endocrinology,Lab Result,high
4878,CXR PA: Sternotomy wires intact. Hyperinflated lungs consistent with COPD. Pacemaker leads in appropriate position. Right-sided pneumothorax. Left lower lobe consolidation.,"Chest X-ray results: The wires from prior heart surgery are intact. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. The pacemaker wires are in the correct position. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax]. There is an area in the lower left lung that appears infected.",Pulmonology,Radiology Report,high
4879,"Rx: Tab rosuvastatin 10mg QHS. Tab furosemide 40mg BID. Tab warfarin 5mg daily. Tab pantoprazole 40mg AC breakfast. Tab losartan 50mg daily. Adv: low salt low sugar diet, regular exercise Adv: smoking cessation, pulmonary rehab. F/U INR in 3 days.","Your medicines: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]. (2) furosemide (Lasix) 40mg twice daily [water pill]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (4) pantoprazole 40mg before breakfast [acid-reducing medicine]. (5) losartan 50mg once daily [blood pressure medicine]. Advice: eat less salt and sugar, and exercise at least 30 minutes most days Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 3 days for a blood thinner level check [INR].",Cardiology,Prescription,high
4880,"39 y/o M with PMH of CKD Stage 4, osteoporosis, s/p CABG, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on ciprofloxacin 500mg BID x 5 days, prednisone taper, gabapentin 300mg TID, glipizide 5mg BID AC, Lantus 20U QHS. F/U neurology in 2 weeks.","A 39-year-old man with a history of advanced kidney disease, weak bones [osteoporosis], and prior heart bypass surgery was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (3) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (4) glipizide 5mg twice daily before meals [helps release insulin]; (5) Lantus insulin 20 units at bedtime [long-acting insulin]. Follow-up with the brain/nerve doctor in 2 weeks.",Gastroenterology,Discharge Summary,high
4881,"Rx: Tab sertraline 50mg daily. Humalog per SSI. Tab omeprazole 20mg AC breakfast. Spiriva 18mcg daily. Adv: wound care with daily dressing changes. F/U 1 week with CBC, CMP.","Your medicines: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]. (2) Humalog insulin before meals as directed [fast-acting insulin]. (3) omeprazole 20mg before breakfast [acid-reducing medicine]. (4) Spiriva inhaler once daily [long-acting lung medicine]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Pulmonology,Prescription,high
4882,"79 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 79-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4883,"Rx: Tab potassium chloride 20mEq daily. Tab empagliflozin 10mg daily. Adv: wound care with daily dressing changes Adv: fall precautions, home safety evaluation. F/U 1 week with wound check.","Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Advice: change the wound dressing once daily — clean with saline, apply ointment, cover with fresh bandage Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week to have the wound checked.",Endocrinology,Prescription,medium
4884,Procedure: TURP for BPH. Pt 65 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 65-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
4885,"Rx: Tab Dulcolax 10mg QHS PRN. Tab rosuvastatin 10mg QHS. Tab tramadol 50mg Q6H PRN pain. Tab warfarin 5mg daily. Tab losartan 50mg daily. Adv: elevate affected limb, compression stockings. F/U PCP in 1 week for BP recheck.",Your medicines: (1) Dulcolax 10mg at bedtime as needed [for constipation]. (2) rosuvastatin 10mg at bedtime [cholesterol medicine]. (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. (4) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (5) losartan 50mg once daily [blood pressure medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings. See your primary care doctor in 1 week to recheck blood pressure.,Cardiology,Prescription,high
4886,CXR PA: No pneumothorax. Small left pleural effusion. Hyperinflated lungs consistent with COPD. Patchy bilateral infiltrates.,"Chest X-ray results: There is no collapsed lung. There is a small amount of fluid around the left lung. The lungs appear over-inflated, which is typical of chronic lung disease [COPD/emphysema]. There are scattered cloudy patches in both lungs suggesting infection or inflammation.",Pulmonology,Radiology Report,high
4887,MRI Lumbar Spine: C5-C6 disc herniation with cord compression. L5-S1 disc desiccation with mild bulge. No compression fracture. Central canal stenosis at L3-L4.,"MRI of the lower back results: At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. No bones are broken or collapsed. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
4888,"CBC: WBC 22.3 (H), Hgb 11.0 (L), Plt 417 (H).","Your blood count results: White blood cells are 22.3 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 11.0, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 417, which is high — your blood may clot too easily.",Hematology,Lab Result,high
4889,Delivery Note: G?P? at 39+1 weeks. Primary low-transverse C-section. Live male infant. APGAR 7/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 7/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4890,"63 y/o M with PMH of osteoporosis, h/o TIA, depression, Parkinson's disease, admitted for DVT. Ultrasound confirmed DVT. Anticoagulation started. Managed per protocol with improvement. Strict I&O, daily weights. D/C on omeprazole 20mg AC breakfast, metformin 1000mg BID, ibuprofen 400mg Q6H PRN with food, amoxicillin 500mg TID x 10 days, acetaminophen 650mg Q6H PRN. F/U hematology in 2 weeks.","A 63-year-old man with a history of weak bones [osteoporosis], history of mini-stroke, depression, and Parkinson's disease was admitted for a blood clot in the leg [deep vein thrombosis]. Ultrasound confirmed DVT. Anticoagulation started. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) metformin 1000mg twice daily with meals [blood sugar medicine]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]; (4) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (5) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. Follow-up with the blood disorder doctor in 2 weeks.",Hematology,Discharge Summary,high
4891,Amiodarone load per protocol then maintenance; monitor thyroid and liver tests.,Heart rhythm medicine starts with a supervised loading phase then a lower daily dose. Blood tests monitor thyroid and liver.,Cardiology,Medication Instruction,high
4892,"79 y/o M with PMH of h/o CVA, CHF, BPH, obesity (BMI 38), admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on levothyroxine 75mcg daily on empty stomach, gabapentin 300mg TID, omeprazole 20mg AC breakfast. F/U orthopedics in 6 weeks with X-ray.","A 79-year-old man with a history of history of stroke, heart failure, enlarged prostate, and obesity was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Endocrinology,Discharge Summary,high
4893,HbA1c: 5.5% (N). FBS: 398 mg/dL (H).,"Your diabetes blood test results: HbA1c is 5.5%, which is normal — you do not have diabetes. Fasting blood sugar was 398, which is high (normal is 70-100). No diabetes treatment needed. Continue healthy lifestyle.",Endocrinology,Lab Result,high
4894,"58 y/o M with PMH of GERD, s/p TKR, OA, CKD Stage 3, admitted for cellulitis R lower extremity. Leg was red, swollen, and warm. IV antibiotics started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on ciprofloxacin 500mg BID x 5 days, albuterol MDI 2 puffs Q4-6H PRN, amlodipine 5mg daily, escitalopram 10mg daily. F/U GI in 1 week.","A 58-year-old man with a history of acid reflux, prior knee replacement, arthritis [osteoarthritis], and moderate kidney disease was admitted for a skin infection in the right leg. Leg was red, swollen, and warm. IV antibiotics started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) ciprofloxacin 500mg twice daily for 5 days [antibiotic — avoid dairy within 2 hours]; (2) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Follow-up with the stomach doctor in 1 week.",Infectious Disease,Discharge Summary,high
4895,"Lipid panel: TC 275, LDL 177, HDL 76, TG 261.","Your cholesterol results: Total cholesterol is 275. LDL (bad cholesterol) is very high at 177 (goal under 100), significantly increasing heart disease risk. HDL (good cholesterol) is good at 76. Triglycerides are high at 261.",Cardiology,Lab Result,high
4896,"US Abdomen: GB wall thickening with stones, positive Murphy's sign. No focal hepatic lesion. Simple renal cysts bilaterally. CBD 12mm, dilated.","Abdominal ultrasound results: The gallbladder wall is thickened and gallstones are present — pressing on the gallbladder area caused pain [positive Murphy's sign], suggesting infection. No tumors or masses were found in the liver. Both kidneys have harmless fluid-filled cysts. The bile duct is wider than normal [dilated], which may indicate a blockage.",Gastroenterology,Radiology Report,high
4897,"46 y/o M with PMH of HFrEF (EF 30%), BPH, admitted for TIA. Symptoms resolved. MRI negative for infarct. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on pantoprazole 40mg AC breakfast, clopidogrel 75mg daily, Dulcolax 10mg QHS PRN, Xarelto 20mg daily with dinner, ASA 81mg daily. F/U INR check in 3 days.","A 46-year-old man with a history of heart failure with weak pumping (30%), and enlarged prostate was admitted for a mini-stroke [temporary loss of brain function]. Symptoms resolved. MRI negative for infarct. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) Plavix (clopidogrel) 75mg once daily [blood thinner]; (3) Dulcolax 10mg at bedtime as needed [for constipation]; (4) Xarelto 20mg once daily with dinner [blood thinner]; (5) baby aspirin 81mg once daily [prevents blood clots]. Follow-up for a blood thinner level check in 3 days.",Neurology,Discharge Summary,high
4898,"27 y/o M with PMH of CAD, hypothyroidism, HFpEF, A-fib, admitted for AECOPD. O2 sat dropped. Required supplemental oxygen. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on albuterol MDI 2 puffs Q4-6H PRN, ASA 81mg daily, glipizide 5mg BID AC. F/U nephrology in 5 days.","A 27-year-old man with a history of coronary artery disease [heart artery blockages], underactive thyroid, heart failure with stiff heart muscle, and irregular heartbeat [atrial fibrillation] was admitted for a severe flare-up of chronic lung disease. Oxygen levels dropped. Required supplemental oxygen. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) baby aspirin 81mg once daily [prevents blood clots]; (3) glipizide 5mg twice daily before meals [helps release insulin]. Follow-up with the kidney doctor in 5 days.",Pulmonology,Discharge Summary,high
4899,"85 y/o M presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 85-year-old man came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4900,"PATH: Colon: tubular adenoma with low-grade dysplasia, completely excised.","Pathology results in plain language: Colon polyp is a benign growth with mild abnormal cells, fully removed.",Oncology,Pathology Report,high
4901,"50 y/o M with PMH of h/o CVA, CKD Stage 4, PAD, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Head injury precautions x 48hrs. D/C on pantoprazole 40mg AC breakfast, potassium chloride 20mEq daily, Spiriva 18mcg daily, levothyroxine 75mcg daily on empty stomach. F/U nephrology in 5 days.","A 50-year-old man with a history of history of stroke, advanced kidney disease, and poor blood flow in the legs [peripheral artery disease] was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Watch for: worsening headache, vomiting, confusion, unequal pupils, unusual drowsiness — go to ER immediately if any occur.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) Spiriva inhaler once daily [long-acting lung medicine]; (4) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Follow-up with the kidney doctor in 5 days.",General Surgery,Discharge Summary,high
4902,"Rx: Tab acetaminophen 650mg Q6H PRN. Tab ferrous sulfate 325mg BID. Tab furosemide 40mg daily. Avoid grapefruit juice Adv: low potassium diet. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. Do not drink grapefruit juice as it interferes with this medication Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",General,Prescription,medium
4903,"73 y/o M with PMH of seizure disorder on Keppra, anxiety, HLD, h/o CVA, OA, admitted for alcohol withdrawal. CIWA protocol initiated. Lorazepam given as needed. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on metoprolol succinate 50mg daily, warfarin 5mg daily, latanoprost 0.005% OU QHS, hydroxychloroquine 200mg BID. F/U endocrine in 1 week.","A 73-year-old man with a history of seizure disorder [on Keppra], anxiety, high cholesterol, history of stroke, and arthritis [osteoarthritis] was admitted for withdrawal symptoms after stopping alcohol. CIWA protocol initiated. Lorazepam given as needed. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (4) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Follow-up with the hormone/diabetes doctor in 1 week.",Psychiatry,Discharge Summary,high
4904,"66 y/o M with PMH of HFrEF (EF 30%), s/p CABG, cirrhosis, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on ondansetron 4mg Q8H PRN N/V, Eliquis 5mg BID. F/U INR check in 3 days.","A 66-year-old man with a history of heart failure with weak pumping (30%), prior heart bypass surgery, and liver scarring [cirrhosis] was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) ondansetron (Zofran) 4mg every 8 hours as needed [anti-nausea medicine]; (2) Eliquis 5mg twice daily [blood thinner]. Follow-up for a blood thinner level check in 3 days.",Urology,Discharge Summary,high
4905,"83 y/o M with PMH of HFrEF (EF 30%), CHF, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on losartan 50mg daily, Augmentin 875/125 BID x 7 days, ibuprofen 400mg Q6H PRN with food. F/U nephrology in 1 week.","A 83-year-old man with a history of heart failure with weak pumping (30%), and heart failure was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) losartan 50mg once daily [blood pressure medicine]; (2) Augmentin 875mg twice daily for 7 days [antibiotic]; (3) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up with the kidney doctor in 1 week.",Cardiology,Discharge Summary,high
4906,"US Abdomen: Spleen 16cm, splenomegaly. Right kidney 10.5cm, no hydronephrosis. Moderate right hydronephrosis.","Abdominal ultrasound results: The spleen is enlarged [splenomegaly]. Right kidney is normal size with no blockage. The right kidney is swollen because urine is backing up [hydronephrosis], possibly from a blockage.",Gastroenterology,Radiology Report,high
4907,"Rx: Tab furosemide 40mg daily. Tab calcium + vitamin D 600/400 daily. Tab Xarelto 20mg daily with dinner. Adv: smoking cessation, pulmonary rehab Adv: elevate affected limb, compression stockings. F/U 6 weeks with LFTs.",Your medicines: (1) furosemide (Lasix) 40mg once daily [water pill to remove extra fluid]. (2) calcium plus vitamin D once daily [bone strengthening]. (3) Xarelto 20mg once daily with dinner [blood thinner]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 6 weeks for liver function blood tests.,Cardiology,Prescription,medium
4908,Procedure: TURP for BPH. Pt 61 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 61-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
4909,"Rx: Tab omeprazole 20mg AC breakfast. Tab hydroxychloroquine 200mg BID. Adv: high fiber diet, adequate hydration. F/U 2 weeks with FBS, HbA1c, lipid panel, KFT.","Your medicines: (1) omeprazole 20mg before breakfast [acid-reducing medicine]. (2) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks with blood tests for: fasting blood sugar [FBS], 3-month sugar average [HbA1c], cholesterol levels [lipid panel], and kidney function [KFT].",Gastroenterology,Prescription,medium
4910,Insulin lispro: count carbs and match units per sliding scale; treat lows per rule.,Fast-acting insulin dosing follows carbohydrate counting and your prescribed sliding scale; treat low blood sugar using your education handout.,Endocrinology,Medication Instruction,medium
4911,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. No mass effect. Paranasal sinuses clear. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There are no tumors or masses pushing on the brain. The sinuses are clear with no infection. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
4912,"CBC: WBC 20.0 (H), Hgb 12.0 (N), Plt 34 (L).","Your blood count results: White blood cells are 20.0 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 12.0. Platelets are 34, which is low — your blood may not clot properly, increasing bleeding risk.",Hematology,Lab Result,high
4913,"PATH: Shave bx: actinic keratosis, suggest sunscreen and dermatology follow-up.",Pathology results in plain language: Sun-damaged spot on skin — precancerous change. Protect skin from sun and follow with skin doctor.,Dermatology,Pathology Report,high
4914,"59 y/o F presenting to ED with severe allergic reaction after eating shellfish, diffuse urticaria, lip/tongue swelling, wheezing. Vitals: BP 82/50, HR 132, RR 28, O2 90%. Clinical diagnosis of anaphylaxis based on exam. Dx: Anaphylaxis. Epinephrine 0.3mg IM x 2 doses. IV NS 2L bolus. IV methylprednisolone 125mg. IV diphenhydramine 50mg. IV famotidine 20mg. Observed 6hrs. EpiPen prescribed on D/C. Allergy referral.","A 59-year-old woman came to the emergency room with severe allergic reaction after eating shellfish — hives all over body, lips and tongue swelling, wheezing. Vital signs: blood pressure dangerously low (shock), heart rate very fast, breathing rapid, oxygen low. Examination and vital signs support a severe systemic allergic reaction affecting breathing and circulation. Diagnosis: a life-threatening allergic reaction. Two doses of epinephrine (adrenaline) injected into the muscle. Large amounts of IV fluids. Steroid, antihistamine, and acid-blocker given through IV. Observed for 6 hours for delayed reaction. Prescribed an EpiPen to carry at all times. Referred to allergy specialist. MUST AVOID all shellfish permanently.",Emergency Medicine,Clinical Note,high
4915,HbA1c: 8.0% (H). FBS: 82 mg/dL (N).,"Your diabetes blood test results: HbA1c is 8.0%, which is high, meaning your blood sugar has been poorly controlled over the past 3 months (target is under 7%). Fasting blood sugar was 82, which is normal (normal is 70-100). Your diabetes treatment needs to be changed. This level increases risk of complications.",Endocrinology,Lab Result,high
4916,"Rx: prednisone taper. Tab glipizide 5mg BID AC. Spiriva 18mcg daily. Tab amlodipine 5mg daily. Adv: high fiber diet, adequate hydration Adv: low potassium diet. F/U PCP in 1 week for BP recheck.","Your medicines: (1) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]. (2) glipizide 5mg twice daily before meals [helps release insulin]. (3) Spiriva inhaler once daily [long-acting lung medicine]. (4) amlodipine 5mg once daily [blood pressure medicine]. Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. See your primary care doctor in 1 week to recheck blood pressure.",Cardiology,Prescription,high
4917,Procedure: Colonoscopy with polypectomy. Pt 39 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes colon exam with removal of polyps for a 39-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4918,"Rx: Tab metformin 500mg BID. Tab amlodipine 10mg daily. Tab metoprolol 25mg BID. Do not stop abruptly, taper as directed Adv: high fiber diet, adequate hydration. F/U 1 week with CBC, CMP.","Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) amlodipine 10mg once daily [blood pressure medicine]. (3) metoprolol 25mg twice daily [slows heart rate and lowers blood pressure]. Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,medium
4919,"LFTs: AST 167 (H), ALT 147 (H), ALP 191, T.Bili 2.9 (H), Albumin 2.4.","Your liver blood test results: Liver enzymes (AST 167, ALT 147) are moderately elevated, indicating liver irritation (normal is under 40). Bilirubin is high at 2.9 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is low at 2.4 (normal 3.5-5.5), suggesting the liver is struggling to make important proteins.",Gastroenterology,Lab Result,high
4920,"65 y/o M presenting to ED with acute onset pleuritic CP, SOB, R calf swelling x 3 days. Vitals: BP 132/88, HR 112, RR 24, O2 91% on RA. D-dimer elevated. CTA chest: bilateral PE with RV strain. US R LE: popliteal DVT. Dx: Bilateral PE with DVT. Heparin drip started. Consider catheter-directed thrombolysis given RV strain. Admit ICU. Transition to Eliquis on discharge.","A 65-year-old man came to the emergency room with sudden chest pain that worsens with breathing, shortness of breath, and right calf swelling for 3 days. Vital signs: blood pressure normal, heart rate fast, breathing rapid, oxygen low at 91%. A blood clot screening test was positive. CT scan confirmed blood clots in both lung arteries with strain on the right side of the heart. Ultrasound confirmed a blood clot in the right leg. Diagnosis: blood clots in both lungs [pulmonary embolism] and in the right leg [deep vein thrombosis]. Blood thinner drip started immediately. Doctors are considering a procedure to dissolve the clots directly given the strain on the heart. Admitted to ICU. Will switch to an oral blood thinner (Eliquis) before going home.",Emergency Medicine,Clinical Note,high
4921,"80 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 80-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4922,"Rx: Tab potassium chloride 20mEq daily. Tab ferrous sulfate 325mg BID. Tab pregabalin 75mg BID. Adv: low salt diet, fluid restriction 1.5L/day. F/U PCP in 1 week for BP recheck.",Your medicines: (1) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (3) pregabalin 75mg twice daily [nerve pain medicine]. Advice: eat less salt and limit your total fluid intake to about 6 cups per day. See your primary care doctor in 1 week to recheck blood pressure.,General,Prescription,medium
4923,Procedure: Laparoscopic cholecystectomy. Pt 28 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 28-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
4924,"69 y/o M with PMH of PAD, OSA on CPAP, osteoporosis, Parkinson's disease, HFrEF (EF 30%), admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on omeprazole 20mg AC breakfast, montelukast 10mg QHS, ferrous sulfate 325mg BID, latanoprost 0.005% OU QHS. F/U nephrology in 1 week.","A 69-year-old man with a history of poor blood flow in the legs [peripheral artery disease], sleep apnea [uses a breathing machine at night], weak bones [osteoporosis], Parkinson's disease, and heart failure with weak pumping (30%) was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) omeprazole 20mg before breakfast [acid-reducing medicine]; (2) montelukast 10mg at bedtime [asthma/allergy medicine]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
4925,CXR PA: No pneumothorax. Widened mediastinum. Elevated left hemidiaphragm.,"Chest X-ray results: There is no collapsed lung. The space between the lungs appears wider than normal, which needs further evaluation. The left side of the breathing muscle [diaphragm] is sitting higher than normal.",Pulmonology,Radiology Report,high
4926,"55 y/o F with PMH of CKD Stage 4, GERD, seizure disorder on Keppra, depression, admitted for DKA. Blood sugar >500. pH 7.1. Anion gap elevated. Managed per protocol with improvement. Wound care: daily dressing changes with wet-to-dry gauze. D/C on sertraline 50mg daily, Spiriva 18mcg daily, tramadol 50mg Q6H PRN pain. F/U neurology in 2 weeks.","A 55-year-old woman with a history of advanced kidney disease, acid reflux, seizure disorder [on Keppra], and depression was admitted for diabetic ketoacidosis [dangerously high blood sugar with acid buildup]. Blood sugar >500. blood became dangerously acidic. Anion gap elevated. They were treated according to standard guidelines and improved. Change the wound dressing daily: wet the gauze with saline, place on wound, cover with dry gauze and tape.. Medications on discharge: (1) sertraline 50mg once daily [antidepressant/anxiety medicine]; (2) Spiriva inhaler once daily [long-acting lung medicine]; (3) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the brain/nerve doctor in 2 weeks.",Endocrinology,Discharge Summary,high
4927,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab lisinopril 20mg daily. Adv: elevate affected limb, compression stockings. F/U 1 week with wound check.",Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) lisinopril 20mg once daily [blood pressure medicine]. Advice: keep the affected leg elevated when resting and wear compression stockings. Come back in 1 week to have the wound checked.,Cardiology,Prescription,medium
4928,CXR PA: Pacemaker leads in appropriate position. NG tube tip in stomach. Left lower lobe consolidation. Patchy bilateral infiltrates. Increased interstitial markings suggesting pulmonary edema.,"Chest X-ray results: The pacemaker wires are in the correct position. The feeding/drainage tube tip is correctly positioned in the stomach. There is an area in the lower left lung that appears infected. There are scattered cloudy patches in both lungs suggesting infection or inflammation. There are signs of extra fluid in the lung tissue, suggesting the heart may not be pumping efficiently [pulmonary edema].",Pulmonology,Radiology Report,high
4929,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
4930,"Thyroid panel: TSH 1.43 (N), Free T4 2.4.",Your thyroid test results: TSH is normal at 1.43. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
4931,"44 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 44-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4932,Procedure: TURP for BPH. Pt 87 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes scope surgery to trim enlarged prostate tissue for a 87-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Urology,Procedure Note,high
4933,CXR PA: Compression fracture T12. Port-a-cath in appropriate position. Left lower lobe consolidation.,Chest X-ray results: There is a compression fracture [collapsed bone] in the lower spine at T12. The implanted medication port is in the correct position. There is an area in the lower left lung that appears infected.,Pulmonology,Radiology Report,high
4934,"Thyroid panel: TSH 3.6 (N), Free T4 1.5.",Your thyroid test results: TSH is normal at 3.6. Free T4 is normal — your thyroid function is balanced.,Endocrinology,Lab Result,medium
4935,CT Head without contrast: Paranasal sinuses clear. Acute ischemic infarct in R MCA territory. No midline shift. 4cm right subdural hematoma with 5mm midline shift. No mass effect.,"CT scan of the head results: The sinuses are clear with no infection. There is a new stroke affecting the right side of the brain, in the area supplied by the middle cerebral artery. The brain is centered normally. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious. There are no tumors or masses pushing on the brain.",Neurology,Radiology Report,high
4936,"70 y/o M with PMH of OSA on CPAP, HFpEF, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on amoxicillin 500mg TID x 10 days, latanoprost 0.005% OU QHS, timolol 0.5% OU BID, sertraline 50mg daily. F/U surgery in 10 days.","A 70-year-old man with a history of sleep apnea [uses a breathing machine at night], and heart failure with stiff heart muscle was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (3) timolol eye drops in both eyes twice daily [lowers eye pressure for glaucoma]; (4) sertraline 50mg once daily [antidepressant/anxiety medicine]. Follow-up with the surgeon in 10 days.",General Surgery,Discharge Summary,high
4937,Delivery Note: G?P? at 38+2 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4938,"38 y/o M presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 38-year-old man came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4939,"40 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 40-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4940,Delivery Note: G?P? at 37+3 weeks. SVD. Live male infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 37+3 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy male. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4941,MRI Lumbar Spine: L5-S1 disc desiccation with mild bulge. C5-C6 disc herniation with cord compression. No compression fracture.,"MRI of the lower back results: At the L5-S1 level, the disc is dried out [worn] with a slight bulge, but not causing significant pressure. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. No bones are broken or collapsed.",Orthopedics,Radiology Report,high
4942,"67 y/o M with PMH of PAD, OA, HTN, ESRD on HD, Parkinson's disease, admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on Eliquis 5mg BID, ferrous sulfate 325mg BID, montelukast 10mg QHS. F/U hematology in 2 weeks.","A 67-year-old man with a history of poor blood flow in the legs [peripheral artery disease], arthritis [osteoarthritis], high blood pressure, kidney failure requiring dialysis, and Parkinson's disease was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) Eliquis 5mg twice daily [blood thinner]; (2) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Follow-up with the blood disorder doctor in 2 weeks.",Pulmonology,Discharge Summary,high
4943,"Rx: Tab metformin 500mg BID. Tab methotrexate 15mg weekly. Tab furosemide 40mg BID. Tab escitalopram 10mg daily. Adv: DASH diet, daily BP monitoring. F/U 1 month with repeat imaging.","Your medicines: (1) metformin 500mg twice daily with meals [blood sugar medicine]. (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (3) furosemide (Lasix) 40mg twice daily [water pill]. (4) escitalopram 10mg once daily [antidepressant/anxiety medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
4944,Rivaroxaban 15mg BID x 21d then 20mg daily with food for PE.,Blood thinner dosing changes after the first 3 weeks — always take with food as instructed for lung clots.,Pulmonology,Medication Instruction,high
4945,"72 y/o F with PMH of h/o CVA, Parkinson's disease, obesity (BMI 38), CAD, HFpEF, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Strict I&O, daily weights. D/C on spironolactone 25mg daily, potassium chloride 20mEq daily, glipizide 5mg BID AC, Spiriva 18mcg daily. F/U hematology in 2 weeks.","A 72-year-old woman with a history of history of stroke, Parkinson's disease, obesity, coronary artery disease [heart artery blockages], and heart failure with stiff heart muscle was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Track how much you drink and urinate. Weigh yourself every morning.. Medications on discharge: (1) spironolactone 25mg once daily [heart-protecting water pill]; (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]; (3) glipizide 5mg twice daily before meals [helps release insulin]; (4) Spiriva inhaler once daily [long-acting lung medicine]. Follow-up with the blood disorder doctor in 2 weeks.",General Surgery,Discharge Summary,high
4946,Procedure: ERCP with sphincterotomy. Pt 67 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes procedure to open the bile duct using a scope for a 67-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Gastroenterology,Procedure Note,high
4947,"BMP: Na 125 (L), K 5.6 (H), BUN 49, Cr 1.5 (H), Glucose 220.","Your blood chemistry results: Sodium is low at 125 (normal 136-145), meaning too much water in your body. Potassium is dangerously high at 5.6 (normal 3.5-5.0) — this can affect your heart and needs immediate treatment. Creatinine is mildly elevated at 1.5. Blood sugar is 220 (high).",Nephrology,Lab Result,high
4948,"Rx: Tab amlodipine 5mg daily. Tab potassium chloride 20mEq daily. Adv: smoking cessation, pulmonary rehab. F/U 1 week with CBC, CMP.",Your medicines: (1) amlodipine 5mg once daily [blood pressure medicine]. (2) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Advice: stop smoking (ask about nicotine patches or gum) and attend lung rehabilitation program. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].,Cardiology,Prescription,medium
4949,Procedure: PCI with DES to LAD. Pt 24 y/o F. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes heart catheter procedure to place a stent in a heart artery for a 24-year-old woman. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Cardiology,Procedure Note,high
4950,Procedure: Port-a-cath placement. Pt 31 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes implanted vein port for chemotherapy for a 31-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Oncology,Procedure Note,high
4951,"US Abdomen: Spleen 11cm, normal. Left kidney 8cm, cortical thinning consistent with CKD. Right kidney 10.5cm, no hydronephrosis. CBD 12mm, dilated. Liver 18cm, diffusely echogenic consistent with hepatic steatosis.","Abdominal ultrasound results: The spleen is a normal size. Left kidney is small with thin outer layer, consistent with chronic kidney disease. Right kidney is normal size with no blockage. The bile duct is wider than normal [dilated], which may indicate a blockage. The liver is slightly enlarged and appears brighter than normal, indicating fatty liver disease.",Gastroenterology,Radiology Report,high
4952,HbA1c: 10.3% (H). FBS: 173 mg/dL (H).,"Your diabetes blood test results: HbA1c is 10.3%, which is very high, meaning blood sugar has been dangerously uncontrolled (target is under 7%). Fasting blood sugar was 173, which is high (normal is 70-100). Urgent medication adjustment needed. Very high risk of diabetes complications at this level.",Endocrinology,Lab Result,high
4953,CXR PA: Right lower lobe consolidation. Right middle lobe atelectasis. Port-a-cath in appropriate position. Clear lung fields bilaterally.,"Chest X-ray results: There is an area in the lower right lung that appears infected, suggesting pneumonia. Part of the right lung has partially collapsed [atelectasis], possibly from mucus plugging. The implanted medication port is in the correct position. Both lungs look clear with no problems.",Pulmonology,Radiology Report,high
4954,"Rx: Tab ferrous sulfate 325mg BID. Tab atorvastatin 80mg QHS. Humalog per SSI. Tab Dulcolax 10mg QHS PRN. Lantus 20U QHS. Adv: low potassium diet. F/U 1 week with CBC, CMP.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. (3) Humalog insulin before meals as directed [fast-acting insulin]. (4) Dulcolax 10mg at bedtime as needed [for constipation]. (5) Lantus insulin 20 units at bedtime [long-acting insulin]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Pediatrics,Prescription,high
4955,Delivery Note: G?P? at 38+2 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4956,"85 y/o F presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 85-year-old woman came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4957,Latanoprost OU QHS; remove contacts before drops; punctal occlusion 1 min.,Glaucoma drops at bedtime in both eyes; remove contacts before use and gently press inner corners for one minute.,Ophthalmology,Medication Instruction,low
4958,"CBC: WBC 3.3 (L), Hgb 8.6 (L), Plt 209 (N).","Your blood count results: White blood cells are 3.3 (low, meaning your immune system may be weakened). Hemoglobin is low at 8.6, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 209, which is normal.",Hematology,Lab Result,high
4959,"42 y/o F presenting to ED with RLQ pain x 12hrs, anorexia, low-grade fever. Vitals: BP 128/76, HR 96, T 100.8F. CT abdomen: 9mm dilated appendix with periappendiceal fat stranding, no perforation. Dx: Acute uncomplicated appendicitis. NPO, IV Zosyn. Surgery consulted for laparoscopic appendectomy. Admit surgery.","A 42-year-old woman came to the emergency room with pain in the lower right belly for 12 hours, loss of appetite, and mild fever. Vital signs: blood pressure normal, heart rate slightly fast, mild fever. CT scan showed the appendix is swollen (9mm, normal <6mm) with inflammation around it but no rupture. Diagnosis: appendix inflammation [appendicitis] — not yet burst. No food by mouth. Antibiotic started through IV. Surgeon called for keyhole surgery to remove the appendix.",Emergency Medicine,Clinical Note,high
4960,CT Head without contrast: Subarachnoid hemorrhage in bilateral sylvian fissures. Chronic lacunar infarcts in bilateral basal ganglia. 4cm right subdural hematoma with 5mm midline shift.,"CT scan of the head results: There is bleeding around the brain surface, particularly in the grooves on both sides. There are signs of small old strokes in the deep parts of the brain. There is a significant blood collection (4cm) on the right side between the brain and skull, pushing the brain 5mm to the left — this is serious.",Neurology,Radiology Report,high
4961,CXR PA: Bilateral pleural effusions. Small left pleural effusion. Widened mediastinum. Bilateral hilar lymphadenopathy.,"Chest X-ray results: There is fluid collecting around both lungs. There is a small amount of fluid around the left lung. The space between the lungs appears wider than normal, which needs further evaluation. There are enlarged lymph nodes at the root of both lungs, which needs further evaluation.",Pulmonology,Radiology Report,high
4962,Delivery Note: G?P? at 38+2 weeks. Primary low-transverse C-section. Live male infant. APGAR 9/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 38+2 weeks gestation. The baby was delivered by C-section through a low horizontal cut on the uterus. The newborn is a healthy male. APGAR scores were 9/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4963,Delivery Note: G?P? at 39+1 weeks. SVD. Live female infant. APGAR 8/9. EBL within expected limits. Mother stable.,Birth summary: pregnancy reached about 39+1 weeks gestation. The baby was delivered by normal vaginal delivery. The newborn is a healthy female. APGAR scores were 8/9. Bleeding was normal. Mother did well after delivery.,Obstetrics,Delivery Note,high
4964,"BMP: Na 142 (N), K 4.4 (N), BUN 63, Cr 6.2 (H), Glucose 184.","Your blood chemistry results: Sodium is normal at 142. Potassium is normal at 4.4. Creatinine is elevated at 6.2 (normal under 1.2), indicating your kidneys are not filtering well. Blood sugar is 184 (high).",Nephrology,Lab Result,high
4965,"43 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 43-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4966,"Rx: Tab methotrexate 15mg weekly. Tab Xarelto 20mg daily with dinner. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab amlodipine 10mg daily. Adv: DASH diet, daily BP monitoring Do not stop abruptly, taper as directed. F/U 1 month with repeat imaging.","Your medicines: (1) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]. (2) Xarelto 20mg once daily with dinner [blood thinner]. (3) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (4) amlodipine 10mg once daily [blood pressure medicine]. Advice: follow the DASH diet (rich in fruits, vegetables, lean protein, low in salt) and check blood pressure at home daily Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. Come back in 1 month — a repeat scan will be ordered.",Cardiology,Prescription,high
4967,"78 y/o F with PMH of SLE, h/o TIA, anemia, admitted for lower GI bleeding. Bright red blood per rectum. Hemoglobin dropping. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on amlodipine 10mg daily, levothyroxine 75mcg daily on empty stomach, hydroxychloroquine 200mg BID, prednisone taper, tramadol 50mg Q6H PRN pain. F/U nephrology in 1 week.","A 78-year-old woman with a history of lupus, history of mini-stroke, and low blood count [anemia] was admitted for bleeding from the large intestine. Bright red blood per rectum. Hemoglobin dropping. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) amlodipine 10mg once daily [blood pressure medicine]; (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]; (3) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (4) prednisone steroid — dose gradually decreases as directed [do not stop suddenly]; (5) tramadol 50mg every 6 hours as needed for pain [may cause drowsiness — max 4/day]. Follow-up with the kidney doctor in 1 week.",Gastroenterology,Discharge Summary,high
4968,Procedure: Laparoscopic cholecystectomy. Pt 87 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes minimally invasive gallbladder removal for a 87-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",General Surgery,Procedure Note,high
4969,"37 y/o M with PMH of DVT/PE on warfarin, PPM in situ, DM1, admitted for sepsis secondary to cellulitis. Blood cultures drawn. IV antibiotics started emergently. Managed per protocol with improvement. Incentive spirometry Q1H while awake, ambulate TID. D/C on rosuvastatin 10mg QHS, amlodipine 5mg daily, ferrous sulfate 325mg BID, empagliflozin 10mg daily. F/U oncology in 1 week.","A 37-year-old man with a history of blood clots [on blood thinner warfarin], implanted pacemaker, and type 1 diabetes was admitted for a serious blood infection from a skin infection. Blood cultures drawn. IV antibiotics started emergently. They were treated according to standard guidelines and improved. Use the breathing exercise device every hour while awake. Walk at least 3 times per day.. Medications on discharge: (1) rosuvastatin 10mg at bedtime [cholesterol medicine]; (2) amlodipine 5mg once daily [blood pressure medicine]; (3) iron supplement 325mg twice daily [for low blood count — take with vitamin C]; (4) empagliflozin 10mg once daily [blood sugar medicine that also protects heart and kidneys]. Follow-up with the cancer doctor in 1 week.",Infectious Disease,Discharge Summary,high
4970,"30 y/o F with PMH of seizure disorder on Keppra, HFrEF (EF 30%), OA, HTN, RA on MTX, admitted for small bowel obstruction. CT showed dilated loops of bowel with transition point. Managed per protocol with improvement. Strict NPO after midnight before procedure. D/C on amoxicillin 500mg TID x 10 days, acetaminophen 650mg Q6H PRN, sertraline 50mg daily, rosuvastatin 10mg QHS. F/U wound care in 3 days.","A 30-year-old woman with a history of seizure disorder [on Keppra], heart failure with weak pumping (30%), arthritis [osteoarthritis], high blood pressure, and rheumatoid arthritis [on immune-suppressing medicine] was admitted for a blockage in the small intestine. CT scan showed dilated loops of bowel with transition point. They were treated according to standard guidelines and improved. Do not eat or drink anything after midnight the night before your procedure.. Medications on discharge: (1) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]; (2) Tylenol (acetaminophen) 650mg every 6 hours as needed [do not exceed 3000mg/day]; (3) sertraline 50mg once daily [antidepressant/anxiety medicine]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up at the wound care clinic in 3 days.",General Surgery,Discharge Summary,high
4971,"24 y/o M presenting to ED with hematemesis x 2 episodes, dark tarry stools x 2 days. Vitals: BP 92/58, HR 122, RR 22, O2 96%. Hgb 6.8 (baseline 13). Type and crossmatch sent. 2 units pRBC transfused. EGD: bleeding duodenal ulcer, treated with epinephrine injection + clips. Dx: Upper GI bleed secondary to duodenal ulcer. IV PPI drip x 72hrs. NPO then clear liquid diet. H. pylori testing. Admit GI/medicine.","A 24-year-old man came to the emergency room with vomiting blood twice and having dark, tarry stools for 2 days. Vital signs: blood pressure dangerously low, heart rate very fast (signs of significant blood loss). Blood count dropped severely (6.8, was 13). Two units of blood transfused. Camera test of stomach found a bleeding ulcer in the small intestine, treated by injecting medicine and placing clips to stop the bleeding. Diagnosis: bleeding in the upper digestive tract from a stomach ulcer. High-dose acid-blocking medicine through IV for 3 days. No food initially, then clear liquids. Testing for a stomach bacteria that causes ulcers. Admitted to the hospital.",Emergency Medicine,Clinical Note,high
4972,"Rx: Tab metoprolol succinate 50mg daily. Tab azithromycin 500mg day 1 then 250mg x 4 days. Tab warfarin 5mg daily. Adv: avoid alcohol, hepatotoxic drugs. F/U 6 weeks with LFTs.","Your medicines: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]. (2) azithromycin: 500mg on day 1, then 250mg for the next 4 days [antibiotic]. (3) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 6 weeks for liver function blood tests.",Cardiology,Prescription,medium
4973,"52 y/o F presenting to ED with substernal CP radiating to L arm x 1hr, diaphoresis. Vitals: BP 165/95, HR 92, RR 18, O2 98%. ECG: ST elevation V1-V4. Troponin 2.1 (H). Dx: STEMI. Cath lab activated. ASA 325mg, Plavix 600mg, heparin bolus. Emergent PCI.","A 52-year-old woman came to the emergency room with crushing chest pain spreading to the left arm for 1 hour with heavy sweating. Vital signs: blood pressure elevated, heart rate slightly fast, breathing normal, oxygen normal. Heart test (ECG) showed a heart attack pattern. Blood test confirmed heart muscle damage. Diagnosis: a heart attack — the heart artery is blocked. The heart catheterization team was called immediately. Blood thinners were given. Emergency procedure to open the blocked artery is being performed.",Emergency Medicine,Clinical Note,high
4974,"52 y/o M with PMH of GERD, DM2, anxiety, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Compression stockings when ambulating. D/C on pregabalin 75mg BID, sertraline 50mg daily, Spiriva 18mcg daily, omeprazole 20mg AC breakfast. F/U orthopedics in 6 weeks with X-ray.","A 52-year-old man with a history of acid reflux, type 2 diabetes, and anxiety was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) pregabalin 75mg twice daily [nerve pain medicine]; (2) sertraline 50mg once daily [antidepressant/anxiety medicine]; (3) Spiriva inhaler once daily [long-acting lung medicine]; (4) omeprazole 20mg before breakfast [acid-reducing medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",General Surgery,Discharge Summary,high
4975,"88 y/o M with PMH of anemia, hypothyroidism, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Compression stockings when ambulating. D/C on pantoprazole 40mg AC breakfast, Xarelto 20mg daily with dinner, amlodipine 10mg daily, rosuvastatin 10mg QHS. F/U orthopedics in 6 weeks with X-ray.","A 88-year-old man with a history of low blood count [anemia], and underactive thyroid was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Wear compression stockings on your legs when walking to prevent blood clots.. Medications on discharge: (1) pantoprazole 40mg before breakfast [acid-reducing medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) amlodipine 10mg once daily [blood pressure medicine]; (4) rosuvastatin 10mg at bedtime [cholesterol medicine]. Follow-up with the bone doctor in 6 weeks (bring new X-ray).",Urology,Discharge Summary,high
4976,"43 y/o M with PMH of A-fib, RA on MTX, Parkinson's disease, admitted for acute CHF exacerbation. BNP elevated. CXR showed pulmonary edema. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on atorvastatin 40mg QHS, Xarelto 20mg daily with dinner, amlodipine 5mg daily, lisinopril 10mg daily. F/U surgery in 2 weeks for drain removal.","A 43-year-old man with a history of irregular heartbeat [atrial fibrillation], rheumatoid arthritis [on immune-suppressing medicine], and Parkinson's disease was admitted for worsening heart failure with fluid buildup. BNP elevated. Chest X-ray showed pulmonary edema. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) atorvastatin 40mg at bedtime [cholesterol medicine]; (2) Xarelto 20mg once daily with dinner [blood thinner]; (3) amlodipine 5mg once daily [blood pressure medicine]; (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Follow-up with the surgeon in 2 weeks to remove the drain.",Cardiology,Discharge Summary,high
4977,"39 y/o F with PMH of HFrEF (EF 30%), COPD, admitted for GI bleeding. Hemoglobin dropped. Required blood transfusion. Managed per protocol with improvement. Low potassium diet. D/C on hydroxychloroquine 200mg BID, amlodipine 10mg daily. F/U INR check in 3 days.","A 39-year-old woman with a history of heart failure with weak pumping (30%), and chronic lung disease was admitted for bleeding in the digestive tract. Blood count dropped. Required blood transfusion. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) hydroxychloroquine 200mg twice daily [immune-modulating medicine — eye exams needed]; (2) amlodipine 10mg once daily [blood pressure medicine]. Follow-up for a blood thinner level check in 3 days.",Gastroenterology,Discharge Summary,high
4978,"CBC: WBC 16.8 (H), Hgb 16.5 (N), Plt 318 (N).","Your blood count results: White blood cells are 16.8 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is normal at 16.5. Platelets are 318, which is normal.",Hematology,Lab Result,high
4979,"51 y/o F with PMH of seizure disorder on Keppra, CHF, cirrhosis, GERD, gout, admitted for appendicitis. CT confirmed. Taken to OR for laparoscopic appendectomy. Managed per protocol with improvement. BRAT diet x 48hrs, advance as tolerated. D/C on Lantus 20U QHS, gabapentin 300mg TID, Spiriva 18mcg daily, metoprolol succinate 50mg daily, Xarelto 20mg daily with dinner. F/U surgery in 2 weeks for drain removal.","A 51-year-old woman with a history of seizure disorder [on Keppra], heart failure, liver scarring [cirrhosis], acid reflux, and gout was admitted for inflammation of the appendix. CT confirmed. Taken to OR for laparoscopic appendectomy. They were treated according to standard guidelines and improved. Eat bland food for 48 hours (bananas, rice, applesauce, toast), then slowly return to normal diet.. Medications on discharge: (1) Lantus insulin 20 units at bedtime [long-acting insulin]; (2) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (3) Spiriva inhaler once daily [long-acting lung medicine]; (4) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (5) Xarelto 20mg once daily with dinner [blood thinner]. Follow-up with the surgeon in 2 weeks to remove the drain.",General Surgery,Discharge Summary,high
4980,"Rx: Tab Augmentin 875/125 BID x 7 days. Tab levothyroxine 75mcg daily on empty stomach. Adv: low potassium diet Adv: avoid alcohol, hepatotoxic drugs. F/U 2 weeks with INR.","Your medicines: (1) Augmentin 875mg twice daily for 7 days [antibiotic]. (2) levothyroxine 75mcg on empty stomach 30 min before breakfast [thyroid medicine]. Advice: avoid high-potassium foods like bananas, oranges, potatoes, and tomatoes Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess). Come back in 2 weeks for a blood thinner level check [INR].",Endocrinology,Prescription,medium
4981,Methotrexate 15mg weekly on fixed weekday only; folic acid except MTX day; avoid alcohol.,Take methotrexate only once per week on the same day — never daily. Take folic acid as directed. Avoid alcohol.,Rheumatology,Medication Instruction,low
4982,Procedure: ORIF L distal radius. Pt 67 y/o M. Consent obtained. Time-out performed. Procedure completed without immediate complication. Specimen/labs as indicated. Stable to PACU/floor. Post-op orders placed.,"This note describes surgery to fix a wrist fracture with plate and screws for a 67-year-old man. Consent was reviewed, safety checks were done, and the procedure finished without immediate problems. The care team monitored recovery and placed routine post-procedure orders.",Orthopedics,Procedure Note,high
4983,"CBC: WBC 11.7 (H), Hgb 9.4 (L), Plt 249 (N).","Your blood count results: White blood cells are 11.7 (high, suggesting your body is fighting an infection or inflammation). Hemoglobin is low at 9.4, meaning you are anemic (low blood count) — you may feel tired, weak, or short of breath. Platelets are 249, which is normal.",Hematology,Lab Result,high
4984,"Rx: Lantus 20U QHS. Tab ASA 81mg daily. Tab amoxicillin 500mg TID x 10 days. Tab lisinopril 10mg daily. Adv: fall precautions, home safety evaluation. F/U 1 week with CBC, CMP.","Your medicines: (1) Lantus insulin 20 units at bedtime [long-acting insulin]. (2) baby aspirin 81mg once daily [prevents blood clots]. (3) amoxicillin 500mg three times daily for 10 days [antibiotic — complete full course]. (4) lisinopril 10mg once daily [blood pressure medicine that also protects kidneys]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights. Come back in 1 week for blood tests: complete blood count [CBC] and comprehensive metabolic panel [CMP].",Cardiology,Prescription,high
4985,"24 y/o M with PMH of HTN, DVT/PE on warfarin, depression, hypothyroidism, admitted for hypertensive urgency. BP 210/120. IV medications started to lower gradually. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on metoprolol succinate 50mg daily, methotrexate 15mg weekly, latanoprost 0.005% OU QHS, potassium chloride 20mEq daily. F/U pulmonology in 2 weeks.","A 24-year-old man with a history of high blood pressure, blood clots [on blood thinner warfarin], depression, and underactive thyroid was admitted for dangerously high blood pressure. BP 210/120. IV medications started to lower gradually. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) metoprolol 50mg once daily [heart rate and blood pressure medicine]; (2) methotrexate 15mg once weekly [immune-suppressing medicine for arthritis — requires monitoring]; (3) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]; (4) potassium supplement 20mEq once daily [replaces potassium lost from water pills]. Follow-up with the lung doctor in 2 weeks.",Cardiology,Discharge Summary,high
4986,"53 y/o F presenting to ED with sudden onset R-sided weakness, facial droop, slurred speech x 45 min. Vitals: BP 188/102, HR 88, RR 16, O2 97%. CT Head: no hemorrhage. CTA: L MCA occlusion. NIHSS 14. Dx: Acute ischemic stroke, L MCA territory. tPA administered (within 3hr window). Thrombectomy team activated. Admit stroke unit. Permissive HTN (goal SBP <185).","A 53-year-old woman came to the emergency room with sudden right-sided weakness, face drooping on one side, and slurred speech for 45 minutes. Vital signs: blood pressure very high, heart rate normal, breathing normal, oxygen normal. CT scan ruled out bleeding. Blood vessel scan showed a blocked artery on the left side of the brain. Stroke severity score is 14 (moderate-severe). Diagnosis: a stroke — blocked blood vessel on the left side of the brain. Clot-dissolving medicine was given within the treatment window. A team to physically remove the clot has been called. Admitted to the stroke unit. Blood pressure being allowed to stay slightly elevated to maintain blood flow to the brain.",Emergency Medicine,Clinical Note,high
4987,CXR PA: Port-a-cath in appropriate position. Patchy bilateral infiltrates. NG tube tip in stomach. Small left pleural effusion.,Chest X-ray results: The implanted medication port is in the correct position. There are scattered cloudy patches in both lungs suggesting infection or inflammation. The feeding/drainage tube tip is correctly positioned in the stomach. There is a small amount of fluid around the left lung.,Pulmonology,Radiology Report,high
4988,"80 y/o M presenting to ED with seizure witnessed by family, GTC x 3 min, postictal x 15 min. Vitals: BP 152/88, HR 98, T 98.6F, GCS 14 (postictal). CT Head: no hemorrhage. BMP: Na 128 (L). Keppra level <5 (subtherapeutic). Known seizure disorder, off meds x 1 week. Dx: Breakthrough seizure secondary to medication noncompliance and hyponatremia. Keppra reload 1g IV then 750mg BID. Correct Na with NS. Admit for monitoring. Seizure precautions. Neuro consult. Do not drive x 6 months.","A 80-year-old man came to the emergency room with a full-body seizure witnessed by family lasting about 3 minutes, followed by 15 minutes of confusion. Vital signs: blood pressure elevated (from seizure), heart rate slightly fast, no fever, mostly alert but still slightly confused. CT scan shows no bleeding. Sodium is low (128). Seizure medicine level is far below the effective range. Patient has a known seizure disorder but stopped taking medicine 1 week ago. Diagnosis: a seizure caused by not taking seizure medicine and low sodium levels. Loading dose of seizure medicine (Keppra) given through IV, then increased to 750mg twice daily. Salt water given through IV to correct sodium. Admitted for monitoring. Safety precautions for seizures. Brain/nerve doctor consulted. MUST NOT drive for at least 6 months.",Emergency Medicine,Clinical Note,high
4989,MRI Lumbar Spine: No compression fracture. C5-C6 disc herniation with cord compression. Facet joint hypertrophy at L4-L5. Central canal stenosis at L3-L4.,"MRI of the lower back results: No bones are broken or collapsed. At C5-C6 in the neck, a disc has pushed out and is pressing on the spinal cord — this is significant. The small joints in the spine at L4-L5 are enlarged from arthritis. The spinal canal is narrowed at L3-L4, which may be pressing on the nerves.",Orthopedics,Radiology Report,high
4990,"LFTs: AST 343 (H), ALT 311 (H), ALP 229, T.Bili 2.4 (H), Albumin 4.8.","Your liver blood test results: Liver enzymes (AST 343, ALT 311) are severely elevated, indicating significant liver damage (normal is under 40). Bilirubin is high at 2.4 (normal under 1.2) — may cause yellowing of skin and eyes [jaundice]. Albumin is normal at 4.8.",Gastroenterology,Lab Result,high
4991,"49 y/o M with PMH of gout, Parkinson's disease, admitted for pyelonephritis. UA showed infection. Flank pain and fever. IV antibiotics started. Managed per protocol with improvement. Blood sugar log, bring to next appointment. D/C on albuterol MDI 2 puffs Q4-6H PRN, lisinopril 20mg daily. F/U PCP in 2 weeks.","A 49-year-old man with a history of gout, and Parkinson's disease was admitted for a serious kidney infection. Urine test confirmed infection. Flank pain and fever. IV antibiotics started. They were treated according to standard guidelines and improved. Write down your blood sugar readings in a log book and bring it to your next doctor visit.. Medications on discharge: (1) albuterol inhaler 2 puffs every 4-6 hours as needed [rescue inhaler for breathing]; (2) lisinopril 20mg once daily [blood pressure medicine]. Follow-up with the primary care doctor in 2 weeks.",Urology,Discharge Summary,high
4992,"45 y/o M presenting to ED with altered mental status, found unresponsive at home. Vitals: BP 88/52, HR 128, RR 8, T 96.2F, O2 88%, GCS 8. Glucose 32 (L). UDS positive for opioids. Narcan 2mg IV x 2 with improvement. Dx: Mixed presentation: hypoglycemia + opioid overdose. D50 IV push, Narcan drip. Monitor for re-sedation. Social work consult. Admit medicine.","A 45-year-old man came to the emergency room with found unconscious at home, not responding normally. Vital signs: blood pressure dangerously low, heart rate very fast, breathing slow, temperature low, oxygen very low, barely responsive. Blood sugar was dangerously low at 32. Drug screen positive for opioids. Narcan (opioid reversal medicine) given twice with improvement in responsiveness. Diagnosis: dangerously low blood sugar combined with opioid drug effects. Sugar solution given through IV. Narcan drip to prevent re-sedation. Social worker consulted for substance use support. Admitted for monitoring.",Emergency Medicine,Clinical Note,high
4993,"77 y/o M with PMH of gout, ICD in situ, obesity (BMI 38), admitted for PE. CTA positive for PE. Heparin started. Managed per protocol with improvement. Low potassium diet. D/C on clopidogrel 75mg daily, carvedilol 12.5mg BID. F/U neurology in 2 weeks.","A 77-year-old man with a history of gout, implanted heart defibrillator, and obesity was admitted for a blood clot in the lungs [pulmonary embolism]. CT scan confirmed a blood clot in the lungs. Heparin started. They were treated according to standard guidelines and improved. Avoid high-potassium foods: bananas, oranges, potatoes, tomatoes, and salt substitutes.. Medications on discharge: (1) Plavix (clopidogrel) 75mg once daily [blood thinner]; (2) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the brain/nerve doctor in 2 weeks.",Pulmonology,Discharge Summary,high
4994,CXR PA: Moderate right pleural effusion. Compression fracture T12. Sternotomy wires intact. Right-sided pneumothorax.,Chest X-ray results: There is a moderate amount of fluid around the right lung. There is a compression fracture [collapsed bone] in the lower spine at T12. The wires from prior heart surgery are intact. The right lung has partially collapsed due to air leaking into the chest cavity [pneumothorax].,Pulmonology,Radiology Report,high
4995,CT Head without contrast: Paranasal sinuses clear. Mild generalized cerebral atrophy appropriate for age. No midline shift. Periventricular white matter hypodensities consistent with chronic small vessel ischemic disease. No acute intracranial hemorrhage.,"CT scan of the head results: The sinuses are clear with no infection. There is mild brain shrinkage, which is normal for your age. The brain is centered normally. There are aging-related changes in the brain's white matter from reduced blood flow to small vessels over time. There is no bleeding in the brain.",Neurology,Radiology Report,high
4996,"36 y/o M with PMH of asthma, HFrEF (EF 30%), Parkinson's disease, COPD, admitted for STEMI. ECG showed ST elevation. Troponin markedly elevated. Managed per protocol with improvement. Fall precautions, PT/OT consult. D/C on gabapentin 300mg TID, carvedilol 12.5mg BID. F/U cardiology in 2 weeks.","A 36-year-old man with a history of asthma, heart failure with weak pumping (30%), Parkinson's disease, and chronic lung disease was admitted for a serious heart attack requiring emergency treatment. ECG showed ST elevation. Troponin markedly elevated. They were treated according to standard guidelines and improved. Be careful to prevent falls. Physical therapy and occupational therapy will help with safe movement.. Medications on discharge: (1) gabapentin 300mg three times daily [nerve pain medicine — may cause drowsiness]; (2) carvedilol 12.5mg twice daily [heart medicine]. Follow-up with the heart doctor in 2 weeks.",Cardiology,Discharge Summary,high
4997,Enoxaparin 40mg SC daily until walking regularly.,Injection helps prevent clots until you are walking normally.,General,Medication Instruction,medium
4998,"46 y/o M with PMH of CKD Stage 3, h/o TIA, admitted for cholecystitis. US showed gallbladder wall thickening and stones. Surgery consulted. Managed per protocol with improvement. Diabetic diet, SMBG BID. D/C on carvedilol 12.5mg BID, ibuprofen 400mg Q6H PRN with food. F/U wound care in 3 days.","A 46-year-old man with a history of moderate kidney disease, and history of mini-stroke was admitted for gallbladder infection/inflammation. US showed gallbladder wall thickening and stones. Surgery consulted. They were treated according to standard guidelines and improved. Follow a diabetes-friendly diet (limit sweets and refined carbs). Check blood sugar twice daily.. Medications on discharge: (1) carvedilol 12.5mg twice daily [heart medicine]; (2) ibuprofen 400mg every 6 hours as needed with food [anti-inflammatory pain reliever]. Follow-up at the wound care clinic in 3 days.",General Surgery,Discharge Summary,high
4999,"Rx: Tab ferrous sulfate 325mg BID. Tab spironolactone 25mg daily. Tab metformin 1000mg BID. Tab furosemide 40mg BID. Tab atorvastatin 80mg QHS. Adv: fall precautions, home safety evaluation Adv: high fiber diet, adequate hydration. F/U 2 weeks with INR.","Your medicines: (1) iron supplement 325mg twice daily [for low blood count — take with vitamin C]. (2) spironolactone 25mg once daily [heart-protecting water pill]. (3) metformin 1000mg twice daily with meals [blood sugar medicine]. (4) furosemide (Lasix) 40mg twice daily [water pill]. (5) atorvastatin 80mg at bedtime [high-dose cholesterol medicine]. Advice: take steps to prevent falls — remove loose rugs, install grab bars, use night lights Advice: eat plenty of fiber (fruits, vegetables, whole grains) and drink enough water. Come back in 2 weeks for a blood thinner level check [INR].",Cardiology,Prescription,high
5000,"Rx: Tab latanoprost 0.005% OU QHS. Tab warfarin 5mg daily. Tab montelukast 10mg QHS. Adv: avoid alcohol, hepatotoxic drugs Do not stop abruptly, taper as directed. F/U PCP in 1 week for BP recheck.",Your medicines: (1) latanoprost eye drops in both eyes at bedtime [glaucoma medicine]. (2) warfarin 5mg once daily [blood thinner — requires regular INR blood tests]. (3) montelukast 10mg at bedtime [asthma/allergy medicine]. Advice: do not drink alcohol and avoid medications that can harm the liver (including acetaminophen in excess) Do not suddenly stop this medicine — your doctor will gradually reduce the dose if needed. See your primary care doctor in 1 week to recheck blood pressure.,Pulmonology,Prescription,medium