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Apr 19 17:55
• exam for coccyx contusion
+ sm
Thu Apr 19 22:55:14 2018 sm
There is no motor deficit that I can detect, quadriceps, hamstrings, s/l ag moid extensors or great toe extensors.

• This is a 31-year-old male incarcerated who presented to the urology p ...
+ wav
Thu Apr 19 22:50:13 2018 wav
This is a 31-year-old male incarcerated who presented to the urology prison clinic complaining of pain at his frenulum with maturation and erections. After discussion with the patient, the patient wanted to proceed with frenuloplasty and circumcision. On exam, he was noted to have three penile dominos to avoid _____ where his circumcision incision would be and one that was more towards the proximal dorsal penile shaft.
** • Not sure, but could it be ???too near??? - Questyr
Thu Apr 19 23:40:32 2018 Questyr

**** • Thanks a lot. - guy
Thu Apr 19 23:53:32 2018 guy


• Pt with metastatic ER-positive breast cancer. On letrozole plus S/L "fish collie"
+ T
Thu Apr 19 22:41:20 2018 T
This was a drug that could be added later or else Ibrance. I looked at the FDA's list of treatments approved for breast cancer and didn't see anything that looked like it could sound like this. Thanks....
** • Found it I think... Kisqali. Thanks for looking. - b e n e m n
Thu Apr 19 22:48:27 2018 b e n e m n


• apostrophe
+ kk
Thu Apr 19 22:30:06 2018 kk
The patient has to follow up in three weeks' time - correct?
** • Yes. (see link) + Questyr
Thu Apr 19 23:41:44 2018 Questyr
link

• After obtaining full informed consent from the patient, a drop of tetr ...
+ wav
Thu Apr 19 21:59:30 2018 wav
After obtaining full informed consent from the patient, a drop of tetracaine was placed in the right eye and the eye was marked with 180-degree position as the patient was sitting upright. This was confirmed to be correct _____. Next, the patient was brought to the operating room and a surgical time-out was performed.
** • toriCAM ? - sea
Thu Apr 19 22:28:14 2018 sea

**** • Thanks a lot. - guy
Thu Apr 19 22:46:22 2018 guy


• The anterior midline left side and right side appeared to be notable o ...
+ mp3
Thu Apr 19 18:42:32 2018 mp3
The anterior midline left side and right side appeared to be notable only for minimal small internal hemorrhoids and no other lesions; however, upon examining the right posterior _____. With the help of provision retractor, we noticed that there was a large bulging in the hemorrhoids which easily prolapsed on exam.
** • midline, - poi
Thu Apr 19 19:57:06 2018 poi

**** • Thanks a lot. - guy
Thu Apr 19 22:07:38 2018 guy

** • never mind. Thanks to anyone who tried. - guy-
Thu Apr 19 18:52:31 2018 guy-


• The patient was brought to the operating room and placed on the operat ...
+ mp3
Thu Apr 19 18:33:13 2018 mp3
The patient was brought to the operating room and placed on the operating room table in the supine position. A time-out was performed and all parties were identified. The patient then underwent induction of general anesthesia. He was then placed in high lithotomy position with all bony prominences adequately padded. We then cleaned his perianal _____ Betadine. Upon external exam, there was noted to be what initially appeared to be relatively small right posterior hemorrhoids. Digital rectal exam was performed and was notable for a large mass on the right posterior aspect of the anus but no other masses.
** • Thanks a lot. - guy
Thu Apr 19 18:41:33 2018 guy

** • region using - billybob
Thu Apr 19 18:36:11 2018 billybob


• The patient is a 48-year-old male who had recently presented to genera ...
+ wav
Thu Apr 19 18:23:07 2018 wav
The patient is a 48-year-old male who had recently presented to general surgery clinic with complaint of rectal pain and a large bulging perianal mass _____ bowel movements. The patient had _____ nifedipine. _____. The patient had large prolapsed internal hemorrhoids. All material risks, benefits, and alternatives to hemorrhoidectomy were explained to the patient. Informed consent was obtained. He agreed to proceed with surgery.
** • never mind. Thanks to anyone who tried. - guy-
Thu Apr 19 18:52:23 2018 guy-


• Pan-lumbar??
+ n o d k e h
Thu Apr 19 17:54:36 2018 n o d k e h
He has had a thoracolumbar, s/l *pan-lumbar* fusion.
** • yes, just as you have it - mn
Thu Apr 19 20:41:15 2018 mn


• The patient has been managed by the plastic surgery service with a del ...
+ wav
Thu Apr 19 17:43:52 2018 wav
The patient has been managed by the plastic surgery service with a delayed reverse sural flap to a distal third of the tibia chronic wound resulting from hardware placed several years ago for a traumatic injury. The patient had his hardware removed and the wound debrided and subsequently had a _____ sinus and wound that was chronic in nature and nonhealing.
** • residual - sea
Thu Apr 19 18:00:15 2018 sea

**** • Thanks a lot. - guy
Thu Apr 19 18:01:29 2018 guy


• The remainder of the robotic trocars were removed under direct visuali ...
+ wav
Thu Apr 19 17:12:25 2018 wav
The remainder of the robotic trocars were removed under direct visualization. The fascia at the camera port site was identified and reapproximated with #0 Vicryl suture in an interrupted figure-of-eight suture. A digital palpation revealed that the fascia was intact. Skin was closed with 4-0 Monocryl in a subcuticular fashion. The patient was cleaned. Sterile dressings were applied. We _____ Foley catheter was removed. Sterile cystoscopy was performed with 70-degree cystoscope under instillation of normal saline.
** • never mind. Thanks to anyone who tried. - guy
Thu Apr 19 17:24:58 2018 guy


• FINDINGS: Vaginal: Normal external female genitalia, no vulvar or va ...
+ wav
Thu Apr 19 16:30:56 2018 wav
FINDINGS: Vaginal: Normal external female genitalia, no vulvar or vaginal masses or lesions, nearly flush cervix without gross lesions, mobile retroverted uterus. Remainder of exam limited by habitus, smooth rectovaginal septum. Abdominal: 8-week size uterus with subserosal fibroid by left cornua, bilateral adnexa adherent to pelvic sidewalls _____ normal, enlarged, approximately 2 cm, right external iliac lymph node, 3 cm soft, fleshy, pink mass on mesentery _____ without involvement of bowel lumen. Grossly normal large bowel, appendix, and omentum.
** • second blank: on mesentery to terminal ileum. - mn
Thu Apr 19 16:54:40 2018 mn

** • otherwise grossly normal... - billybob
Thu Apr 19 16:52:17 2018 billybob

**** • Thanks a lot everybody - guy
Thu Apr 19 17:02:40 2018 guy


• Underlying hypercalcemia, multifactorial etiology, status post resolut ...
+ d h k h k o
Thu Apr 19 16:20:13 2018 d h k h k o
Underlying hypercalcemia, multifactorial etiology, status post resolution, iatrogenic etiology, suspect use of vitamin D/intake of calcium based and "ASETS" contributing
** • calcium-based antacids - taco
Thu Apr 19 16:26:46 2018 taco

**** • ... + p c m d i c
Thu Apr 19 18:33:21 2018 p c m d i c


• The patient has been followed in plastic surgery clinic for reconstruc ...
+ wav
Thu Apr 19 16:00:48 2018 wav
The patient has been followed in plastic surgery clinic for reconstruction of bilateral breasts for breast cancer after undergoing bilateral skin-sparing mastectomies with implant-based reconstruction. Of note, the patient has had a protracted course, given a complication of a tissue explant due to cellulitis and infection. The patients reconstruction was laid and then underwent replacement of the expander and subsequently underwent an exchange of expanders _____ implants which she currently has in place. The patient presented to clinic requesting nipple reconstruction and said she was ready for the final stage of her reconstruction.
** • definitive? - p o l i j c
Thu Apr 19 16:05:22 2018 p o l i j c

**** • Thanks a lot. - guy
Thu Apr 19 16:06:32 2018 guy


• s/l resting disturbance
+ a e i j a a
Thu Apr 19 15:42:30 2018 a e i j a a
We decided to repeat her home portable sleep test to reestablish a baseline resting disturbance to see if any treatment is truly necessary.
** • baseline *respiratory* disturbance - taco
Thu Apr 19 15:44:21 2018 taco

**** • Thank you !!! - a e i j a a
Thu Apr 19 15:45:07 2018 a e i j a a


• METRx X-Tube approach?
+ d h k h k o
Thu Apr 19 14:49:43 2018 d h k h k o
The patient was then prepped and draped in standard fashion for a METRx "step 1" X-Tube approach.
** • i googled METRx step 1 and got some hits for spinal surgery. - b o l b o m
Thu Apr 19 15:09:26 2018 b o l b o m


• Congenital anomaly
+ Lilly
Thu Apr 19 14:47:15 2018 Lilly
he was born with an s/l epilith which is a congenital growth of the dental laminal tissue.
** • Thank you ... + f h g l n g
Thu Apr 19 22:30:01 2018 f h g l n g
Thank you
** • short for epithelial - The dental lamina is a band of epithelial tissue seen in histologic + b o l b o m
Thu Apr 19 15:10:53 2018 b o l b o m
The dental lamina is a band of epithelial tissue seen in histologic sections of a developing tooth

• echo s/l punctuated
+ sm
Thu Apr 19 14:27:41 2018 sm
Diastolic blood pressure elevations were noted during recovery. The test was s/l punctuated by frequent exercise ectopy.


** • punctuated makes sense - taco
Thu Apr 19 14:41:56 2018 taco

**** • ty - :)
Thu Apr 19 14:57:28 2018 :)


• He will continue on with two-monthly monitoring ___ and in August 2018, we can consid
+ WAV
Thu Apr 19 13:50:58 2018 WAV
He will continue on with two-monthly monitoring ___ and in August 2018, we can consider dropping down to a maintenance dose of methotrexate 15 mg subcutaneously weekly.

• Chest x-ray 11/30/14 showed s/l*extensor-ated* pulmonary interstitial markings,
+ SM
Thu Apr 19 13:39:36 2018 SM
Chest x-ray 11/30/14 showed s/l*extensor-ated* pulmonary interstitial markings, question acute versus chronic. Chest x-ray 05/27/15 suggested volume overload superimposed on chronic changes.
** • accentuated? - taco
Thu Apr 19 14:01:47 2018 taco


• totally stumped, s/l "bar-boh-sah" sm for context plse
+ mm
Thu Apr 19 13:07:56 2018 mm
The common bile duct was cannulated and visualized. It was tortuous. There were some filling defects present, some of which were **barbosa**. A stone was extracted, then it was difficult to get back in the duct.


** • OMG my ears were so off!!! "bubbles" - mm
Thu Apr 19 15:14:32 2018 mm


• GYN
+ d h k h k o
Thu Apr 19 09:54:36 2018 d h k h k o
Dilation approximately 1 cm, dilated to 21 mm, and "Zofar" forceps used to extract the fetus and placenta in multiple passes. "PSEs" examined and found complete
** • #1 ???Sopher??? - Questyr
Thu Apr 19 11:35:23 2018 Questyr


• He is harboring a small right posterior frontal anterior parietal AVM that is
+ hyphens needed?
Thu Apr 19 08:31:26 2018 hyphens needed?
He is harboring a small right posterior frontal anterior parietal AVM that is embedded in the motor sensory area.
** • Like this: right posterior frontal/anterior parietal + link
Thu Apr 19 08:38:28 2018 link
link
**** • ... - thanks
Thu Apr 19 08:58:45 2018 thanks


• Preoperative Diagnosis: LEFT FIRST METACARPAL FRACTURE AND RIGHT LO ...
+ wav
Wed Apr 18 22:38:02 2018 wav
Preoperative Diagnosis:
LEFT FIRST METACARPAL FRACTURE AND RIGHT LOWER EXTREMITY WOUND DEBRIDEMENT.

Procedure:
CRPP OF FIRST METACARPAL FRACTURE AND EXPLORATION OF THUMB WITH REPAIR OF NAIL BED AND PARTIAL CLOSURE OF LATERAL FASCIOTOMY SITE.

This is a 36-year-old gentleman who was crossing the street and hit by a car. The patient had a lower extremity fracture complicated by compartment syndrome requiring fasciotomy. The patient has been taken to the operating room several times for this wound and now has a partially _____ fasciotomy site. The patient also was noted to have a left first metacarpal fracture requiring operative fixation.
** • never mind. Thanks to anyone who tried. - guy
Wed Apr 18 23:05:14 2018 guy


• Minimally displaced distal fibular fracture.
+ d h k h k o
Wed Apr 18 22:34:23 2018 d h k h k o
He had tenderness to palpation over the proximal fibula, consistent with "Dutley's knot" overlying the fracture site.

• Preoperative Diagnosis: APHONIA. Procedure: ESOPHAGOSCOPY ...
+ wav
Wed Apr 18 20:45:37 2018 wav
Preoperative Diagnosis:
APHONIA.

Procedure:
ESOPHAGOSCOPY AND A TRACHEOESOPHAGEAL PUNCTURE PLACEMENT.

This is a 56-year-old male with a history of a laryngectomy in 2008 after failed primary radiation therapy who presents after a failed TEP insertion at an outside hospital. The patient was initially brought here to _____ for secondary TEP. He agreed and consented to the surgery _____ esophagoscopy with TEP placement.
** • follow up with plan for ...for which is - poi
Wed Apr 18 20:54:55 2018 poi

**** • Thanks a lot. - guy
Wed Apr 18 20:58:31 2018 guy


• : The patient is a 61-year-old woman with significant right leg pain ...
+ wav
Wed Apr 18 18:47:15 2018 wav
: The patient is a 61-year-old woman with significant right leg pain ___________ L4-5 and L5-S1, brought to the operating room for epidural steroid injections.
** • ... - wav deleted
Wed Apr 18 19:49:22 2018 wav deleted


• No idea what he's going for. I and D of amputation stump, see msg
+ CO MT
Wed Apr 18 17:07:39 2018 CO MT
"We then elevated a flap proximally. At this point, we incised what I felt was the possible muscle and fascia near the location of where the *myoplasty ordesis* would have been."

He sounds like he's making it up on the fly as he hesitates between the two words. Any thoughts?

** • maybe he means: ..."myoplasty or -desis" (implying myoplasty or myodesis) - mn
Wed Apr 18 17:26:45 2018 mn

**** • Thank you - CO MT
Wed Apr 18 17:39:22 2018 CO MT

** • I think he might have meant myodesis. I see that's related to amputations - CO MT
Wed Apr 18 17:10:24 2018 CO MT


• No residual dissection was seen at the origin of the stent, and the st ...
+ mp3
Wed Apr 18 16:58:01 2018 mp3
No residual dissection was seen at the origin of the stent, and the stented area sewed nicely with no residual defects. Distally, runoff was much more brisk and demonstrated patency through the same vessel _____. At this point, we also checked Doppler signals which were greatly improved in the DP and PT from the baseline. The patient had previously been heparinized to achieve an ACT greater than 200. This was reversed at this point with protamine.
** • ...same vessel as described before? - mn
Wed Apr 18 17:28:46 2018 mn

**** • Thanks a lot. - guy
Wed Apr 18 20:48:27 2018 guy

** • never mind. Thanks to anyone who tried. - guy
Wed Apr 18 17:14:28 2018 guy


• Next, we proceeded with stenting using Cook Zilver 518 bare metal sten ...
+ mp3
Wed Apr 18 16:52:26 2018 mp3
Next, we proceeded with stenting using Cook Zilver 518 bare metal stents. We deployed first a 5 x 60 mm, then a 5 x 30 mm, then a 5 x 20 mm stent. Completion arteriography here showed some minor residual dissection at the proximal end of the stents. Next, we withdrew our sheath to the level of the common femoral artery. We obtained a 5 x 100 _____ mm balloon and performed balloon angioplasty of the residual SFA and the stent.
** • 15 mm - mn
Wed Apr 18 16:57:35 2018 mn

**** • Thanks a lot. - guy
Wed Apr 18 16:58:40 2018 guy


• Procedures: 1. DIAGNOSTIC ARTERIOGRAM, LEFT LOWER EXTREMITY. 2. ...
+ wav
Wed Apr 18 16:38:54 2018 wav
Procedures:
1. DIAGNOSTIC ARTERIOGRAM, LEFT LOWER EXTREMITY.
2. BALLOON ANGIOPLASTY, LEFT SUPERFICIAL FEMORAL ARTERY.
3. BARE METAL STENT PLACEMENT, LEFT SUPERFICIAL FEMORAL ARTERY.

Arteriography then revealed the chronic total occlusion of approximately 11 cm in the SFA. We also noted patent runoff through the popliteal artery, TP trunk, and peroneal artery. The anterior tibial artery was patent _____ proximal course and became quite diminutive. It then had a collateralization more robust.
** • near its - CO MT
Wed Apr 18 17:08:34 2018 CO MT

**** • Thanks a lot. - guy
Wed Apr 18 17:09:08 2018 guy

****** • YW - CO MT
Wed Apr 18 17:13:00 2018 CO MT


• Overall, the abundant amount of tenosynovium ______ from about the pal ...
+ mp4
Wed Apr 18 14:46:05 2018 mp4
Overall, the abundant amount of tenosynovium ______ from about the palm and the finger was excised. We sent this off to Pathology for evaluation. There was concern, again, of _____ tenosynovium.
** • ... - mp4 deleted
Wed Apr 18 15:46:02 2018 mp4 deleted


• After excision of the extensive tenosynovium on the palm area, we ____ ...
+ mp3
Wed Apr 18 14:43:44 2018 mp3
After excision of the extensive tenosynovium on the palm area, we ________distally. The A1 pulley had been released. We flexed the finger and ____________tendons. Again, _____flexor tenosynovium was noted along the flexor tendons and the tendon sheath.
** • ... - mp3 deleted
Wed Apr 18 15:45:56 2018 mp3 deleted


• as well as ________going off the flexor sheath
+ wav
Wed Apr 18 14:38:52 2018 wav
There was noted to be an abundant amount of tenosynovium throughout. The area of the A1 pulley overlying this A1 pulley area as well as ________going off the flexor sheath
** • ... - wav deleted
Wed Apr 18 15:45:49 2018 wav deleted


• Medication
+ ESL, yes
Wed Apr 18 13:46:09 2018 ESL, yes
Patient has now been put on "austeada" 15 mg at 2 tabs a day for that tic.
** • Got it! + d h k h k o
Wed Apr 18 13:52:09 2018 d h k h k o
Austedo

• prolapsing on the *head two* components
+ sm
Wed Apr 18 12:38:40 2018 sm
This is a 59-year-old gentleman evaluated as an outpatient for complaints of hemorrhoids and prolapse. The patient had undergone banding. However, during one of his office evaluations he was noted to a very large anal papilla that was prolapsing on the head two components.
** • nm - said, that had two components. - -
Wed Apr 18 12:58:01 2018 -


• Patellar Instability
+ d h k h k o
Wed Apr 18 11:26:31 2018 d h k h k o
MRI shows a "shell" trochlear groove.
** • Got it! + ESL, yes
Wed Apr 18 11:29:18 2018 ESL, yes
"Shallow"

• heparinized saline flush. A ______ was placed proximally
+ mp3
Wed Apr 18 10:56:18 2018 mp3
Left common femoral artery was accessed using consolidated technique, sequentially using a micropuncture needle microwire #5-French dilator and starter wire #5-French sheath connected to continuous heparinized saline flush. A ________ was placed proximally at the ascending aorta under continuous fluoroscopic guidance of a Terumo 0.038 glidewire in the left common carotid artery was selectively catheterized. Subsequently, left common carotid artery injection was performed extracranially.
** • I hope he doesn't talk like that fast when he talks to patients. - p o l i j c
Wed Apr 18 11:32:25 2018 p o l i j c

**** • He's Hideous. I hope you don't get dinged for leaving blanks?? He would get them from me! - DBMT
Wed Apr 18 11:55:26 2018 DBMT

****** • no dings - thanks - :)
Wed Apr 18 12:02:09 2018 :)


• ure cutting _______ the endometrial cavity/starting at the ______ region coming acros
+ wav
Wed Apr 18 10:50:20 2018 wav
Using the resectoscope with 60 pure cutting _______ the endometrial cavity was serially and systematically ablated starting at the ______ region coming across anteriorly fundally and then posterolaterally down to the level of the cervix. After completing this, the uterine cavity was inspected and found to be completely devoid of normal-appearing tissue. There was no evidence of perforation.
** • pure cutting, no blend... - billybob
Wed Apr 18 10:59:00 2018 billybob

**** • thank you - !
Wed Apr 18 12:00:17 2018 !


• EKG, angiography s/l core lids
+ sm
Wed Apr 18 10:31:47 2018 sm
showed concentric left ventricular hypertrophy. Chest pain episode had no angiography s/l core likds. There was a nondiagnostic treadmill tests. His EKGs and troponins were reportedly nondiagnostic
** • and it might be "angiographic correlates" (rather than angiography) - taco
Wed Apr 18 10:36:32 2018 taco

** • correlates - taco
Wed Apr 18 10:35:54 2018 taco

**** • thanks - me
Wed Apr 18 10:49:11 2018 me


• He experiences a pressure-like sensation and he cannot seem to burp, but once he
+ mp3
Wed Apr 18 10:29:59 2018 mp3
He experiences a pressure-like sensation and he cannot seem to burp, but once he passes gas ____, he feels that he is 100%.
** • or it moves through - p o l i j c
Wed Apr 18 10:32:49 2018 p o l i j c

**** • ... - thanks a lot
Wed Apr 18 10:40:56 2018 thanks a lot


• blood work
+ sm
Wed Apr 18 10:20:17 2018 sm
A1c 8.0; normal below 5.6. Cholesterol 170, trigs 152, HDL 55, LDL 85. Normal CBC. s/l proc toe sa made 276; normal 270.
** • found fructosamine - nevermind
Wed Apr 18 10:21:48 2018 nevermind


• MRI report of the lumbar spine: Postural alteration s/l*satisfied*??
- ESL- please nm
Wed Apr 18 10:06:25 2018 ESL- please nm


• s/l Gundry technique, I know I h've seen this before but cannot document the way i se
+ arched
Wed Apr 18 09:02:56 2018 arched
OPERATION: Minimally invasive replacement of aortic valve with #25 Medtronic Mosaic bioprosthetic valve using _____ technique.
** • Dr Steven Gundry. Many hits as surgeon, and few hits for "Gundry's technique" heart surg - b c l b i m
Wed Apr 18 09:16:09 2018 b c l b i m

**** • ty - nm
Wed Apr 18 09:21:40 2018 nm


• 2. Holter monitor shows prolonged QT with good heart rate variability. There is no
+ mp3
Wed Apr 18 07:20:50 2018 mp3
2. Holter monitor shows prolonged QT with good heart rate variability. There is no evidence of _______.
** • never mind, got it - op
Wed Apr 18 07:22:11 2018 op


• Prior to administration of anesthesia, a time-out was completed verify ...
+ mp3
Wed Apr 18 05:01:39 2018 mp3
Prior to administration of anesthesia, a time-out was completed verifying correct patient, procedure site, laterality, positioning, allergies, perioperative antibiotics, DVT prophylaxis, fire risk, and the surgical and postoperative plan. Pertinent images were displaced on the OR monitor at this time. Next, anesthesia was administered and _____ placed. Table was rotated, arm placed in 90 degrees of abduction on armboard and tourniquet placed.
** • Can you repost M3P? I think the word "displaced' should be 'displayed' in prior sentence. - mn
Wed Apr 18 06:57:44 2018 mn

**** • Thanks for the correction. - guy
Wed Apr 18 16:40:31 2018 guy


• Preoperative Diagnosis: LEFT ELBOW INJURY. Procedure: NER ...
+ wav
Wed Apr 18 04:39:41 2018 wav
Preoperative Diagnosis:
LEFT ELBOW INJURY.

Procedure:
NERVE EXPLORATION, ELBOW WASHOUT, RADIAL AND CUBITAL TUNNEL RELEASE.

INDICATIONS: The patient is a 69-year-old female, who _____ at a party early Sunday morning. The patient sustained lacerations on the medial and lateral forearm and over the elbow with an open joint.

• A transbuccal trocar was used to pierce through the tissue until it wa ...
+ wav
Wed Apr 18 03:51:23 2018 wav
A transbuccal trocar was used to pierce through the tissue until it was visualized intraorally. A trocar cheek retractor was then adapted to that side. A four-hole lateral border plate was then adapted to the patients right native mandible using a standard trocar portal system. Four drill holes were made and subsequently tightened with two 2 x 12 mm Stryker screws placed in the proximal segment of the fracture while 2 x 2.6 mm Stryker screw were placed in the distal fracture site. _____ was achieved and fixation on both sides. The patient was taken out of maxillomandibular fixation. Upon opening for MMF, the patient was _____ place. Occlusion was able to be reproduced without any difficulties.
** • never mind. Thanks to anyone who tried. - guy
Wed Apr 18 04:40:02 2018 guy


• Once adequate level of anesthesia was obtained, the operating microsco ...
+ wav
Tue Apr 17 23:07:42 2018 wav
Once adequate level of anesthesia was obtained, the operating microscope was brought in position and right ear canal was visualized with a 4 mm operating speculum. Significant amount of wax and skin cell _____ was removed. The tympanic membrane behind the obstruction was ____.
** • 1. cast 2. moist - poi
Tue Apr 17 23:12:12 2018 poi

** • got it. thanks. - guy
Tue Apr 17 23:11:53 2018 guy


• The patient is a 35-year-old female with a history of multiple psych i ...
+ mp3
Tue Apr 17 22:06:12 2018 mp3
The patient is a 35-year-old female with a history of multiple psych issues including personality disorder who has roughly six-week history of a mass in the upper part of her forehead along the midline just past the hairline that was _____ that she was apparently struck in the head by an object. This was reportedly biopsied at an outside institution and showed findings consistent with the sebaceous cyst _____ biopsy, the mass continued to grow and does have potential area of ulceration concerning for malignancy. Therefore, it was felt the best option would be take the patient for excisional biopsy of the mass. All material risks, benefits, and alternatives of the operation were explained to the patient.
** • hairline but presently at issue is that she ..... 2) cyst, however, since the biopsy.... - ltt
Tue Apr 17 22:30:49 2018 ltt

**** • Thanks a lot. - guy
Tue Apr 17 23:01:07 2018 guy

** • 1. present after she was apparently...2. however, ever since the - poi
Tue Apr 17 22:27:56 2018 poi

**** • Thanks a lot. - guy
Tue Apr 17 22:29:04 2018 guy

** • never mind. Thanks to anyone who tried. - p c m d i c
Tue Apr 17 22:23:51 2018 p c m d i c


• On a recent stress test, she had a blunted response to exercise as well as
+ Stress test
Tue Apr 17 22:02:14 2018 Stress test
s/l "tire out" in the second stage?

Thanks!
** • tired out? as in *got tired* - guess-poi
Tue Apr 17 22:29:00 2018 guess-poi


• Preoperative Diagnosis: FOREHEAD MASS. Procedure: EXCISIO ...
+ wav
Tue Apr 17 21:50:14 2018 wav
Preoperative Diagnosis:
FOREHEAD MASS.

Procedure:
EXCISION OF FOREHEAD MASS.

FINDINGS: A 3 x 3 cm protruding mass in the middle of the forehead _____.

SPECIMENS: Forehead mass, short stitch superior, long stitch lateral.

** • ? excised with 4 mm margins ? - ltt
Tue Apr 17 22:32:48 2018 ltt

** • never mind. Thanks to anyone who tried. - p c m d i c
Tue Apr 17 22:23:43 2018 p c m d i c


• SURGICAL INDICATION: This is a 45-year-old right hand dominant _____ ...
+ mp3
Tue Apr 17 20:56:54 2018 mp3
SURGICAL INDICATION: This is a 45-year-old right hand dominant _____ worker who was using a saw and amputated the distal portion of his left third finger.
** • custodial - poi
Tue Apr 17 21:34:43 2018 poi

**** • Thanks a lot. - guy-
Tue Apr 17 21:50:31 2018 guy-

** • never mind. Thanks to anyone who tried. - p c m d i c
Tue Apr 17 21:29:19 2018 p c m d i c


• Preoperative Diagnosis: LEFT THIRD DIGIT TRAUMA. Procedure: ...
+ wav
Tue Apr 17 20:54:19 2018 wav
Preoperative Diagnosis:
LEFT THIRD DIGIT TRAUMA.

Procedure:
_____ FLAP OF THE LEFT THIRD DIGIT.

** • homodigital flap - poi
Tue Apr 17 21:36:00 2018 poi

**** • Thanks a lot. - guy
Tue Apr 17 21:50:41 2018 guy

** • never mind. Thanks to anyone who tried. - p c m d i c
Tue Apr 17 21:29:13 2018 p c m d i c


• Preoperative Diagnosis: LEFT THIRD DIGIT TRAUMA. Procedure: ...
+ wav
Tue Apr 17 20:53:59 2018 wav
Preoperative Diagnosis:
LEFT THIRD DIGIT TRAUMA.

Procedure:
_____ FLAP OF THE LEFT THIRD DIGIT.

** • oops. sorry for the duplicate post - p c m d i c
Tue Apr 17 20:54:45 2018 p c m d i c


• Primary care physician: Dr. Gott and _______ PA
- wav
Tue Apr 17 19:23:13 2018 wav

** • ... - wav deleted
Tue Apr 17 19:46:53 2018 wav deleted


• nerve s/l trafficking agents, neurotropic?
+ h o f o a d
Tue Apr 17 18:40:52 2018 h o f o a d
She has had ongoing pain management described previously with narcotics, s/l nerve trafficking/trapping agents and nonsteroidals for the above.

Thinking neurotropic ?


** • neurotrophic? - sea
Tue Apr 17 20:44:17 2018 sea


• Preoperative Diagnosis: MACROMASTIA. Procedure: BILATERAL ...
+ wav
Tue Apr 17 17:03:52 2018 wav
Preoperative Diagnosis:
MACROMASTIA.

Procedure:
BILATERAL BREAST REDUCTION USING A WISE PATTERN EXCISION WITH AN INFERIOR PEDICLE.

We then proceeded to raise our skin flaps with an approximate thickness of 2 cm, extended to 4 cm at the base of the skin flaps superomedially and superolaterally as well as inferiorly. We then carved our pedicle _____ to leave a broad base. Of note, our pedicle did have a width of 10 cm per preoperative markings.
** • , preparing - taco
Tue Apr 17 17:12:13 2018 taco

**** • Thanks a lot. - guy
Tue Apr 17 17:12:57 2018 guy


• PTF-moderate airflow as s/l lema stations.
+ sm
Tue Apr 17 16:58:47 2018 sm
concave contour of the expiratory flow-volume curve indicated an obstructive ventilatory defect. There was moderate airflow as s/l lema stations.
** • limitation(s) ? - taco
Tue Apr 17 17:13:14 2018 taco

**** • just listening again and that's it-just a bit slurry - thanks
Tue Apr 17 18:02:10 2018 thanks


• Amputation of toe. SEntence does not make sense as dictated.
+ wav
Tue Apr 17 14:22:22 2018 wav
The specimen will be passed off for gross and microscopic examination. No purulent drainage was appreciated.

"The fat was white and glistening noted"?? within the confines of the wound site. We did perform deep cultures
** • makes sense to me. The wound showed fat that was white and glistening - poi
Tue Apr 17 14:25:49 2018 poi

**** • Okay. I usually hear 'white and glistening' in conjunction with a mass. I thought fat is - yellow wav
Tue Apr 17 14:31:00 2018 yellow wav

****** • I edited this way: + wav
Tue Apr 17 14:32:30 2018 wav
It was noted that the fat was white and glistening within the confines of the wound site.

• started on a new type of insulin line called ___, which is a metal line that needs to
+ WAV
Tue Apr 17 12:57:00 2018 WAV
She has recently been started on a new type of insulin line called ___, which is a metal line that needs to be changed every few days
** • Sure-T - he says "S-u-r-e, then capital T" - p o l i j c
Tue Apr 17 13:05:41 2018 p o l i j c

**** • Aha! Genius! Thank you p o l i j c! - :)
Tue Apr 17 13:14:04 2018 :)


• Lumbar Disk Disease
+ d h k h k o
Tue Apr 17 11:27:31 2018 d h k h k o
Anterior "extraneural" exposure for neurosurgical anterior diskectomy, fusion, stabilization, and instrumentation at L5-S1.


** • could it be extradural? - mn
Tue Apr 17 12:35:06 2018 mn


• s/l baxton vasectomy
- t
Tue Apr 17 10:09:37 2018 t




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