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Oct 20 16:52
• s/l M-spike zenith or zenus, related to multiple myeloma?
- coco
Sun Oct 21 07:33:44 2018 coco

** • Coco, at the very least we need the full sentence. - please
Sun Oct 21 12:27:02 2018 please

** • Need more info - words before and after, preferably the whole paragraph? - nm
Sun Oct 21 10:36:03 2018 nm


• ... and subsequently, that ________ flap was cauterized. ...
+ mp3 posted
Sat Oct 20 13:10:35 2018 mp3 posted
Using a knife, an incision was made along the inferior edge of the inferior turbinate. Mucosal flap elevated. Bone and mucosa taken. Flap placed into position, and subsequently, that ________ flap was cauterized.


This constituted submucous resection of left inferior turbinate.

** • ... - mp3 deleted
Sat Oct 20 18:20:16 2018 mp3 deleted


• cancer staging, Stage IV, or stage IV (? cap the word stage)
- coco
Sat Oct 20 04:32:23 2018 coco

** • no cap - mn
Sat Oct 20 07:06:55 2018 mn

**** • thank you - coco
Sun Oct 21 07:33:59 2018 coco


• The patient was brought to the operating room and general anesthesia w ...
+ wav
Fri Oct 19 23:03:09 2018 wav
The patient was brought to the operating room and general anesthesia was obtained without difficulty. The patient was placed in dorsal lithotomy position. She was examined under anesthesia and found to have a 22-week size uterus with a bulging _____ fetal head as the presenting part. Cervix was dilated around the fetal head
** • bulging forebag; fetal head as the presenting part - ltt
Sat Oct 20 00:18:42 2018 ltt


• Preoperative Diagnosis: DEPRESSED FRONTAL SKULL FRACTURE WITH EXTEN ...
+ wav
Fri Oct 19 21:04:15 2018 wav
Preoperative Diagnosis:
DEPRESSED FRONTAL SKULL FRACTURE WITH EXTENSION INTO THE FRONTAL SINUS AND SUPERIOR ORBITAL PLATE.

Procedure:
ASSISTANCE WITH ELEVATION OF FRONTAL BONE FRACTURE AND OBLITERATION OF FRONTAL SINUS.

PROCEDURE IN DETAIL: The full dictation for the procedure will be dictated separately by the otolaryngology team _____ neurosurgical portion of the procedure. When we entered the case, the patient was supine on a Mizuho table with a bicoronal incision and the frontal region and superior orbital plate exposed.
** • by the otolaryngology team. This represents the dictation for the neurosurgical portion - ltt
Fri Oct 19 22:58:02 2018 ltt

**** • Thanks a lot. - guy
Fri Oct 19 23:03:58 2018 guy

** • ???as well as _____ dictation for the??? - Questyr
Fri Oct 19 21:29:38 2018 Questyr

**** • Thanks a lot. - guy
Fri Oct 19 21:39:54 2018 guy


• A curved 'free' needle was used. ENT surgery. Cannot confirm.
- Thanks
Fri Oct 19 19:23:10 2018 Thanks

** • try: curved Freer needle - coco
Sat Oct 20 04:34:08 2018 coco

**** • I'm having trouble getting any good google hits for this...can you provide some? - Q
Sat Oct 20 16:31:15 2018 Q

** • Yes, "a curved free needle" (see link for definition of free needle) + Questyr
Fri Oct 19 21:27:01 2018 Questyr
link
**** • Thanks a lot, Questyr! - Thanks
Sat Oct 20 13:06:06 2018 Thanks

** • Please ignore post right below + mp3 posted
Fri Oct 19 19:25:21 2018 mp3 posted
Starting on the left-hand side, an incision was made just anterior to the inferior turbinate vertically as well as _________. An incision was made just inferior to the left lateral canthi. A double-armed 3-0 Prolene suture was placed in the nose, removing the sutures through the skin incision. Next, a curved _____ needle was used to approximate the suture to the underlying ___________ maxillary periosteum.


**** • 3. ____ slash (/) maxillary. 1. previous to it (?) - k d i e m n
Fri Oct 19 21:31:05 2018 k d i e m n


• and subsequently, that __________ flap was cauterized.
+ mp3
Fri Oct 19 19:19:23 2018 mp3
. Mucosal flap elevated. Bone and mucosa taken. Flap placed into position, and subsequently, that __________ flap was cauterized. This constituted submucous resection of left inferior
** • ... - mp3 deleted
Fri Oct 19 19:28:45 2018 mp3 deleted


• She understands the risks of tonsillectomy, additionally __________ to ...
+ mp3 posted
Fri Oct 19 17:35:17 2018 mp3 posted
She understands the risks of tonsillectomy, additionally __________ to the exclusive risks of rhinoplasty, which include poor results, ...
** • additionally understands the? - k d i e m n
Fri Oct 19 18:22:04 2018 k d i e m n

**** • It is additionally understands the... Thank you so much! - mp3 posted
Fri Oct 19 19:00:56 2018 mp3 posted

** • Can you post with more volume? - Questyr
Fri Oct 19 18:03:42 2018 Questyr


• what is the correct way to type heart sounds S1-2?
- coco
Fri Oct 19 10:41:29 2018 coco

** • two different sounds. I type S1 S2 - fwiw
Fri Oct 19 11:35:52 2018 fwiw

**** • Thank you, think I used a comma, S1, S2, had to send it through. - coco
Fri Oct 19 12:03:00 2018 coco

****** • That's how I do it too, with a comma. - sea
Fri Oct 19 14:23:05 2018 sea

******** • thank you - coco
Sat Oct 20 04:47:35 2018 coco


• long head biceps tendon was scarred in the groove in a s/l*ma-leck-tan* position
+ sm
Fri Oct 19 10:28:08 2018 sm
The long head biceps tendon was scarred in the groove in a s/l*ma-leck-tan* position so we trimmed this out and then resected all but about 3 cm of the tendon.
** • mal-extended position ? - ltt
Fri Oct 19 12:13:23 2018 ltt


• Is it 6th nerve palsy or sixth nerve palsy? I'm seeing both
- tia
Fri Oct 19 04:52:06 2018 tia

** • either way is acceptable, some accounts have specifics - where I work it is 6th. - taco
Fri Oct 19 09:22:58 2018 taco


• See message please. Thanks!
+ tlh
Fri Oct 19 02:02:44 2018 tlh
She had a bipolar hemiarthroplasty with an Ovation hip stem, size 7, with a 12/14 taper, a 28 ______[by plus three] mm femoral head, a bipolar insert from the consensus hips ...
** • Thanks! - tlh
Fri Oct 19 02:42:25 2018 tlh

** • 28 by +3 - nm
Fri Oct 19 02:39:00 2018 nm


• .. avoiding taking Ioban ____________. ..
+ mp3
Thu Oct 18 20:12:10 2018 mp3
Prior to entering the joint, however, we had only taken a slip of skin and subcutaneous tissue 3 mm wide from each side of the wound anteriorly and posteriorly to get fresh edges. I went to the Ioban drape carefully, avoiding taking Ioban ____________. I aspirated 80 of the 90 mL into a 10-mL syringe
** • ... - mp3 deleted
Thu Oct 18 20:23:45 2018 mp3 deleted


• The patient was placed into the 'reflexed' or 'reflex' position?
- Thanks
Thu Oct 18 17:14:10 2018 Thanks

** • not sure what either of those positions would be~sorry - poi
Thu Oct 18 17:58:27 2018 poi

**** • I guess they mean flexed, but I keep hearing reflexed?! - Thanks
Thu Oct 18 18:51:54 2018 Thanks


• I feel I should edit to 'into the left...' or just leave as is? Thanks
+ m h j k l f
Thu Oct 18 16:52:08 2018 m h j k l f
250 mL of tumescent was infiltrated to the left lateral abdomen
** • I would "as dictated" - poi
Thu Oct 18 17:56:26 2018 poi

**** • Okay. thanks - g h p l i k
Thu Oct 18 18:51:20 2018 g h p l i k


• ..With this _____________ noted to be the majority of the lesion ....
+ wav posted
Thu Oct 18 15:24:13 2018 wav posted
We had to, again, excise the small, little ganglion cyst coming from the wrist joint itself. With this _____________ noted to be the majority of the lesion that was palpable on the skin, decision was made to proceed and excise the artery.
** • lesion again noted - poi
Thu Oct 18 15:25:20 2018 poi

**** • Thanks poi, I heard that but though I heard incorrectly with 'lesion' mentioned again in + wav posted
Thu Oct 18 15:29:05 2018 wav posted
that same sentence.
****** • ... - wav deleted
Thu Oct 18 15:38:12 2018 wav deleted


• ...postoperative visit _______ removable thumb spica brace ....
+ mp3 posted
Thu Oct 18 15:15:49 2018 mp3 posted
We can likely transition her out of the splint at the first postoperative visit _______ removable thumb spica brace that she has if needed for her de Quervains on the left side
** • in order to move to the thumb??? - wag-poi
Thu Oct 18 15:24:53 2018 wag-poi

**** • Not sure. But do you hear 'and order a removable...' ? - mp3 posted
Thu Oct 18 15:32:35 2018 mp3 posted

****** • with "that she has"? I don't know, sorry - poi
Thu Oct 18 15:46:45 2018 poi

******** • though after listening again, maybe so - poi
Thu Oct 18 15:47:36 2018 poi

********** • Thanks a lot, poi :) - mp3 deleted
Thu Oct 18 15:49:13 2018 mp3 deleted


• Three blanks :(
+ wav posted
Thu Oct 18 14:39:07 2018 wav posted
I obtained, again, additional __________ clearance, again, on the day of surgery ___________ position, but this was not documented previously in her chart. After adequate clearance was obtained, she was taken back _________just IV sedation with some Propofol.
** • 1. medical 2. from her primary care physician 3. and placed under - poi
Thu Oct 18 15:08:01 2018 poi

**** • Thanks a million, poi! I am still struggling with same dictator. Will have to post again. - wav posted
Thu Oct 18 15:10:12 2018 wav posted


• exposed to titanium, ________, beryllium, and explosives
- mp3 posted
Thu Oct 18 13:27:11 2018 mp3 posted

** • flagged. Thanks for listening - OP
Thu Oct 18 14:21:17 2018 OP

** • sounds like she is saying beryllium without the B? I can't find anything, all google + lb
Thu Oct 18 13:48:52 2018 lb
guesses go right to beryllium.
**** • thanks what I was getting too. Thanks for listening. - OP
Thu Oct 18 13:52:26 2018 OP

**** • and she sounds just like an NP on one of my accounts. - k d i e m n
Thu Oct 18 13:49:17 2018 k d i e m n

****** • could be...she is a NP - OP
Thu Oct 18 13:53:47 2018 OP

******** • Ummm...New York? - k d i e m n
Thu Oct 18 13:54:37 2018 k d i e m n

********** • No, California. - OP
Thu Oct 18 13:55:38 2018 OP


• We 'resected'out deep through some of the fascia, tissues, and ______ in the pulp..
- wav
Thu Oct 18 13:25:04 2018 wav

** • the pulp - k d i e m n
Thu Oct 18 14:22:50 2018 k d i e m n

** • we dissected out - sounds like he stuttered over the pulp - k d i e m n
Thu Oct 18 13:50:27 2018 k d i e m n

**** • So, would it be then fascia, tissues, and pulp? - wav
Thu Oct 18 13:59:35 2018 wav

****** • I meant "the pulp" - k d i e m n
Thu Oct 18 14:23:06 2018 k d i e m n

******** • Thanks - wav
Thu Oct 18 14:38:34 2018 wav


• How do you type guardian study? (Guard during ischemia against necrosis (GUARDIAN))
+ tia
Thu Oct 18 12:44:39 2018 tia
I am seeing it in all caps, but since the "guard" part is not an actual acronym, didn't see why that part would be capped.
** • I found: Guard During Ischemia Against Necrosis, but I'd probably cap it all since that's + k d i e m n
Thu Oct 18 13:54:23 2018 k d i e m n
how all the other sites have it cap'd
**** • Thanks. That is what I did. - OP
Thu Oct 18 14:22:22 2018 OP


• Child with near fingertip amputaiton, which was
+ h j b b m c
Thu Oct 18 12:09:13 2018 h j b b m c
sutured back on.

"Her injury occurred on Friday. She has had s/l a splay duh dressing on until now.

PHYSICAL EXAMINATION:
Her wound looks excellent. There is no necrosis at the time. It looks viable."


• We resected out deep through some of the fascia, tissues, and ______ i ...
+ wav
Thu Oct 18 12:03:21 2018 wav
We resected out deep through some of the fascia, tissues, and ______ in the pulp of the finger.
** • I REPOSTED ABOVE. THANKS! - wav
Thu Oct 18 13:25:20 2018 wav

** • ... - wav reposted
Thu Oct 18 13:15:26 2018 wav reposted

** • It sounds like 'septi' to me, but not sure if that fits - wav
Thu Oct 18 13:05:53 2018 wav

** • your wav is not the wav that I'm hearing - nm
Thu Oct 18 13:00:00 2018 nm

** • Hi. Still waiting :) - wav
Thu Oct 18 12:45:00 2018 wav

**** • ... - wav posted now
Thu Oct 18 13:00:52 2018 wav posted now

****** • sorry, I'm still hearing the wav posted earlier on trigger thumb release - nm
Thu Oct 18 13:04:55 2018 nm


• Trigger thumb release
+ mp3
Thu Oct 18 12:00:38 2018 mp3
The A1 pulley to the thumb was incised longitudinally, releasing the sheath around the FPL tendon. I released distally to the level of the oblique pulley, _______ piece of overlying tissue. Adequate release of the _______ was performed.
** • Thanks poi. I think you're right with #1. Then 2nd blank I now hear 'FPL tendon' + mp3
Thu Oct 18 13:03:24 2018 mp3
Let me know if you hear the same. Thanks!
** • 1. proximal piece? - poi
Thu Oct 18 12:57:03 2018 poi

** • Hi. Still waiting :) - mp3
Thu Oct 18 12:45:15 2018 mp3

**** • you have the same file on both wav and mp3 - poi
Thu Oct 18 12:56:08 2018 poi


• Preoperative Diagnosis: RUPTURED CEREBRAL ANEURYSM. Procedur ...
+ wav
Thu Oct 18 09:21:26 2018 wav
Preoperative Diagnosis:
RUPTURED CEREBRAL ANEURYSM.

Procedure:
RIGHT PTERIONAL CRANIOTOMY FOR CLIPPING OF POSTERIOR COMMUNICATING ARTERY ANEURYSM AND ANTERIOR CHOROIDAL ARTERY ANEURYSM WITH INTRAOPERATIVE ANGIOGRAM.

This is a 50-year-old woman who presented to an outside hospital with a severe headache and altered mental status and was found to have diffuse subarachnoid hemorrhage. A CT angiogram was performed which showed a possible right-sided _____ ICA aneurysm, but was not definitive due to _____ contamination.
** • 2. venous - poi
Thu Oct 18 09:35:32 2018 poi

** • 1. supraclinoid - poi
Thu Oct 18 09:33:46 2018 poi

**** • Thanks a lot. - guy
Thu Oct 18 09:47:43 2018 guy


• Preoperative Diagnosis: RIGHT BREAST CANCER. Procedure: R ...
+ wav
Thu Oct 18 08:36:32 2018 wav
Preoperative Diagnosis:
RIGHT BREAST CANCER.

Procedure:
RIGHT BREAST EXCHANGE OF TISSUE EXPANDER WITH PERMANENT IMPLANT, RIGHT BREAST CAPSULOTOMY, LEFT BREAST TOTAL CAPSULECTOMY, SUBPECTORAL PERMANENT IMPLANT PLACEMENT WITH ALLODERM.

Electrocautery was then used to take the incision down to the subglandular pocket and capsule. There was a well formed capsule and attention was paid to performing a total capsulectomy using lighted _____ retractors, as well as Allis clamp to help retract the skin and the capsule in opposite directions using electrocautery and staying right on the capsule. The capsule was dissected free from the breast parenchyma.
** • Invuity? - dd
Thu Oct 18 08:59:58 2018 dd

**** • Thanks a lot. - guy
Thu Oct 18 09:00:38 2018 guy


• Preoperative Diagnosis: CONDUCTIVE HEARING LOSS AND TYMPANIC MEMBRA ...
+ wav
Thu Oct 18 07:34:59 2018 wav
Preoperative Diagnosis:
CONDUCTIVE HEARING LOSS AND TYMPANIC MEMBRANE PERFORATION.

Procedure:
RIGHT POSTAURICULAR TYMPANOPLASTY.

a tragal cartilage graft was harvested using a #15 blade through the tragus leaving the dome intact and a graft piece with perichondrium was removed. Next, as we were looking postauricularly, we then took a large postage size stamp of _____ fascia from the temporalis which was placed in the Gelfoam press and set aside.
** • fool's fascia - nm
Thu Oct 18 07:50:24 2018 nm

**** • Thanks a lot. - guy-
Thu Oct 18 07:58:30 2018 guy-


• Preoperative Diagnosis: HISTORY OF UTERINE SEROUS CARCINOMA, WITH I ...
+ wav
Wed Oct 17 21:21:57 2018 wav
Preoperative Diagnosis:
HISTORY OF UTERINE SEROUS CARCINOMA, WITH IMAGING CONSISTENT WITH RECURRENT DISEASE.

Procedure:
DIAGNOSTIC LAPAROSCOPY, EXPLORATORY LAPAROTOMY WITH REMOVAL OF RIGHT PERICOLIC MASS, LYSIS OF ADHESIONS.

OPERATIVE FINDINGS: Surgically absent uterus, cervix, and fallopian tubes, lap band seen. Cystic and solid-appearing 8 cm mass adhesed to the transverse colon and cecum at the hepatic flexure. The mass was incidentally ruptured with release of dark brown fluid. There was no evidence of bowel _____ . There were no other areas of disease noted. At the end of the procedure, there was no residual tumor.
** • invasion. - poi
Wed Oct 17 21:38:22 2018 poi

**** • thanks a lot. - guy
Wed Oct 17 21:39:07 2018 guy


• sounds like "infection/inspection"
+ guy
Wed Oct 17 20:21:55 2018 guy
The uterosacral ligament pedicles were held and this was used to aid in **inspection** for hemostasis.
** • inspection - poi
Wed Oct 17 20:29:51 2018 poi

**** • thanks a lot. - guy
Wed Oct 17 20:32:53 2018 guy

** • wav posted. Thanks. - g
Wed Oct 17 20:24:03 2018 g


• Preoperative Diagnosis: A 71-YEAR-OLD WITH HISTORY OF CERVICAL INTR ...
+ wav
Wed Oct 17 20:07:51 2018 wav
Preoperative Diagnosis:
A 71-YEAR-OLD WITH HISTORY OF CERVICAL INTRAEPITHELIAL NEOPLASIA 2, CERVICAL INTRAEPITHELIAL NEOPLASIA 3, STATUS POST LOOP ELECTROSURGICAL EXCISION PROCEDURE.

Procedure:
TOTAL VAGINAL HYSTERECTOMY AND BILATERAL SALPINGECTOMY.

At the level of the cornua, the each cornua was grasped with Heaney clamps and the uterus excised and the specimen was handed off the field. The uteroovarian and fallopian tubes were then doubly tied using a free tie as well as _____ suture and good hemostasis was achieved.
** • never mind. Thanks to anyone who tried. - guy
Wed Oct 17 20:22:12 2018 guy


• Photocoagulation was delivered around the far periphery ________ the p ...
+ MP3
Wed Oct 17 14:52:44 2018 MP3
Photocoagulation was delivered around the far periphery ________ the previous retinal breaks were well-treated.
** • this is how I hear it... + p o l i j c
Wed Oct 17 15:37:14 2018 p o l i j c
Photocoagulation was delivered around the far periphery. Noted previous retinal breaks were well-treated.
**** • Note: No hyphen for well treated as it follows the verb. (see message box) + Questyr
Wed Oct 17 18:30:08 2018 Questyr
https://data.grammarbook.com/blog/adjectives-adverbs/are-we-hyphenating-well/

Apr 3, 2018 - As a general rule, a compound adjective can include an adverb. The compound is often hyphenated before a noun but not after a noun (a well-dressed man, the man is well dressed). Well also would not be hyphenated when compounded with other adverbial modifiers, such as very (a very well dressed man).
**** • Thanks for confirming, polijc! - MP3
Wed Oct 17 15:49:59 2018 MP3

** • Noted previous retinal breaks..?? - cb
Wed Oct 17 14:58:07 2018 cb

**** • I think that's it, sentence starting after period and then "noted" - MP3
Wed Oct 17 15:27:19 2018 MP3

**** • Thanks, cb. It seems like a word would be missing then. Can you hear 'though'? - MP3
Wed Oct 17 15:16:00 2018 MP3


• Photocoagulation was delivered around the far periphery ________ the p ...
+ MP3
Wed Oct 17 14:52:40 2018 MP3
Photocoagulation was delivered around the far periphery ________ the previous retinal breaks were well-treated.
** • Sorry for double post. Please see above. - MP3
Wed Oct 17 14:53:38 2018 MP3


• There was no evidence of spread outside of the planned resection field ...
+ wav
Wed Oct 17 11:27:48 2018 wav
There was no evidence of spread outside of the planned resection field, specifically there were no liver or peritoneal modules, nor was there obvious local extension, ascites or lymphadenopathy. A _____ retractor was placed.
** • Rochard? - p o l i j c
Wed Oct 17 12:12:22 2018 p o l i j c

**** • thanks a lot. - guy
Wed Oct 17 20:24:31 2018 guy


• med s/l flu it all
+ ?
Wed Oct 17 10:07:33 2018 ?
is a 67-year-old man, who was readmitted to the hospital because of shortness of breath. He was noted to have a black stool and hemoglobin of 7.1 g% which was slightly lower than his blood count a couple of weeks ago. He does have history of GI bleed including GI angiodysplasia. In the recent past, a suspicious lesion was biopsied from his colon, but it was not seen on subsequent exams when resection was contemplated. He has heart disease with cardiomyopathy, atrial fibrillation, and has been on anticoagulation.

MEDICATIONS: His medications prior to admission include Proventil, Abilify, aspirin 81 mg daily, Lipitor, Plavix 75 mg daily, Lanoxin, Cardizem, Cymbalta, vitamin D, fluticasone, _____, vilanterol inhaler, Neurontin, Amaryl, Glucophage, Lopressor, Protonix, MiraLax, and 5 mg of Coumadin.
** • phenobarbital? - guy
Wed Oct 17 11:29:50 2018 guy

** • Sorry, I could not find anything helpful. - Questyr
Wed Oct 17 10:52:36 2018 Questyr

**** • thank you - !
Wed Oct 17 11:05:06 2018 !


• FINDINGS: At completion of case, there was a good thrill in the _____ ...
+ wav
Wed Oct 17 07:57:10 2018 wav
FINDINGS: At completion of case, there was a good thrill in the _____ collaterals and a pulsatile thrill in the cephalic vein.
** • brachial system - what I hear
Wed Oct 17 09:12:31 2018 what I hear

**** • thanks a lot. - guy
Wed Oct 17 11:28:33 2018 guy

** • never mind. Thanks to anyone who tried. - guy
Wed Oct 17 08:15:14 2018 guy


• Preoperative Diagnosis: RIGHT GUSTILO-ANDERSON TYPE 2 OPEN MEDIAL M ...
+ wav
Tue Oct 16 20:48:19 2018 wav
Preoperative Diagnosis:
RIGHT GUSTILO-ANDERSON TYPE 2 OPEN MEDIAL MALLEOLUS FRACTURE.

Procedures:
1. IRRIGATION AND DEBRIDEMENT OF RIGHT ANKLE.
2. OPEN REDUCTION AND INTERNAL FIXATION OF RIGHT MEDIAL MALLEOLUS FRACTURE.

He was brought to the Bellevue Hospital Emergency Room for evaluation. He was found to have an open fracture of his right medial malleolus with soft tissue injury. The patient was _____ 15 in the trauma slot. The patient has a past medical history of depression. He is on Haldol
** • ???Glasgow Coma Scale??? - Questyr
Tue Oct 16 21:08:28 2018 Questyr

**** • thanks a lot. - guy
Tue Oct 16 21:40:18 2018 guy


• Preoperative Diagnosis: LEFT KNEE PRIMARY OSTEOARTHRITIS. Pr ...
+ wav
Tue Oct 16 19:35:43 2018 wav
Preoperative Diagnosis:
LEFT KNEE PRIMARY OSTEOARTHRITIS.

Procedure:
LEFT TOTAL KNEE ARTHROPLASTY.

We performed a medial parapatellar arthrotomy using a sharp scalpel to sublux the patella laterally. We removed the fat pad behind the patellar tendon ensuring not to injure the patellar tendon. We then performed a release of the anteromedial deep MCL fibers. We also removed the anterior fat pad off the distal femur for referencing _____. We released the anterior horn of the medial and lateral meniscus and as well released the ACL and PCL off of its tibial insertion as well as in the femoral notch.
** • never mind. Thanks to anyone who tried. - guy
Tue Oct 16 20:28:05 2018 guy


• Not sure what heading to use for lymph node exam
+ d n l m p d
Tue Oct 16 19:20:26 2018 d n l m p d
Under what heading in Physical Exam do you put:

There are no palpable cervical, supraclavicular, axillary, or inguinal lymph nodes.

MD finished dictating on extremities, then went on to the lymph nodes. Can I keep them under extremities?
** • lymphatic? - poi
Tue Oct 16 19:38:19 2018 poi


• Cannot confirm, therefore not 100% sure this is correct. Thanks
+ MP3
Tue Oct 16 16:24:47 2018 MP3
1. PAINFUL ANKLE SUBTALAR JOINT, RIGHT FOOT, WITH HYPERTROPHIC EXOSTOSIS.
2. SUBTALAR s/l 'STOP BLOCK' OR INTERNAL FIXATION DEVICE NOTED WITHIN THE JOINT, WHICH WILL NEED TO BE REMOVED.

** • found hits for stop/block so you are hearing correctly - sea
Tue Oct 16 16:50:53 2018 sea

**** • Awesome. DId not know how to type it correctly. Thanks! - MP3
Tue Oct 16 17:01:29 2018 MP3

****** • I found it that way and stop block so not sure but it is a "thing". :) - sea
Tue Oct 16 17:04:07 2018 sea

******** • Thanks :) - MP3
Tue Oct 16 17:18:31 2018 MP3


• doing short clinic notes for fast dictator, sm pls
+ ns
Tue Oct 16 15:08:48 2018 ns
Can't tell if he is saying:
Most prevalent, or most prominent diagnosis as a heading.
Is one more "usually heard" than another?

Thanks for any input.
** • fwiw - I'd vote for "prominent" over "prevalent", but could be maybe "relevant?" - taco
Tue Oct 16 15:30:18 2018 taco


• Probably should know this. Patient had shortness of breath but was not s/l tip-nic
- c g b f b n
Tue Oct 16 15:05:00 2018 c g b f b n

** • tachypneic - taco
Tue Oct 16 15:08:43 2018 taco

**** • Thanks, taco! - c g b f b n
Tue Oct 16 15:12:57 2018 c g b f b n


• Guy, did you want to try reposting the two WAVs that didn't get answers?
- Questyr
Mon Oct 15 00:49:41 2018 Questyr

** • responded below. Thanks. :-) - guy
Mon Oct 15 00:56:22 2018 guy


• Preoperative Diagnosis: STRESS URINARY INCONTINENCE. Procedu ...
+ wav
Mon Oct 15 00:18:06 2018 wav
Preoperative Diagnosis:
STRESS URINARY INCONTINENCE.

Procedure:
MIDURETHRAL SLING, ADVANTAGE FIT, CYSTOSCOPY.

The periurethral tissue was dissected with just Metzenbaum scissors and blunt dissection to the level of the pubic bone on either side. The midline was marked just above the suprapubic region with a sterile marker. Using a guided Foley was placed into the bladder urethrally _____ the patient of the bladder throughout the procedure.
** • ???urethrally allowing irrigation of the bladder??? - Questyr
Mon Oct 15 00:48:18 2018 Questyr

**** • Thanks a lot. - guy
Mon Oct 15 00:54:23 2018 guy


• The external ring was identified and the cord contents controlled usin ...
+ wav
Sun Oct 14 23:51:09 2018 wav
The external ring was identified and the cord contents controlled using a vessel loop. Dissection of the cord contents was begun bluntly, at which time a distinct hernia sac was appreciated. This was dissected free of the surrounding cord structures taking care to protect the patients _____ which was easily palpable.
** • i used "patient's vas" here, but was not sure - guy
Mon Oct 15 00:56:00 2018 guy

** • never mind. Thanks to anyone who tried. - guy-
Mon Oct 15 00:18:35 2018 guy-


• The umbilical cord was doubly clamped and cut and the fetus passed to ...
+ wav
Sun Oct 14 23:09:08 2018 wav
The umbilical cord was doubly clamped and cut and the fetus passed to the nursing staff in attendance. Cord gases were obtained. The uterus was too large to be exteriorized and was left in situ. The placenta was removed manually with all _____ membranes removed.
** • Q i flagged this one as i did not get it. - guy
Mon Oct 15 00:54:55 2018 guy

** • never mind. Thanks to anyone who tried. - guy
Sun Oct 14 23:15:48 2018 guy


• This patient is a 28-year-old gravida 2, para 0-0-1-0 at 38 weeks gest ...
+ wav
Sun Oct 14 22:48:48 2018 wav
This patient is a 28-year-old gravida 2, para 0-0-1-0 at 38 weeks gestational age who presented to labor and delivery with complaints of right _____ uterine contractions. While reevaluating in the triage area, she was noted to have spontaneous rupture of membranes with meconium stained amniotic fluid. In view of rupture of membranes and early labor, the patient was taken for the operating room for primary cesarean delivery. Previously, she was planned to have a primary cesarean delivery at 39 weeks in the view of 15 cm lower segment
** • complaints of regular uterine contractions - ltt
Sun Oct 14 23:00:55 2018 ltt

**** • Thanks a lot. - guy
Sun Oct 14 23:07:00 2018 guy


• ESL help - s/l saver gallara dilators (see msg.) Patient with esophageal stricture.
+ sea
Sun Oct 14 12:54:45 2018 sea
I decided to do an EGD under general anesthesia with a possibility of s/l saver gallara dilators. From my understanding, this is up high in the oropharyngeal area.
** • Savary-Gilliard dilators - Questyr
Sun Oct 14 13:02:24 2018 Questyr

**** • Thank you! - sea
Sun Oct 14 13:05:38 2018 sea


• labs: s/l cardio-deem PS73 ?
- coco
Sun Oct 14 07:50:45 2018 coco

** • You must provide more info. Surrounding words, complaint, diagnosis, etc. - please
Sun Oct 14 12:48:36 2018 please

** • More info please. Sentence before and after, and maybe diagnoses? - nm
Sun Oct 14 10:47:31 2018 nm


• Preoperative Diagnosis: UMBILICAL HERNIA. Procedure: UMBI ...
+ wav
Sun Oct 14 01:53:48 2018 wav
Preoperative Diagnosis:
UMBILICAL HERNIA.

Procedure:
UMBILICAL HERNIA REPAIR WITH MESH.

This is a 71-year-old male who presented to general surgery clinic at Hospital with complaints of umbilical hernia _____ size, nor did he have obstructive _____ did bother him occasionally. The patient states that the hernia was always reducible.
** • #2 is something like....symptoms, though it.....(or maybe...symptoms. He said it....) - Questyr
Sun Oct 14 02:12:59 2018 Questyr

**** • Thanks a lot. - guy
Sun Oct 14 02:30:56 2018 guy


• PROCEDURE IN DETAIL: The patient was brought to the operating room an ...
+ mp3
Sun Oct 14 00:26:26 2018 mp3
PROCEDURE IN DETAIL: The patient was brought to the operating room and placed on the table in a supine position. _____. The head of the bed was turned 90 degrees and the patient was prepped and draped in the usual sterile fashion.
** • NOTE: The head was turned (not 'The head of the bed') - Questyr
Sun Oct 14 00:40:57 2018 Questyr

**** • Wouldn't turning your head 90 degrees kinda be a tad uncomfortable? Heck, mine only goes - about 45.
Sun Oct 14 16:58:54 2018 about 45.

****** • I think is was using the word turned in the sense of 'the head was positioned' - Q
Sun Oct 14 18:13:03 2018 Q

**** • She's terrible...I'm sorry I couldn't get either the WAV or the mp3 - Q
Sun Oct 14 00:41:31 2018 Q

****** • Thanks for the correction. - guy
Sun Oct 14 00:46:55 2018 guy

******** • never mind. Thanks to anyone who tried. - guy-
Sun Oct 14 01:28:45 2018 guy-


• Preoperative Diagnoses: 1. DEVIATED NASAL SEPTUM. 2. NASAL OBS ...
+ wav
Sun Oct 14 00:22:12 2018 wav
Preoperative Diagnoses:
1. DEVIATED NASAL SEPTUM.
2. NASAL OBSTRUCTION.
3. INFERIOR NASAL TURBINATE HYPERTROPHY.
4. ACQUIRED NASAL DEFORMITY.

Procedures:
1. SEPTORHINOPLASTY.
2. OUTFRACTURE INFERIOR TURBINATE

This is a 27-year-old male with no significant past medical history who had an altercation in January of 2018 _____ he noted significant changes _____ of the nose and nasal obstruction, left side greater than right.
** • never mind. Thanks to anyone who tried. - guy
Sun Oct 14 01:28:38 2018 guy


• PAST SURGICAL HISTORY: ____________
+ mp3
Sat Oct 13 17:03:16 2018 mp3
PAST MEDICAL HISTORY: Diabetes, hearing loss, hyperlipidemia.

PAST SURGICAL HISTORY: ____________

MEDICATIONS:

** • Denies. - sea
Sat Oct 13 17:46:46 2018 sea

** • denies - poi
Sat Oct 13 17:32:58 2018 poi

**** • Thank you! - mp3
Sun Oct 14 07:28:03 2018 mp3


• s/l assumed due to avocate during the procedure, sm plse
+ ns
Sat Oct 13 15:04:17 2018 ns
C-section.
Note was made of blood stained urine in foley catheter, **assumed due to ah-voe-cate during the procedure.**
** • don't know, but s/b blood-stained (with hyphen) - Questyr
Sat Oct 13 21:41:19 2018 Questyr

** • not sure but Foley is cap'd - nm
Sat Oct 13 16:16:27 2018 nm


• is tased a correct word?
+ guy
Sat Oct 13 10:04:23 2018 guy
The patient was also tased and handcuffed by police
** • For archives - Merriam-Webster shows the verb is tase (so yes, tased) (see link) + Questyr
Sat Oct 13 11:00:09 2018 Questyr
link
** • got it. thanks. - guy
Sat Oct 13 10:25:42 2018 guy


• med for MS, s/l ness en tees ?
+ coco
Sat Oct 13 09:15:00 2018 coco
x



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