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May 30 09:49
• Cotton ball placed into the external auditory canal. A__________ dressing applie
- mp4 posted
Fri May 29 19:40:22 2020 mp4 posted

** • Hello. I can wait over the weekend unless someone else needs to post. Thanks so much! - mp4 posted
Fri May 29 20:12:24 2020 mp4 posted

**** • I understood now: Glasscock dressing. Still need 2 blanks below. Thank you! - mp4 deleted
Fri May 29 20:18:27 2020 mp4 deleted

****** • ... - mp4 deleted
Fri May 29 20:19:44 2020 mp4 deleted


• Middle ear surgery. Thanks for trying. MD so hard to understand
+ mp3 posted
Fri May 29 19:35:21 2020 mp3 posted
Once I reached Koerners septum, the antrum was opened and drilling continued towards a safe distance away from the potential middle ear ossicles, which in essence were ossicles. In essence, he did have reconstruction
________________. Where I noted was some granulation tissue inside the mastoid. There was also granulation tissue on the 3:38_________________ aspect of the middle ear. I gently removed this with cupped forceps and suction.
** • 1. Reconstruction of the middle ear. Still need #2 and #3 Thanks - mp3 posted
Fri May 29 20:16:20 2020 mp3 posted

**** • ... - mp3 deleted
Fri May 29 20:19:14 2020 mp3 deleted

**** • ... - mp3 deleted
Fri May 29 20:19:09 2020 mp3 deleted


• Middle ear surgery.
+ wav posted
Fri May 29 19:32:47 2020 wav posted
Next, looking inside the middle ear through elevation of the tympanic membrane revealed that the patient has had a prosthetic implant. ____________ involving the incus. The patient had some granulation tissue in the area. This was persistent otorrhea. I started drilling by identifying, in spite of ___________ drilling laterally and inferiorly.
** • 1. piston type 2. spine of Henle - nm
Fri May 29 20:10:35 2020 nm

**** • Thank you, nm :) - wav posted
Fri May 29 20:14:23 2020 wav posted

****** • ... - wav deleted
Fri May 29 20:15:06 2020 wav deleted


• Surgical history: _______ removal in 2003.
- mp3 posted
Thu May 28 14:15:24 2020 mp3 posted

** • no guesses? - OP
Fri May 29 10:24:48 2020 OP

**** • flagged. thanks for listening - OP
Fri May 29 13:15:06 2020 OP

****** • Sorry no one could help. I tried many, many times and just couldn't get it. - nm
Fri May 29 19:48:34 2020 nm

******** • Thank you - OP
Sat May 30 10:38:12 2020 OP


• ?Exilon? rod. sm for context
+ Doris
Thu May 28 10:24:53 2020 Doris
we turned our attention to the tibia. Using the Exilon rod, we referenced along the lateral compartment and proceeded to resect 9 mm of bone off the proximal tibia.
** • axial rod - nm
Thu May 28 12:32:52 2020 nm


• the superior labrum was well within the limits of normal ____________ age and activi
+ wav posted
Tue May 26 14:28:53 2020 wav posted
Diagnostic arthroscopy of the glenohumeral joint was performed with findings as noted above. The glenoid labrum was probed throughout its entire circumference. Increased mobility of the superior labrum was noted. The biceps anchor was largely intact, and both the superior and middle glenohumeral ligaments were intact with no laxity. I felt that the appearance of the superior labrum was well within the limits of normal ____________ age and activity level. The arthroscope and all instruments were removed from the glenohumeral joint.
** • or maybe "for a person of his" - billybob
Tue May 26 15:09:13 2020 billybob

** • for a person of this - nm
Tue May 26 15:07:28 2020 nm

**** • Thank you so much! - wav deleted
Tue May 26 15:20:10 2020 wav deleted


• Starting inferiorly to superiorly, the cyst, which was midline but ___ ...
+ wav [posted
Fri May 22 19:27:14 2020 wav [posted
Starting inferiorly to superiorly, the cyst, which was midline but __________ towards the left superiorly, was dissected away from the underlying soft tissue. It then was attached as one expects through 10:01_______________. The central part of the attachment was removed by cutting the hyoid bone lateral to the cyst with bone cutters.
** • 1. only? 2. expects to the hyoid - poi
Fri May 22 22:31:23 2020 poi

** • Hello. I can wait for any answers until Monday night. Thanks so much for helping! - wav posted
Fri May 22 19:51:37 2020 wav posted

**** • I can't thank you enough, poi! Hope you have a wonderful weekend. - wav deleted
Sat May 23 10:53:41 2020 wav deleted


• The ______ was then carried below the normal fat down to just above th ...
+ wav posted
Fri May 22 17:22:26 2020 wav posted
The ______ was then carried below the normal fat down to just above the _________area. At that point in time, fibrous type of lipoma was noted
** • No clue on the first part of that sentence - poi
Fri May 22 18:56:09 2020 poi

** • 2. muscular? - poi
Fri May 22 18:55:29 2020 poi

**** • For the first I chose 'incision.' Thanks on the 'muscular', poi! :)) - wav deleted
Fri May 22 19:02:35 2020 wav deleted


• : Nasopharyngeal carcinoma __________ radiation therapy. She, in esse ...
+ wav posted
Fri May 22 17:13:38 2020 wav posted
: Nasopharyngeal carcinoma __________ radiation therapy. She, in essence, has osteonecrosis
** • with subsequent? - poi
Fri May 22 17:20:20 2020 poi

**** • THanks, poi. I am really struggling with this doc and may need some more help. - wav deleted
Fri May 22 17:23:30 2020 wav deleted


• Includes hysterectomy, partial colectomy, appendectomy, partial ______ ...
+ mp3 posted
Fri May 22 15:39:49 2020 mp3 posted
Includes hysterectomy, partial colectomy, appendectomy, partial ___________, gastric bypass surgery.
** • partial "hepectomy" (hepatectomy) for mets - mt
Tue May 26 11:52:20 2020 mt

**** • thanks mt - OP
Tue May 26 12:01:13 2020 OP


• Includes pneumonia in 2016 and ________.
- mp3 posted
Fri May 22 15:10:17 2020 mp3 posted

** • got in - erythema nodosum - OP
Fri May 22 15:14:36 2020 OP


• She was on omeprazole, but because of interaction with _________ was c ...
+ mp3 posted
Thu May 21 18:52:00 2020 mp3 posted
She was on omeprazole, but because of interaction with _________ was changed to Pepcid,
** • got it - testosterone - OP
Thu May 21 19:34:42 2020 OP


• MICROSCOPIC s/l RESECTION OF THE SPINAL NERVES.... Is resection correct? Thanks
- mp4 posted
Thu May 21 13:27:44 2020 mp4 posted

** • I think he says microscopic dissection - a i h h e n
Thu May 21 14:49:57 2020 a i h h e n

** • Just heard the mp4 .. could he be saying microdissection? I'm not sure. - Questyr
Thu May 21 14:47:59 2020 Questyr

** • see message + Questyr
Thu May 21 14:44:53 2020 Questyr
Resection Definition - Spine-Health
www.spine-health.com/glossary/resection

Resection Definition. Resection is the surgical removal of part or all of a damaged organ or structure, particularly the removal of a tumor. Spinal tumors and lesions that develop on the nerves can cause chronic back pain and should be excised through resection. Likewise, coccydynia can also be treated through the resection of the hypermobile segment of the coccyx to relieve pain.
**** • Disregard this - Q
Thu May 21 14:45:46 2020 Q

****** • Thank you both! - mp4 deleted
Thu May 21 14:54:47 2020 mp4 deleted


• After adequate decompression was achieved, hemostasis was achieved wit ...
+ mp3 posted
Thu May 21 13:24:03 2020 mp3 posted
After adequate decompression was achieved, hemostasis was achieved with bilateral electrocautery __________ bone wax. The wound was irrigated and closed using Vicryls and skin glue.
** • I can't the blank, sorry. - Q
Thu May 21 14:50:35 2020 Q

** • NOTE: I think he says "bipolar electrocautery" not bilateral - Questyr
Thu May 21 14:49:40 2020 Questyr

**** • Thanks for trying and catching the 'bipolar' - mp3 posted
Thu May 21 14:51:52 2020 mp3 posted


• Same surgery as below. Thanks
+ mp4 posted
Thu May 21 12:59:46 2020 mp4 posted
Self-retaining retractor was placed. Under the microscope, _________ partial hemilaminectomy __________ at the L4-5, hypertrophy of the ligamentum and medial facet, removed the ______ rongeur, thus creating a lateral recess decompression and foraminotomy.
** • see msg + ltt
Thu May 21 13:17:43 2020 ltt
Self-retaining retractor was placed. Under the microscope, high speed drill performed a partial hemilaminectomy and medial facetectomy at the L4-5. Hypertrophy of the ligamentum and medial facet removed with the Kerrison rongeur, thus creating a lateral recess decompression and foraminotomy.
**** • Thank you, ltt! - wav deleted
Thu May 21 13:24:35 2020 wav deleted


• This surgery, and the one below, is hemilaminectomy recess decompression foraminotomy
+ wav posted
Thu May 21 12:56:58 2020 wav posted


Under lateral fluoroscopic guidance, skin and _______ were infiltrated with Marcaine with epinephrine. __________ skin, and Bovie electrocautery ____ subcutaneous tissue, fascia, and 2nd paraspinal musculature free from response. __________ and medial facet at L4-5.

HEMILAMINECTOMY, LATERAL RECESS DECOMPRESSION FORAMINOTOMY.
** • see msg - best I could do + ltt
Thu May 21 13:11:49 2020 ltt
Under lateral fluoroscopic guidance, skin and and paraspinal muscles *__ were infiltrated with Marcaine with epinephrine. Knife was used for the skin, and Bovie electrocautery in the subcutaneous tissues. Fascia, and 2nd paraspinal musculature were freed from the spinous process, lamina, and medial facet of L4-5.
**** • Thanks again very much! - wav deleted
Thu May 21 13:20:47 2020 wav deleted


• The patient is a woman with low back pain and left leg pain, found to ...
+ mp3 posted
Thu May 21 12:54:26 2020 mp3 posted
The patient is a woman with low back pain and left leg pain, found to have severe stenosis at L4-5, and ___________ symptoms on the L5 radicular pattern, brought to the operating room for decompression.
** • stumbling over words. He says "stenosis at L4-5 "period". Symptoms were in an L5 radicular + ltt (see msg)
Thu May 21 13:00:23 2020 ltt (see msg)
were in a radicular pattern. Brought to the ...
**** • Thank you so much! - mp3 deleted
Thu May 21 13:18:42 2020 mp3 deleted


• .. stool softener, B12, folic acid, lisinopril, Paxil, primidone, ____ ...
+ mp3 posted
Tue May 19 17:29:58 2020 mp3 posted
.. stool softener, B12, folic acid, lisinopril, Paxil, primidone, ___________, tramadol...
** • thiamine - sea
Tue May 19 18:08:19 2020 sea

**** • Thank you, sea! I though I heard 'cya-mine' - mp3 posted
Tue May 19 18:45:41 2020 mp3 posted


• PFT results. S/l o mo lyzing
+ see sentence
Tue May 19 17:26:27 2020 see sentence
Most recent pulmonary function tests showing mixed picture of COPD, CRPD without reversibility and depressed diffusion capacity not completely s/l o/mo/lyzing for alveolar volume.
** • normalizing? - nm
Wed May 20 00:11:24 2020 nm


• Chondroplasty, limited _____________ on the tibial plateau.
+ mp3 posted
Mon May 18 16:56:50 2020 mp3 posted
. We then explored the lateral meniscus thoroughly with a nerve hook.

Chondroplasty, limited _____________ on the tibial plateau.

** • I believe he is saying "Chondroplasty of limited nature on the tibial plateau." - ltt
Mon May 18 18:28:38 2020 ltt

**** • THank you, ltt! - mp3 deleted.
Mon May 18 18:44:45 2020 mp3 deleted.


• FNA
+ l b d f m b
Mon May 18 14:34:39 2020 l b d f m b
Final aspiration biopsy suspicious for "a look for a" follicular neoplasm, but no malignant features
** • Not sure of the area in quotes, but I wonder if it is perhaps 'fine-needle aspiration'. - o j n j f j
Mon May 18 16:58:44 2020 o j n j f j


• urine s/l proper
+ sea
Sat May 16 08:21:25 2020 sea
Her urine proper looks pretty active in the sense that there are greater than 80 ketones but
** • Yes. Here is an example of the term usage (see link) + Questyr
Sat May 16 14:17:00 2020 Questyr
link
**** • Thanks Questyr! - sea
Sat May 16 17:13:23 2020 sea

** • flagged - s
Sat May 16 09:19:26 2020 s


• Bilateral solid pulmonary nodules __________ of which are subcentimete ...
+ mp3 posted
Fri May 15 17:15:07 2020 mp3 posted
Bilateral solid pulmonary nodules __________ of which are subcentimeter, below PET resolution, were seen
** • the majority of which are - ltt
Fri May 15 17:20:09 2020 ltt

**** • thank you ltt - OP
Fri May 15 17:20:57 2020 OP

****** • you are welcome - ltt
Fri May 15 17:21:22 2020 ltt


• rcently stopped her *designa* due to these symptoms
+ says 2x
Fri May 15 12:43:39 2020 says 2x
She recently stopped her _____ due to these symptoms, which were thought to be side effects. She also had her Cardizem discontinued as it can increase levels of _____. Her white counts did jump up significantly since stopping. She was noted to be confused by her daughter and was brought to the hospital. She says she chronic dyspnea but has not changed lately she states.
** • ? Tasigna (for leukemia I believe) - mt
Fri May 15 13:13:19 2020 mt


• Looking for name of food, I think it may be South Asian, sm please
+ mt
Fri May 15 12:16:59 2020 mt
9 yo child's food diary.

At 11 am, he will have **s/l yorskee or yoshi** plus yogurt.
** • never mind, I think it is roti - OP
Fri May 15 12:18:38 2020 OP


• Term/Cardiology
+ Susan
Fri May 15 10:36:33 2020 Susan
Here is the sentence: He has a 1+ regurgitant jet through the mitral valve. E/A did not demonstrate diastolic dysfunction at this time. Left atrial appendage, lots of _____(s/l rouleau?) was noted. Cannot rule out clot discussed with surgeon.
** • rouleaux - k b m l k k
Fri May 15 11:30:09 2020 k b m l k k


• He was hypercalcaemic at presentation, and was treated with fluids, st ...
+ wav
Fri May 15 10:09:20 2020 wav
He was hypercalcaemic at presentation, and was treated with fluids, steroids, and ______.
** • zoledronate makes more sense if patient has hypercalcemia. - sea
Fri May 15 15:59:43 2020 sea

** • only med I find is alendronate, but he's definitely not saying that...s/l starts with L - ltt
Fri May 15 10:18:26 2020 ltt

**** • Thanks a lot. :-) i was hearing zolendronate - guy
Fri May 15 10:19:16 2020 guy


• He is intermittently confused. He is two-person assist and ______ inc ...
+ mp3
Fri May 15 10:08:40 2020 mp3
He is intermittently confused. He is two-person assist and ______ incontinent ______ this, he is not a candidate for systemic therapy, though initially it was hoped that subsequent to radiation if he picks up, he can be treated with palliative chemotherapy.
** • 1) double? 2) incontinent. After this, he is - ltt
Fri May 15 10:10:49 2020 ltt

**** • Thanks a lot. :-) - guy
Fri May 15 10:11:00 2020 guy


• His other issue had been high-grade temperatures while inpatient. Ini ...
+ wav
Fri May 15 09:52:41 2020 wav
His other issue had been high-grade temperatures while inpatient. Initially, he was treated with antibiotics, but ______ has been attributed to disease related. In hospital, he was treated with palliative radiotherapy to help with his dysphagia.
** • but finally it has been - ltt
Fri May 15 10:08:46 2020 ltt

**** • Thanks a lot. :-) - guy
Fri May 15 10:09:00 2020 guy


• Despite improvement in his biochemistry, his confusion persisted. He ...
+ mp3
Fri May 15 09:48:49 2020 mp3
Despite improvement in his biochemistry, his confusion persisted. He has seen geriatrician and it appears that he has background of slowly developing _____ over a period of time.
** • developing dementia - ltt
Fri May 15 10:08:00 2020 ltt

**** • Thanks a lot. :-) - guy
Fri May 15 10:08:17 2020 guy


• Lescol, mag oxide, *sic sic acid*, Ultram, and Vancocin
+ ?
Fri May 15 09:40:16 2020 ?
PAST MEDICAL HISTORY: At the current time, her past medical history is significant for the following: Aortic ectasia, arthritis, osteoarthritis, asthma, fatty liver, gallstones, hyperlipidemia, hypertension, and umbilical hernia. She does not smoke or use recreational drugs nor alcohol.

MEDICATIONS: Her meds at home include Tylenol, Bacid, Cardizem, Lescol, mag oxide, _____ acid, Ultram, and Vancocin for which she has been started.

• She remains well. Her weight is stable. Recent blood test shows ____ ...
+ wav
Fri May 15 09:03:36 2020 wav
She remains well. Her weight is stable. Recent blood test shows ______ stable finding. Clinically, she is well. Her lymphoma has not progressed and she just requires monitoring. I will see her in three months.
** • stumbling over words, but says "Recent blood test shows stable finding." - ltt
Fri May 15 09:11:27 2020 ltt

**** • Thanks a lot. :-) - guy
Fri May 15 09:28:22 2020 guy


• She had a recent scan, which showed stable finding in sternum and else ...
+ mp3
Fri May 15 08:42:52 2020 mp3
She had a recent scan, which showed stable finding in sternum and elsewhere. Since the lesion in sternum _____, plan is for close monitoring and I will see her in six months with repeat scans.
** • hasn't changed - ltt
Fri May 15 09:02:50 2020 ltt

**** • Thanks a lot. :-) - guy
Fri May 15 09:03:51 2020 guy


• Her leg oedema is _____. She had a recent scan, which shows stable fi ...
+ wav
Fri May 15 08:30:03 2020 wav
Her leg oedema is _____. She had a recent scan, which shows stable finding in pancreas, in fact with some improvement and no metastatic disease
** • is present. - billybob
Fri May 15 08:40:45 2020 billybob

**** • Thanks a lot. :-) - guy
Fri May 15 08:42:29 2020 guy


• I will see her again next week with her extended family to discuss thi ...
+ mp3
Fri May 15 08:13:28 2020 mp3
I will see her again next week with her extended family to discuss this further. I also _____ the issue of introducing palliative care and will discuss again next week.
** • broached - billybob
Fri May 15 08:41:23 2020 billybob

**** • Thanks a lot. :-) - guy
Fri May 15 08:42:24 2020 guy


• Her weight is stable. Main issue has been high blood sugar. I have a ...
+ mp3
Fri May 15 07:24:27 2020 mp3
Her weight is stable. Main issue has been high blood sugar. I have asked her to ______ the metformin and I will be grateful if you could advice her ongoing diabetes management
** • up the metformin - mn
Fri May 15 07:32:59 2020 mn

**** • Thanks a lot. :-) - guy
Fri May 15 07:34:45 2020 guy


• medical centre _____ second copy ...
+ mp3
Fri May 15 07:19:29 2020 mp3
medical centre

_____ second copy
** • with only the second copy. - billybob
Fri May 15 07:21:17 2020 billybob

**** • Thanks a lot. :-) - guy
Fri May 15 07:24:08 2020 guy


• The patient has recently been diagnosed with left frontal glioma. The ...
+ wav
Fri May 15 06:30:56 2020 wav
The patient has recently been diagnosed with left frontal glioma. There is no history of seizures. He underwent surgical resection four weeks back. Postop recovery has been good. He has been planned for long course ______. I have given him information about concurrent temozolomide. I ______ prior to start of treatment next week. He understands that these cancers are not curable, but hopefully treatment can prolong survival and maintain quality of life. He is at home, well supported by his partner.
** • radiation - mn
Fri May 15 07:00:50 2020 mn

**** • Thanks a lot. :-) - guy
Fri May 15 07:18:58 2020 guy

** • never mind. Thanks to anyone who tried. - guy
Fri May 15 06:38:23 2020 guy


• In view of ______ underlying problem causing bleeding, despite being o ...
+ mp3
Fri May 15 05:24:05 2020 mp3
In view of ______ underlying problem causing bleeding, despite being on warfarin with very low INR, the risk of bleeding in future after restarting ______ going to be very high.
** • structural (can't get 2nd blank) - mn
Fri May 15 06:57:06 2020 mn

**** • Thanks a lot. :-) - guy
Fri May 15 07:18:52 2020 guy

** • never mind. Thanks to anyone who tried. - guy
Fri May 15 06:38:16 2020 guy


• On examination, the patient has had a normal baby check with the excep ...
+ wav
Thu May 14 20:43:57 2020 wav
On examination, the patient has had a normal baby check with the exception of some minor asymmetry of the ear cartilage, which is likely ______. Her clavicles have been non-tender; however, the left clavicle has felt possibly displaced posteriorly. Her ______ has been symmetric and there is no evidence of an upper limb nerve palsy. She has established breastfeeds, has good output and has lost less than 10% of birth weight.
** • I hear "Her Moro" (I think this is right based on the possibly + Questyr
Thu May 14 21:55:01 2020 Questyr
displaced left clavicle and comment on no evidence of upper limb nerve palsy)
** • Moro? - nm
Thu May 14 21:43:32 2020 nm

**** • Thanks a lot everybody. :-) - guy
Thu May 14 21:55:24 2020 guy

** • #2. ROM? - poi
Thu May 14 21:04:28 2020 poi

**** • Thanks a lot. :-) - guy
Thu May 14 21:15:12 2020 guy

** • 1. a normal variant - poi
Thu May 14 20:46:09 2020 poi

**** • I can't get #2 - fwiw-poi
Thu May 14 20:49:29 2020 fwiw-poi

****** • Thanks a lot. :-) - guy
Thu May 14 20:51:18 2020 guy

******** • if it helps + guy
Thu May 14 20:56:21 2020 guy
I understand that the pregnancy was uncomplicated, but the birth was complicated by shoulder dystocia and was concerned regarding a pop as the left shoulder was delivered.

• Weak family history of cardiac disease with maternal grandmother hav ...
+ mp3
Thu May 14 20:36:29 2020 mp3
Weak family history of cardiac disease with maternal grandmother having an ASD or VSD, and her half uncle having an arrhythmia, _____.
** • NOTE: Both American and British English spell it with a hyphen.. half-uncle - Questyr
Thu May 14 22:05:54 2020 Questyr

**** • Thanks for the correction. - guy
Fri May 15 10:00:40 2020 guy

** • it sounds like SVT - poi
Thu May 14 20:44:51 2020 poi

**** • Thanks a lot. :-) - guy
Thu May 14 20:47:51 2020 guy


• Cardiac, respiratory, abdominal, and hip examinations were normal. Bo ...
+ wav
Thu May 14 20:01:21 2020 wav
Cardiac, respiratory, abdominal, and hip examinations were normal. Both testes were retractile, but able to bring to the base of the scrotum easily. Weight was 7.18 kilos, now tracking at 15th centile. Head circumference 41.1, tracking at 3rd centile with a small anterior fontanelle. Normal head shape and normal ______. Length 67 cm at 15th centile.
** • sutures - what I hear
Thu May 14 20:13:53 2020 what I hear

**** • Thanks a lot. :-) - guy
Thu May 14 20:34:28 2020 guy

** • never mind. Thanks to anyone who tried. - guy
Thu May 14 20:11:37 2020 guy


• He has generally been well. He is making excellent progress with deve ...
+ mp3
Thu May 14 19:56:44 2020 mp3
He has generally been well. He is making excellent progress with development, now crawling and trying to ______ to stand. He is having milk feeds of five bottles a day, proximally 700 mL and now three solid meals also. His sleep is much improved at night after stay at Masada Sleep School.
** • agree with "pull to stand" - poi
Thu May 14 20:25:07 2020 poi

**** • Thanks a lot. :-) - guy
Thu May 14 20:34:50 2020 guy

** • Not really sure she is saying anything at all, maybe trying to pull up to stand. + Also - sm
Thu May 14 20:17:46 2020 Also - sm
I think proximally should probably be approximately.
**** • Thanks a lot. Thanks for the correction. - guy
Thu May 14 20:34:43 2020 guy

** • never mind. Thanks to anyone who tried. - guy
Thu May 14 20:11:32 2020 guy


• Plan: I have recommended Fluvax and _____ basic advice about COVID. ...
+ mp3
Thu May 14 19:37:42 2020 mp3
Plan:
I have recommended Fluvax and _____ basic advice about COVID. I have recommended increasing _____ intake and if needed, Coloxyl drops may be used for mild constipation. I plan to see her in six months time.

** • 1. gave him? some - poi
Thu May 14 19:44:51 2020 poi

** • 2. water - poi
Thu May 14 19:44:24 2020 poi

**** • Thanks a lot. :-) - guy
Thu May 14 19:46:06 2020 guy


• Current Medications: Vitamin D 400 units ______. ...
+ mp3
Thu May 14 19:29:37 2020 mp3
Current Medications:
Vitamin D 400 units ______.

** • 400 units in winter only. - ltt
Thu May 14 19:34:37 2020 ltt

**** • Thanks a lot. :-) - guy
Thu May 14 19:37:22 2020 guy


• However, on presentation, she was *A V S S* and CBC
+ sm
Thu May 14 19:07:00 2020 sm
A CT scan of the abdomen and pelvis noted the stomach within the chest. It looked like a type 3 paraesophageal hiatal hernia. She described dysphagia with solid liquid regurgitation and chronic cough reflux symptoms as well as epigastric abdominal pain. She reported having dark colored serum like urine that collected at the toilet and tolerating only small amounts of solid foods and drinking a bottle of water a day only. However, on presentation, she was _____ and CBC, CMP, and UA were unremarkable. No evidence of BUN, creatinine, or CBC disturbances. She is on Xarelto for PE, which is held four days prior to the operation. She reported heparin infusion while at the hospital, which was stopped six hours prior to the hospital. Her BMI is 37.
** • AVSS - Afebrile. Vital signs stable. - k b m l k k
Thu May 14 19:12:25 2020 k b m l k k


• absorbable **bio A* mesh, **dysfinofication**, and completion
+ ?
Thu May 14 19:05:56 2020 ?
DISCHARGE DIAGNOSIS: Type 4 paraesophageal hiatal hernia continuing to transverse colon and stomach.

PROCEDURE PERFORMED: Laparoscopic tear of type 4 paraesophageal hiatal hernia with absorbable **bio A* mesh, **dysfinofication**, and completion upper endoscopy
** • BIO-A mesh - k b m l k k
Thu May 14 19:17:05 2020 k b m l k k

** • Procedure performed - shouldn't it be laparoscopic repair? rather than tear - k b m l k k
Thu May 14 19:10:06 2020 k b m l k k


• She does have some effortless milky posseting, _____ every feed. She ...
+ mp3
Thu May 14 19:03:34 2020 mp3
She does have some effortless milky posseting, _____ every feed. She is mainly comfortable during feeds, but can intermittently be a _____. There has been no bilious vomiting, no blood or mucous in the stools. There are no developmental concerns.
** • posseting. It is not every feed. ...can intermittently be a bit s/l grizzly - k b m l k k
Thu May 14 19:08:47 2020 k b m l k k

**** • Thanks a lot. :-) - guy
Thu May 14 19:11:49 2020 guy


• On examination, the patient appeared well. She had moderate left plag ...
+ wav
Thu May 14 18:37:22 2020 wav
On examination, the patient appeared well. She had moderate left plagiocephaly and some dribble rash in the left neck. Weight was 4.26 kilos, ______ g in 29 days or 30 g a day, which is excellent weight gain. Hips were stable. She had some dribble rash in the neck, otherwise normal examination.
** • s/l up 875 grams (close to her math of 30 grams daily X29 days = 870) - k b m l k k
Thu May 14 18:51:56 2020 k b m l k k

**** • Thanks a lot. :-) - guy
Thu May 14 18:59:12 2020 guy


• She is mixed feeding, 120 to 130 mL a day EBM or Bellamys term formul ...
+ mp3
Thu May 14 18:33:58 2020 mp3
She is mixed feeding, 120 to 130 mL a day EBM or Bellamys term formula. She has some mild posseting and some dribble rash in the neck. The family have noticed the preference ______ to turn to the left. Her birth weight was 2930 g and last weight was on the 15th of April at 3385 g.
** • preference for her head to turn - ltt
Thu May 14 18:47:46 2020 ltt

**** • Thanks a lot. :-) - guy
Thu May 14 18:48:01 2020 guy


• Pt. takes Wellbutrin, Lexapro, s/l dy-clo-xeh-min, tramadol. ...
+ Cannot confirm
Thu May 14 15:35:18 2020 Cannot confirm
Pt. takes Wellbutrin, Lexapro, s/l dy-clo-xeh-min, tramadol.
** • Pt. has ulcer in colon and intestinal issues due to endometriosis. - Cannot confirm
Thu May 14 15:36:18 2020 Cannot confirm


• I have reassured mother and father that I feel it is highly unlikely t ...
+ wav
Thu May 14 09:50:11 2020 wav
I have reassured mother and father that I feel it is highly unlikely there is any significant language ______ autism in the patient.
** • language delay or autism - what I hear
Thu May 14 09:52:11 2020 what I hear

**** • Thanks a lot. :-) - guy
Thu May 14 09:52:31 2020 guy


• ENT examination was not done today. Chest was clear. She is well gro ...
+ mp3
Thu May 14 09:49:36 2020 mp3
ENT examination was not done today. Chest was clear. She is well grown for age with height on the 85th centile, weight with ______ 14.1 kilos, 97th centile.
** • weight with clothes and shoes - ltt
Thu May 14 09:53:41 2020 ltt

**** • Thanks a lot. :-) - guy
Thu May 14 09:56:57 2020 guy


• She was very interested in looking at a book and playing with toys app ...
+ wav
Thu May 14 09:45:31 2020 wav
She was very interested in looking at a book and playing with toys appropriately. She used several single words appropriately to me, including ______ had good eye contact, proto-declarative pointing, and good reciprocal interactions, fine motor skills and gross motor skills were normal for age.
** • including "out" - ltt
Thu May 14 09:47:08 2020 ltt

**** • Thanks a lot. :-) - guy
Thu May 14 09:49:23 2020 guy


• She is able to follow a three to four-step command and able to point t ...
+ mp3
Thu May 14 09:44:59 2020 mp3
She is able to follow a three to four-step command and able to point to several body parts in the body parts ______ head, shoulders, knees and toes. She has good proto-declarative pointing, good eye contact and no concerns in interacting with family members socially. Her motor skills are definitely on track.
** • in the body parts song "Head, shoulders, knees and toes" - ltt
Thu May 14 09:46:17 2020 ltt

**** • Thanks a lot. :-) - guy
Thu May 14 09:49:18 2020 guy


• She has seen ENT surgeon Dr Deborah Amott for a Telehealth consult, wh ...
+ wav
Thu May 14 09:37:16 2020 wav
She has seen ENT surgeon Dr Deborah Amott for a Telehealth consult, who has reassured ______. There is no significant ENT disease that she can diagnose at present and she has also seen a speech therapist
** • reassured them that there is no significant - ltt
Thu May 14 09:43:57 2020 ltt

**** • Thanks a lot. :-) - guy
Thu May 14 09:44:41 2020 guy


• The patient has had a few ______ of late, but no recent ear infections ...
+ mp3
Thu May 14 09:29:20 2020 mp3
The patient has had a few ______ of late, but no recent ear infections. Note that audiology was normal earlier this year on the 4th of March.
** • a few colds of late - ltt
Thu May 14 09:42:58 2020 ltt

**** • Thanks a lot. :-) - guy
Thu May 14 09:44:36 2020 guy


• He will continue the same dose of medications. He will continue with ...
+ mp3
Thu May 14 09:02:41 2020 mp3
He will continue the same dose of medications. He will continue with OT ______ would be very helpful for the patient to have a formal language assessment including core language and pragmatic language skills. I plan to see him in three to five months time with this assessment, also updated ADHD scales ______.

Thank you and kind regards,




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