Stumped - rheumatology. Please see paragraph for context.
Posted By: This is a tough one. sm on 2007-10-08
In Reply to:
Subject: Stumped - rheumatology. Please see paragraph for context.
Patient is a little girl with an area of atrophic and hyperpigmented skin on her forehead (morphea/linear scleroderma en coup de sabra).
"In addition, there is a secondary area which is approximately 2 cm in diameter and 6 cm in length which is hyperpigmented and lateral to the s/l inituary/immisuary, with again subcutaneous atrophy, but without erythema or adherence."
Totally stumped but hate to give up --- Thanks for any help.
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Here's the context paragraph...sm
Subject: Here's the context paragraph...sm
Patient recently had a positive culture infection with group B strep. He was treated with some Cipro and he says he is actually voiding better now than he has for some time. He probably has been having a little small "ring" prostatitis going on.
Rheumatology - Please see message for context.
Subject: Rheumatology - Please see message for context.
Patient is 5-year-old white male with recurrent episodes of high fever.
Impression is period fever syndrome. Giving brief trial of cimetidine to see if this will cut off his episodes, suggesting that they are in fact s/l foppa/FOPPA
Then s/l SMF gene testing was ordered. He says this part so fast that I'm not sure there could be more initials.
Thanks.
Rheumatology - please see message for context
Subject: Rheumatology - please see message for context
Patient has a strongly positive ANA, but normal C3 and C4, with a normal CBC and sedimentation rate, but she has a weakly positive rheumatoid factor and a low-titer of s/l anti-phos-photetal serian (maybe serum) antibodies.
If any help, patient may have lupus.
Here's the paragraph................
Subject: Here's the paragraph................
"The rest of his past history, review of systems, and social history is otherwise noncontributory, except that he is status post coronary artery bypass graft surgery and has had a pacemaker and is on Coumadin in conjunction with his cerebral vascular disease. He also takes amiodarone, s/l Trazadec, Toprol, Ambien, Cozaar, and Effexor."
The patient is being evaluated by a neurologist for leg and back pain. Thanks.
does this fit at the end of this paragraph? See msg pls.
Subject: does this fit at the end of this paragraph? See msg pls.
Patient is getting back on his medications and will be following up with his psychiatrist Dr. X. They are due within the next few weeks, he says, to recheck his Depakote levels, (Dr. take a drink and says)S/L hemolith normal. (new paragraph)
not sure, here's the paragraph...
Subject: not sure, here's the paragraph...
Neurologic exam/history and physical exam does reveal the patient with parkinsonian features. We are going to go ahead and change him from Sinemet 25/100 mg to Stalevo 100 mg, one in the morning and one at midday, since he really only takes it twice a day. If this does not help, we may try going back to the Sinemet and then trying Azilect for the freezing. I think that may be of great benefit to him, despite the MALB inhibitor.
Here's the rest of the paragraph. I need someone to look at this.
Subject: Here's the rest of the paragraph. I need someone to look at this.
This is listed under the PMH: Do these numbers look right? My question is really the
"FEF 25 to 75 1.66 (65%). " Does this look right? not sure how to type the 75 1.66. ... MD says it like this:
"FEF 25 to 75 one point six six and parentheseses 65%"
Pulmonary – status post pulmonary embolus, status post a prolonged road trip. Coumadin was discontinued in April and MTHFR Heterozygote with an elevated homocysteine level. She has been maintained on Folate. She has also been treated for asthma. Pulmonary function tests in December of 2002 demonstrated a FEV1 of 1.86 (79%), and FVC of 2.41 (83%) an FEV1 of 77% and FEF 25 to 75 1.66 (65%). In March of 2004, a diagnostic polysomnogram demonstrated obesity, hypoventilation; no evidence of obstructive sleep apnea. She has been maintained on 2 liters q.h.s. A repeat study in June of 2005 confirmed that treatment.
if i give you the paragraph for this ....
Subject: if i give you the paragraph for this ....
could you be able to tell if it were a line infection? I will send what they did. thanks
Paragraph numbering
Subject: Paragraph numbering
1.
a.
b.
c.....etc.
When you get all the way through z, how do you number or letter after z? Thanks so much.
paragraph punctuation help..please...
Subject: paragraph punctuation help..please...
MRI scan indicates status post patellar tendon, bone, and anterior cruciate ligament construction, cystic degeneration of the graft with little remaining low signal fibers is noted, tendon enlargement in the tibial tunnel with cystic erosion through the anterior cortex medially to the patellar tendon, extension into the anterior subcutaneous fat of the proximal right lower leg.
Note the doctor does say construction, not reconstruction can this also be correct? TIA.
I'd just leave it a paragraph at the end. NM
Subject: I'd just leave it a paragraph at the end. NM
without any context, maybe concha bullosa? next time give context. thanks!
Subject: without any context, maybe concha bullosa? next time give context. thanks!
I found one paragraph re patients ...sm
Subject: I found one paragraph re patients ...sm
not sure but I found one paragraph thru google about dacron wool........being used on a patient:
Once cooling to -79 C was complete the patient was lifted out of the Silcool bath, the outer, Silcool wetted plastic bag was stripped off and the patient was placed within a polyester cloth bag which was in turn placed inside a standard aluminum neurocan which had been precooled to -90 and packed with dacron
wool. Temperature probes were left externalized to the neurocan for subsequent cooling to -196 C.
I don't really think this is going to help you though but I tried!! 
your paragraph has many grammatical errors
Subject: your paragraph has many grammatical errors
along with punctuation - not sure if you just typed it fast and are aware or not? If you more help, let me know.
Go to format/paragraph and you'll see it. nm
Subject: Go to format/paragraph and you'll see it. nm
Based on the following paragraph written by
Subject: Based on the following paragraph written by
Vanderbilt University in relationship to Troubleshooting PICC problems, in particular; "My patient's arm is red, swollen, and/or painful."
A. How does the arm look in comparison to the arm without a PICC line.
B. If redness is involved, is it a red streak up the arm along the vein tract.
C. If swelling is involved, what is the difference in the girth of the two arms.
Your sound-alike brings to my mind: gorge; as engorged. Definition: gorge, glut; especially: to fill with blood to the point of congestion. Just an educated guess though. Good luck.
This paragraph shows AZT for baby -see message
Subject: This paragraph shows AZT for baby -see message
If an HIV positive woman is taking AZT then it will probably be recommended that her baby is given AZT (usually as a syrup) for the first six weeks of its life starting 8-12 hours after birth. Alternatively, if the mother has taken AZT and 3TC during labour then an effective regime for the baby would be one week of AZT and 3TC.
If only limited AZT is available then one week of AZT can be given to the baby. If only single dose AZT is available then the baby can have this combined with a single dose of NVP, and if no AZT is available then the baby can have a single dose of NVP to help protect it.
Here is the paragraph for the s/l line infection evaluation..
Subject: Here is the paragraph for the s/l line infection evaluation..
Patient here today for a post-op s/l line infection evaluation. She has been doing daily wet to dry dressing changes and today the wound breadown area is less than a cm across and with probing with a Q-tip will not extend any greater than 2 cm in the area. I do not think that this continues to require any packing. I have recommended that she just keep gauze over the area for the drainage. thank you
does she want you to put in a heading, or include more in prior paragraph
Subject: does she want you to put in a heading, or include more in prior paragraph
nm
Thx! I made it through a whole paragraph of tests, with this being the last one and couldn't get
Subject: Thx! I made it through a whole paragraph of tests, with this being the last one and couldn't get the last one! :) Thx for your help!
does this paragraph sound right and is it punctuated correctly
Subject: does this paragraph sound right and is it punctuated correctly
There were findings of a posterior horn tear of the medial meniscus, a small chondral injury of the medial tibial plateau, grade 4 out of 4, chondromalacia of the medial femoral condyle, grade 3 out of 4, chondromalacia patella and trochlea notch of the femur, grade 3 out of 4.
The doctor speeds through this paragraph at 75mph..does it make sense and is the punctuation correct? TIA.
s/l linear partial tear also does this paragraph
Subject: s/l linear partial tear also does this paragraph
make sense?
There is a focal tear of the posterior supraspinatus tendon noted. No other tear or retraction evident. There is also S/L linear partial tear of the long head of the biceps tendon noted. Mild degenerative changes to the glenohumeral joint also indicated. TIA.
Another rheumatology ? sm
Subject: Another rheumatology ? sm
In more than six months of typing for this doc, I've never heard this terminology. Now, he has two patient's one after the other with this FMF.
This patient has been seen at the NIH and noted to have one gene mutation, the V726A but to be a carrier s/l it could be either: without 2 genes or with L2 genes.
Thanks again for your help.
Rheumatology - please sm
Subject: Rheumatology - please sm
We did extensive blood work when I saw her in October, and she turns out to be anticardiolipin antibody-positive with a lupus anticoagulant and s/l nonperoxitis positive.
rheumatology help!
Subject: rheumatology help!
It sounds like he is saying "pausi-articular" inflammatory arthropathy. I searched the internet to no avail.... any ideas?
Rheumatology s/l sm....
Subject: Rheumatology s/l sm....
Patient with knee pain. Doc is dictating what s/l appleton grind - very clear and not saying Apley grind.
About to give up and blank it but wanted to know if anyone heard of appleton grind?
Thanks!!
rheumatology help.
Subject: rheumatology help.
Patient has psoriasis as well as *eficopathy* at the elbow.
Also, there is a family history of *Walden's drome* or something like that.
Rheumatology s/l - please help!
Subject: Rheumatology s/l - please help!
Patient had an episode of stiffness, fever, rash, and was positive for what the mother thinks was s/l air-wick-osis.
I've tried every spelling I can think of with the s/l and can't find it. Thanks!
Need help with a s/l - Rheumatology
Subject: Need help with a s/l - Rheumatology
Patient's blood work is good, but she remains Sm and (s/l either) RMP or RNP or RNT or RNP positive.
Thanks!
rheumatology lab help please
Subject: rheumatology lab help please
SCL-70 is negative. s/l "Jowen" negative. Smith, RNP, SSA and SSB negative.
Rheumatology/dermatology
Subject: Rheumatology/dermatology
Patient was told by one dermatologist she had morphea on inside of thigh and treated with Dovonex. This improved for a while, then returned. Saw a different dermatologist who thought it might be s/l burned out. Could be a type of gout??
Patient now is seeing rheumatologist - has lesions on back of calf - and has stiffness, pain, decreased range of motion.
Thanks for any help.
I'm typing rheumatology....
Subject: I'm typing rheumatology....
and this sentence is all I have to go by:
She was also given an intermittent course of s/l za-fax-in by her gastroenterologist.
He's very clear. There's a "z" sound at the beginning and a very clear "fax" in there. I've tried spelling zo-fax-en, zi-fax-in, etc., and even spelling with "x" at the beginning.
Thanks for your help.
Rheumatology experts - please help!
Subject: Rheumatology experts - please help!
This is a 10-year-old with a previous history of ITP, minimally positive ANA and anticardiolipin antibodies.
Sentence in question:
Most recent blood work showed a s/l dirty urine, and she had antibodies to s/l La/SSB (is this correct way to type ?) while being ANA-negative.
Does sentence make sense? Thanks.
Ophthalmology / rheumatology s/l please see msg
Subject: Ophthalmology / rheumatology s/l please see msg
Patient is 11-year-old with pauciarticular juvenile rheumatoid arthritis and uveitis - increased problems with uveitis and she is on hourly drops.
Ophthalmologist has suggested in addition to this she may need oral prednisone and/or s/l some tee-non injections or sub-tee-non injections.
Thanks for any help.
Rheumatology s/l see message
Subject: Rheumatology s/l see message
Patient with serologic abnormalities. Negative ANA and antithyroid antibodies. Her most recent s/l A1A was negative. Thank you.
Actually I dont think that's it, this is rheumatology, SM
Subject: Actually I dont think that's it, this is rheumatology, SM
did a muscle biopsy
rheumatology - rash
Subject: rheumatology - rash
Help please. Patient with rheumatoid arthritis...s/l "no geofication of rash"....or maybe "judification of rash". Or something similar. Thank you so much.
Just make it the last paragraph in the report. Does it Have to have a title? Maybe Note, Comment,
Subject: Just make it the last paragraph in the report. Does it Have to have a title? Maybe Note, Comment,
s
Another pediatric rheumatology word below
Subject: Another pediatric rheumatology word below
The lesions do not appear to have a complete s/l on two desob connection, but appear in this general distribution.
www.rheumatology.org/educ/hir/7_multisystem_dis.ppt
Subject: www.rheumatology.org/educ/hir/7_multisystem_dis.ppt
a powerpoint presentation, but looks like it has quite useful information in it.
Need a good rheumatology site, anyone know of one?
Subject: Need a good rheumatology site, anyone know of one?
x
Rheumatology drug help needed - please sm
Subject: Rheumatology drug help needed - please sm
Diagnosis is multifocal osteomyelitis. Discussed risks and benefits of Enbrel. Also discussed s/l bisfosinase (or nate) - as far as first letter, can't tell if he's saying "v", "d", "b". Thanks!
Rheumatology - normally a great dictator
Subject: Rheumatology - normally a great dictator
Patient with positive rheumatoid factor and low-titer anti-CCP antibodies, a moderate s/l cell- (or sal-) umentation rate, anticardiolipin antibodies, and joint pain.
Rheumatology/ortho - please see message
Subject: Rheumatology/ortho - please see message
Patient has juvenile rheumatoid arthritis.
Musculoskeletal exam revealed s/l cantalodactyly.
Rheumatology clinic labs ... psm
Subject: Rheumatology clinic labs ... psm
Patient is toddler who has had joint stiffness.
On initial blood tests, he had 4 IgG bands per line.
Does this sound correct? Thanks.
Rheumatology/pain medicine - need help with s/l
Subject: Rheumatology/pain medicine - need help with s/l
Diagnosis: Scleroderma with coronary involvement and Raynaud's phenomenon.
Plan: s/l Opthana ER 40 mg.
Rheumatology - pt has systemic lupus erythematosus... sm
Subject: Rheumatology - pt has systemic lupus erythematosus... sm
and a necrotic left neck mass. Doc thinks patient has a component of *cachooshi/kackoochy* syndrome.
Having a tough time finding this one. Thanks for any help!
Context, context, context. There is a lott
Subject: Context, context, context. There is a lott
of help out here but what is this?
Is this for rheumatology? There is anti-smooth antibody test. nm
Subject: Is this for rheumatology? There is anti-smooth antibody test. nm
x
Rheumatology/Ortho - positive scoli screen? sm
Subject: Rheumatology/Ortho - positive scoli screen? sm
Patient has spondyloarthropathy, back pain/stiffness with a positive s/l scoli screen.
I assume he means scoliosis screen but have never heard him say this and not sure if there is another meaning that s/l scoli. Thanks!
When you get stumped like this try...
Subject: When you get stumped like this try...
...asking yourself a few questions that can help.
For example: You're looking at the cervix (visualize with me), there isn't much in the way of structure in the cervix, so your choices are limited. You've got a clue in the dictation--orifice. What is the orifice called? "Os." Sounds like you've got a doc that belches his way through the term, but the only logical choice for this particular term would be os.
Isn't transcription fun?!
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