1, MRI of the brain negative for visible acute infarction. No "interphernal" hemorrhage, mass or mass affect. IT DOES NOT SOUND LIKE INTERCRANIAL.
2. The patient has a scattered abnormal "signal" on the periventricular and subcortical white matter.............
TIA ...
On CAT scan of head, Dr. very clearly dictates there is evidence of a "macunar" infarct in the right basal ganglia. She also very clearly spells M-A-C-U-N-A-R. I've never heard this before and can't locate to verify it. Can anyone help? Thanks so much! ...
on... HISTORY OF PRESENT ILLNESS
D: Patient is having an ischemic cardiomyopathy and prior infarct.
Q: do i have to expand it to "infarction" ??
same as
D: There is severe tricuspid regurg.
verbatim or need to expand ??? ...
I am seeing this a lot lately. I am on a verbatim acct, and the doctor will often state lab results or diagnostic test results in a paragraph like this: "urinalysis WBCs present, nitrites.... etc." I can't really add a colon because it is in a paragraph and I can't make it into a heading. What should I type or what symbol should I use if I can't add any words to the sentence? TIA, this one has been stumping me lately. ...
CHART NOTE
Laboratory work showed an EKG with sinus tachycardia, 15.7 white count, and hemoglobin 17.8. Can somebody tell me if this is punctuated right? ...
The doctor dictates: Lumbar puncture was performed and the CSF showed cryptococcal trough 1:512. "India ink pains were positive" Has anyone ever heard of this? If so what does "India ink" pains mean? ...
I know this is a really stupid question but, what does acute care consist of? What types of reports are acute care? I understand that it is basically emergency type of care or short-term care, but exactly what types of reports would you be transcribing?
TIA ...
The wedge resection biopsy of the left lingula mass demonstrated Hodgkin’s lymphoma with a nodular sclerosing type demonstrating areas of the thoracoscopy specimen demonstrated aggregates of "resturmberg" cells within the inflammatory myeloid with intertwining in sclerosing fibrosis. ...
Biopsy of this right breast mass showed invasive "diahesive" carcinoma, ER positive, PR positive, and HER-2/neu negative (1+).
Doc says twice in document and sounds like Die a hesive both times. ...
Bone marrow biopsy at showed no evidence of malignancy; however, her right-sided lung mass, as well as her R4 lymph nodes and all other samples, were positive for metastatic adenocarcinoma. "EGFR testing showed that she was well typing off was positive." or "EGFR testing showed that she was, while tapping off, was positive." ...