Thursday, May 14, 2009

Forrest 5-18

ACCURACY: 78%

CONSULTATION REPORT

PATIENT NAME: Lisa Marie Cobb

HOSPITAL NO.: 4569870

DATE: January 14, _____
CONSULTANT: Susan C. Miller, MD

This 48-year-old female is seen at the request of Dr. Nathan Penn concerning multiple, rather vague, complaints. She was a missionary in India for quite a number of years, and while there, unfortunately, suffered the loss 1.5 INCORRECT ENGLISH MAJORof a kidney apparently from staghorn calculus. Actually the kidney was removed here but the problem developed there, and she admits that this event has led 0.5 INCORRECT ENGLISH MINORher to seek medical attention at the slightest hint of any possible abnormality, and she feels that she frequently overreacts to mild symptoms. Additionally, she feels that the stress of caring for her 93-year-old mother certainly 0.5 INCORRECT ENGLISH MINORis adding to the symptomatology 1.5 INCORRECT ENGLISH MAJORshe might be experiencing. Having begun her conversation with those 2 statements, she then related a long list of somatic complaints including substernal and epigastric burning and discomfort, a right lower quadrant pain, and a fear of colon cancer related to prior polyps removed by Dr. Teresa McCullin several years ago. She was actually admitted because of a positive treadmill study done as an outpatient followed by the onset of some epigastric and substernal discomfort. Since admission, a thallium 3.0 INCORRECT MEDICAL TERMstudy has been negative and multiple additional studies including gallbladder ultrasound, pelvic ultrasound, and ultrasound of the right kidney have been normal. I was asked my opinion concerning additional GI studies. Finally I should mention that just prior to admission, she was on nonsteroidal anti-inflammatory medication and was seen in the ER by Dr. Danny Craven several days ago who felt that some of her discomfort might have been related to esophagitis caused by the nonsteroidal which she has since discontinued.

PHYSICAL EXAMINATION
GENERAL: Physical exam 0.5 CAPITALIZATION ERRORreveals a pleasant, elderly female who is alert, cooperative, and in no distress. HEENT: Normal
NECK: Supple
CHEST: Clear
HEART: Regular rhythm without murmur that I appreciate.
ABDOMEN: Soft and nontender, has well-healed appendectomy scar noted. No organomegaly, masses or tenderness. Bowel sounds normoactive. Rectal not performed.

Available for review are her colonoscopic 3.0 INCORRECT MEDICAL TERMstudies from Our Lady of the Lake Hospital from 1995 which indicate a normal exam at this time. My opinion is that this absolutely excludes any possibility of significant colon lesion at this time, and I have counseled her that she need not concern herself with colon cancer specifically.

Actually I think that she is probably quite correct in her belief that much of this is functional and related to stress. I concur completely with the use of H2 blocker and anticholinergic in conjunction to treat both what is probably some degree of reflux coupled with functional complaints. If she fails completely to respond, then we might consider upper endoscopy, but I would certainly give her a trial of both medical therapy and hopefully some lifestyle rearrangement before considering that step.

I appreciate the consult. I see no reason to do further GI studies at this time.

Forrest 4-15

ACCURACY:

OPERATIVE REPORT

PATIENT NAME: Herman Yougo

HOSPITAL NO.: 9256443

PHYSICIAN: Bryan Sego, MD

DATE: 0.5 COMMISSION October 25, _____

SURGEON: Byron Sego, MD

INDICATIONS
Metastatic squamous cell carcinoma to the neck, rule out lung primary.

FINDINGS
I could find nothing to suggest a bronchogenic carcinoma. There was a great deal of erythema and some swelling of the 1.5 INCORRECT ENGLISH MAJORmucosa in the right upper lobe, so this was biopsied. It does not look like gross 1.5 INCORRECT ENGLISH MAJORtumor, however.

PROCEDURE
Flexible bronchoscopy with forceps biopsy.

PREOPERATIVE MEDICATION
Atropine 3.0 INCORRECT MEDICAL TERM0.4 mg IM.

ANESTHESIA
Versed 3.0 INCORRECT MEDICAL TERM1.5 mg IV and Demerol 50 mg IV, topical lidocaine.

PROCEDURE IN DETAIL
After adequate preparation of the nose and posterior pharynx, 3.0 INCORRECT MEDICAL TERMthe fiberscope was introduced 0.5 WRONG ARTICLES/PREPOSITIONSwithout difficulty in the vocal cord area. Both cords moved 1.5 INCORRECT ENGLISH MAJORnormally with phonation and were free of lesions. The trachea and the main carina were 0.5 INCORRECT ENGLISH MINORnormal except there were some scattered thick secretions that almost stopped up the scope. 1.5 INCORRECT ENGLISH MAJOR These were finally suctioned free. 1.5 INCORRECT ENGLISH MAJOR There appeared to be some modest 1.5 INCORRECT ENGLISH MAJORblunting of the main carina. I examined both the left and the right tracheobronchial trees, and I could 0.5 INCORRECT ENGLISH MINORfind nothing specific in any airway to suggest a neoplasm. 3.0 INCORRECT MEDICAL TERM The only abnormality was in the right upper lobe where the mucosal surface 1.5 INCORRECT ENGLISH MAJORwas erythematous and the carina of the upper lobe somewhat blunted. I biopsied several areas here and also took bronchial washings from the area. There were no other suspicious areas, and no other bronchial washings were collected. The patient tolerated the procedure well and had the Versed reversed with Romazicon 3.0 INCORRECT MEDICAL TERMprior to transfer to his room.

Forrest 5-13

ex5_ch13
LOD = 2:28

OPERATIVE REPORT
OPERATION

PATIENT: Eileen NAME: Elaine Halloway

HOSPITAL NO.: 5689997-4

DATE: May 20, _____

SURGEON: John HendrickHendrix, MD

PREOPERATIVE DIAGNOSIS
Incomplete spontaneous abortion.

POSTOPERATIVE DIAGNOSIS
Incomplete spontaneous abortion.

PROCEDURE
Suction curettage.

ANESTHESIA
Intravenous IV sedation phenol [minus 3.0 for INCORRECT MEDICINE NAME] (fentanyl and valiumValium) [minus 1.5 for CASING OF MEDICATIONS] and paracervical block (1% Xylocaine).

ESTIMATED BLOOD LOSS
Estimated blood loss less then [minus 0.5 for WRONG CONJUNCTION / PREPOSITION / ARTICLE] Less than 5 cc.

COMPLICATIONS
None.

FINDINGS
Uterine cavity sounded to a depth of 8 cm., scant tissues tissue obtained on curettage.

PROCEDURE IN DETAILS
After proper consentconsents were obtained, the patient was taken to the operating room and placed on the table in a the supine position. She was then placed in a stirrupstirrups in the modified dorsal lithotomy dorsolithotomy position. The patientpatient’s [minus 0.5 for GRAMMAR ERROR] perineum and vagina were in then [minus 0.5 for WRONG CONJUNCTION / PREPOSITION / ARTICLE] prepped and draped in the usual sterile fashion. She was then given IV sedation consisting of Phenolfentanyl 2 cc given slow IV push and valiumValium 10 mg given slow IV push. A graveGraves [minus 0.5 for CAPITALIZATION ERROR] speculum was then inserted into the vagina and opened a. A [minus 0.5 for OMITTED CRITICAL PUNCTUATIONS] paracervical block was then given at the 3 o’clock and 9 o’clock position positions proximal to the cervix with a 5 mm mL [minus 1.5 for INCORRECT ENGLISH WORD] of 1% Xylocaine infiltrated on each side. The anterior lymphlip [minus 1.5 for INCORRECT ENGLISH WORD] of the cervix was then grasped with a single toothed single-tooth tenaculum and retraction applied. The uterine cavity was then sounded to a depth of 8 cm the . The [minus 0.5 for OMITTED CRITICAL PUNCTUATIONS] internal cervical os was then dilated up to a 17 hankHank [minus 0.5 for CAPITALIZATION ERROR] dilator. The uterine cavity was then evacuated with suction curettage using a 7 -mm suction catheter tip with the a small amount of tissue being obtained and sent for pathology, this. This was followed by sharp curettage. The uterine cavity was then resounded to a depth of 8 cm. The procedure was then terminated. The tenaculum was removed from the patientpatient’s cervix and the. The speculum was removed from the patientpatient’s vagina. She was taken out of the lithotomy postion position [minus 0.5 for TYPO / SPELLING ERROR] and placed back in the supine position. She was awakened at in the operating room in a stable condition. There were no intraoperative complications.

line count = 29.80
negative pts. = 11.50 (38%)
ACCURACY = 62%

Forrest 2-10

ex2_ch10
LOD = 2:08

OPERATIVE REPORT
OPERATION

PATIENT NAME: Jenel BordelanJeanelle Bordelon

HOSPITAL NO.: 5049247

DATE OF PROCEDURE: May 15, _____

SURGEON: John C. Howard, MD

ANESTHESIOLOGIST: Sean Swellow, MD

ANESTHESIA
General Endotracheal.

PREOPERATIVE DIAGNOSIS
Bilateral subdural hematomas.

POST OPERATIVE POSTOPERATIVE DIAGNOSIS
Bilateral subdural hematomas.

PROCEDURES: PROCEDURE
Bilateral burr bur holes, frontal and parietal, for drainage of subdural hematomas.

SURGEON: John C. Howard, MD

ANESTHESIOLOGIST: Sean Suelo, MD

ANESTHESIA
General endotracheal.

PROCEDURE IN DETAIL
The patient was brought into the operating room, and after induction of general endotracheal anesthesia. The , the [minus 0.5 for PUNCTUATION ERROR] head was completely shaved, and prepped and draped in the usual manner. An incision was made over the frontal areas approximately 3.0 cm from the midline on both sides. The incision was The incisions were carried down through the scalp, rainy scalp. Raney [minus ___ for INCORRECT MEDICAL/SURGICAL EQPT NAME] clips were applied for hemostasis, self retaining retractor hemostasis. Self-retaining retractors were placed, burr placed. Bur [minus 0.5 for PUNCTUATION ERROR] holes hashave been made with a common perforator. Bleeding from bone was then controlled with bone wax. The left flexed The last flecks [minus 1.5 for INCORRECT ENGLISH WORD/s] of bone were taken out with a curette and the dura underneath was coagulated in a cruciate fashion. The dura was openopened [minus 0.5 for WRONG TENSE OF VERB] widely and copious amountamounts of old crankcase -colored blood should form. issued forth. [minus 1.5 for INCORRECT ENGLISH WORD] This was irrigated copiously on both side sides, and blakethe Blake 7 -mm [minus 0.5 for CAPITALIZATION ERROR] drain were advancedrains were advanced [minus 0.5 for WRONG TENSE OF VERB] under the scalp and into thisthese [minus 0.5 for GRAMMAR ERROR] holes and to this into the [minus 0.5 for WRONG PREPOSITION] subdural space. Both wounds were close closed [minus 0.5 for WRONG TENSE OF VERB] then with zero vicryl who0 Vicryl to [minus 0.5 for CAPITALIZATION ERROR] close the galeo galea [minus 3.0 for INCORRECT MEDICAL TERM] layer and 3.-0 nylon to close the skin. Xeroform dressingdressings were applied and both drain. Both drains were secured with 2.-0 silks. The patient was recovered from anesthesia and taken to the recovery room in satisfactory condition.

line count = 23.56
negative pts. = 10.50 (44%)
ACCURACY = 56%

Forrest 10-14

ex10_ch14 (ethnic voice)
LOD = 2:14

DISCHARGE SUMMARY

PATIENT NAME: Jennifer Bakutis

HOSPITAL NO.: 9682967

DATE: December 19, _____

ADMISSION DIAGNOSIS
Pneumonia.

HISTORY OF PRESENT ILLNESS
A 7-year-old white female with partial trisomy 13 followed at the University medical center for chronic rewind [minus 1.5 for INCORRECT ENGLISH WORD] pneumonia.

ETIOLOGY
Unknown.

She was seen by Dr. Scott Miller for this [minus 1.5 for INCORRECT ENGLISH WORD/s] prior to admission and began on augmentin. [minus 1.5 for CASING OF MEDICATIONS] She had fever then and continued to have fever and was seen at the emergency room at the hospital on the night of admission showing a right middle and lower lobe infiltrate. She was admitted for further IV treatment.

HISTORY OF PRESENT ILLNESS
A 7-year-old white female with partial trisomy 13, followed at University Medical Center for chronic recurrent pneumonia, etiology unknown. She was seen by Dr. Scott Miller 4 days prior to admission and begun on Augmentin. She had fever then and continued to have fever, and was seen in the emergency room at the hospital on the night of admission, showing a right middle and lower lobe infiltrate. She was admitted for further IV treatment.

PHYSICAL EXAMINATION
Within a [minus 0.5 for ADDING WORDS NOT DICTATED] normal limits, except for ronchi andrhonchi in [minus 3.0 for INCORRECT SPELLING MEDICAL TERM] the chest. The child has no verbal communication and forpoor [minus 1.5 for INCORRECT ENGLISH WORD] socialization.

ADMISSION LABORATORY
On admission hemoglobin was 12.3, hematocrit 36.0, white count 12300, [minus 0.5 for STYLES ERROR] with 54 segs, 37 lymphs, 3 monos, 5 eos, and 1 basos. [minus 0.5 for GRAMMAR ERROR] Chem 6 was within normal limits except for a blood sugar of 141.

URINALYSIS
Within normal limits. Mycoplasma and RSV were negative. Throat culture shows normal flora.

ADMISSION LABORATORY
On admission hemoglobin was 12.3, hematocrit 36.0, white count 12,300, with 54 segs, 37 lymphs, 3 monos, 5 eos, and 1 baso. Chem 6 was within normal limits except for a blood sugar of 141. Routine urinalysis, within normal limits. Mycoplasma and RSV were negative. Throat culture shows normal flora.

HOSPITAL COURSE
She was started on a claforan 300Claforan 300 [minus 1.5 for CASING OF MEDICATIONS] mg IV q.6h q.6 h. and nebulized albuterol q.4h. q.4 h. Temperature was normal during the entire stay. While being treated, the child chests child’s chest [minus 0.5 for GRAMMAR ERROR] finding slowly improved, and the lungs were clear to auscultation on the night of October 16. October 16, _____.

At that time, she was placed on sip cell.Cefzil. [minus 3.0 for INCORRECT MEDICINE NAME] The claforanClaforan was stopped on. On [minus 0.5 for OMITTED CRITICAL PUNCTUATIONS] the morning of discharge, chest x-ray showed the right middle lobe clear and the right lower lobe showing minimal residual infiltrate. Lung was cleared Lungs were clear [minus 0.5 for GRAMMAR ERROR] to auscultation.

DISPOSITION
Discharged. Discharge.

DISCHARGED MEDICATION
Sip cell 250

DISCHARGE MEDICATIONS
Cefzil 250 mg b.i.d.., Ventolin by aerosol 2 to 3 times a day.

FOLLOW UP
Appointment in one 1 week.

line count = 25.76
negative pts. = 16.50 (64%)
ACCURACY = 36%

Forrest 9-14

ex9_ch14
LOD = 2:12

HISTORY AND PHYSICAL EXAMINATION

PATIENT NAME: Baby Taylor

HOSPITAL NO.: 4465578

DATE OF ADMISSION: January 5, _____

HOSPITAL COURSE
The patient was a 1.3-year-old 5 1.305-kg [minus 1.5 for INCORRECT ENGLISH WORD] product of a 27 weeks 27-week gestation to a G1, 15-year-old black female. Pregnancy complicated by preeclampsia and gonorrhea, treated on August 5, 1996. The mother is Rh positive, serology negative, rubella titer reactive, hepatitis surface antigen negative,. HIV negative. The patient was delivered secondary to pre-term labor and increased blood pressure. C-section was performed the. The [minus 0.5 for OMITTED CRITICAL PUNCTUATIONS] patient delivered without spontaneous respiration. The patient was intubated with 3.0 ET tube, and Survanta 5.2 cc were given forper [minus 0.5 for WRONG CONJUNCTION / PREPOSITION / ARTICLE] protocol. The patient was transferred to NICU, and UAC and UVC were placed without difficulty. Apgar Apgars were 11 and 9 at one and five minutes, respectively.

PHYSICAL EXAMINATION
WEIGHT: 1.305 kg.
LENGTH: 38 cm.
HEAD CIRCUMFERENCE: 27.5 cm.
Weight 1.305 kg, length 38 cm, head circumference 27.5 cm.
VITAL SIGNS: Temperature 97.4, pulse 144, respiratory respiration [minus 0.5 for MINOR ERROR] 40.
GENERAL: Well -developed black male, proximately approximately [minus 1.5 for INCORRECT ENGLISH WORD] 27 weeks weeks’ gestation.
HEENT: Normocephalic. [minus 0.5 for PUNCTUATION ERROR] Anterior fontanel Normocephalic, anterior fontanelle is flat and soft. Eyes are open, ears open. Ears are normal. Oral pharynx Oropharynx [minus 1.5 for MISSPELLED MEDTERM] benign.
NECK: Supple without masses.
HEART: Regular rate and rhythm without murmurs, murmur, rub, or galloped. gallop. [minus 1.5 for INCORRECT ENGLISH WORD/s]
LUNGS: Mild subcostal retractions, mild intercostals retraction, rales intercostal retractions. Rales [minus 0.5 for MINOR ERROR] bilaterally, breath sound bilaterally. Breath sounds equal bilaterally.
ABDOMEN: Soft and non tender, positive nontender. Positive bowel sound, GU normal sounds.
GENITOURINARY: Normal male genitalia, no cc or pee. [minus 1.5 for INCORRECT ENGLISH WORD]

EXTREMITIES: No clubbing, cyanosis, or edema.

IMPRESSIONS
IMPRESSION
1. Pre-term birth, living child approximately 29 weeks weeks’ gestation.
2. Hyaline membrane disease.
3. Ruled- Rule out sepsis.
4. Mother pre-treated with steroids and antibiotics.

PLAN
1. Admit to an NICU, [minus 0.5 for MINOR ERROR] IV fluids and antibiotics.
2. Enzai MV SIMV [minus 1.5 for INCORRECT MEDICAL / ENGLISH ABBREVIATIONS] and survanta Survanta. [minus 1.5 for CASING OF MEDICATIONS]
3. Indomethacin.

line count = 26.30
negative pts. = 13.50 (51%)
ACCURACY = 49%

Geneto 2

BMT RED - GENITOURINARY #2
LOD = 0:44

PREOPERATIVE NOTE

A patientPatient is a 65-year-old white male, status post- radical prostatectomy for cancer on carcinoma of the prostate, who during that same year underwent implantation of an inflatable penile prosthesis for [minus 0.5 for OMITTED a DICTATED WORD] organic infinite impotence [minus 1.5 for INCORRECT ENGLISH WORD] secondary to the radical prostatectomy. The prosthesis has been malfunctioning for a number of years and is causing the patient a pain in the right scrotum, and on exam, the pump device seems to have eroded into the right testicle, as they are indistinguishable from one another on exam. The patient another. Patient now present [minus 0.5 for GRAMMAR ERROR] presents for removal of the malfunctioning penile prosthesis and insertion of a new inflatable penile prosthesis.

line count = 9.63
negative pts. = 2.50 (25%)
ACCURACY = 75%

ob 8

BMT GRAY – OB-GYN #15
LOD = 1:59

HISTORY AND PHYSICAL EXAMINATION

DIAGNOSIS: Incomplete abortion.

SUMMARY: This patient is a 16-year-old G1P0 gravida 1, para 0, menarche at aged age 13, whose last menstrual period was March 11 to have a , who had a [minus 1.5 for INCORRECT ENGLISH WORD/s] positive beta HCGhCG; [minus 0.5 for CAPITALIZATION ERROR] previous to that, normal menstrual cyclecycles every 28 days. She saidsays [minus 0.5 for WRONG TENSE OF VERB] that she has never had a Pap smear. She was originally seen 2 days ago regarding vaginal bleeding and thought that she had passpassed [minus 0.5 for WRONG TENSE] some tissue. She felt that she probably had spontaneously abortiveaborted [minus 1.5 for INCORRECT ENGLISH WORD] completely. She was told to come to the office in the event of any increaseincreased [minus 0.5 for GRAMMAR ERROR] vaginal bleeding. The bleeding temporized yesterday, but it then became heavy today with a lot of uterine cramps and passing of large clots since and [minus 0.5 for WRONG CONJUNCTION / PREPOSITION / ARTICLE] some further tissue -like material in herper vagina. She did not save any of this material for cross us [minus 1.5 for INCORRECT ENGLISH WORD] for examination.

At the time of the office visit today, she was bleeding more than would be usual for her period, with crampy abdominal pain, and the cervical os was opened open and blood clot clots [minus 0.5 for GRAMMAR ERROR] were seemsseen [minus 1.5 for INCORRECT ENGLISH WORD] protruding from the os.

PHYSICAL EXAMINATION
GENERAL: : She is alert and oriented timesx 3 and , in [minus 0.5 for WRONG CONJUNCTION / PREPOSITION / ARTICLE] no acute distress.
VITAL SIGNS: Blood pressure 100/66, respirationrespirations 16, pulse 76, temperature 98.6.
PEVIC EXAMINATIONS: Reveals Pelvic examination reveals essentially healthy vagina with blood involved in the vault and [minus 1.5 for INCORRECT ENGLISH WORD] cervical os. The uterus is anteverted, 6 weeks sized and noble. weeks’ size, and mobile. [minus 1.5 for INCORRECT ENGLISH WORD/s] Adnexa are grossly normal. No palpable masses. Rectal examination was negative.
RECTAL EXAMINATIONS: Negative.
I sendsent [minus 0.5 for WRONG TENSE OF VERB] her forfor a sonogram to confirm an incomplete ABabortion, which was confirmed.

PLAN
We: Will [minus 1.5 for INCORRECT ENGLISH WORD] proceed with suctioned suction [minus 0.5 for MINOR ERROR] curettage under general anesthesia. She has been NPO n.p.o. [minus 0.5 for CAPITALIZATION ERROR] since 1:00, and pre operative blood work has been sent, including CBC, Pt, Ptt PT, PTT, [minus 0.5 for CAPITALIZATION ERROR] and urinalysis. She would will be [minus 0.5 for GRAMMAR ERROR] done under outpatient surgery.

line count = 25.49
negative pts. = 16.50 (64%)
ACCURACY = 36%

ob 15

BMT GRAY – OB-GYN #15
LOD = 1:59

HISTORY AND PHYSICAL EXAMINATION

DIAGNOSIS: Incomplete abortion.

SUMMARY: This patient is a 16-year-old G1P0 gravida 1, para 0, menarche at aged age 13, whose last menstrual period was March 11 to have a , who had a [minus 1.5 for INCORRECT ENGLISH WORD/s] positive beta HCGhCG; [minus 0.5 for CAPITALIZATION ERROR] previous to that, normal menstrual cyclecycles every 28 days. She saidsays [minus 0.5 for WRONG TENSE OF VERB] that she has never had a Pap smear. She was originally seen 2 days ago regarding vaginal bleeding and thought that she had passpassed [minus 0.5 for WRONG TENSE] some tissue. She felt that she probably had spontaneously abortiveaborted [minus 1.5 for INCORRECT ENGLISH WORD] completely. She was told to come to the office in the event of any increaseincreased [minus 0.5 for GRAMMAR ERROR] vaginal bleeding. The bleeding temporized yesterday, but it then became heavy today with a lot of uterine cramps and passing of large clots since and [minus 0.5 for WRONG CONJUNCTION / PREPOSITION / ARTICLE] some further tissue -like material in herper vagina. She did not save any of this material for cross us [minus 1.5 for INCORRECT ENGLISH WORD] for examination.

At the time of the office visit today, she was bleeding more than would be usual for her period, with crampy abdominal pain, and the cervical os was opened open and blood clot clots [minus 0.5 for GRAMMAR ERROR] were seemsseen [minus 1.5 for INCORRECT ENGLISH WORD] protruding from the os.

PHYSICAL EXAMINATION
GENERAL: : She is alert and oriented timesx 3 and , in [minus 0.5 for WRONG CONJUNCTION / PREPOSITION / ARTICLE] no acute distress.
VITAL SIGNS: Blood pressure 100/66, respirationrespirations 16, pulse 76, temperature 98.6.
PEVIC EXAMINATIONS: Reveals Pelvic examination reveals essentially healthy vagina with blood involved in the vault and [minus 1.5 for INCORRECT ENGLISH WORD] cervical os. The uterus is anteverted, 6 weeks sized and noble. weeks’ size, and mobile. [minus 1.5 for INCORRECT ENGLISH WORD/s] Adnexa are grossly normal. No palpable masses. Rectal examination was negative.
RECTAL EXAMINATIONS: Negative.
I sendsent [minus 0.5 for WRONG TENSE OF VERB] her forfor a sonogram to confirm an incomplete ABabortion, which was confirmed.

PLAN
We: Will [minus 1.5 for INCORRECT ENGLISH WORD] proceed with suctioned suction [minus 0.5 for MINOR ERROR] curettage under general anesthesia. She has been NPO n.p.o. [minus 0.5 for CAPITALIZATION ERROR] since 1:00, and pre operative blood work has been sent, including CBC, Pt, Ptt PT, PTT, [minus 0.5 for CAPITALIZATION ERROR] and urinalysis. She would will be [minus 0.5 for GRAMMAR ERROR] done under outpatient surgery.

line count = 25.49
negative pts. = 16.50 (64%)
ACCURACY = 36%

dERMA 8

BMT – DERMATOLOGY #8
LOD = 1:40

CONSULTATION REPORT

The patient was admitted to the hospital for treatment of Leg a leg ulceration. Consultation was requested specifically for an eruption on the back and legs, which the patient state states [minus 0.5 for GRAMMAR ERROR] has been present in [minus 0.5 for ADDING WORDS NOT DICTATED] 3 months. No treatment has been given for this. The nurses report that the area had been oozing aton the back, but since the start of oral cuplex Keflex, [minus 3.0 for INCORRECT MEDICINE NAME] the oozing has stopped. The patient is not a good historian, state and states only that the eruption started about 3 months ago, and it is occasionally pruritic.

PHYSICAL EXAMINATION
Physical Examinationexamination showed, covering most of the back and also the medial central buttocks, confluent, erythematous, scaly plaqueplaques with some crusting, similar plaque. Similar plaques were also present on the anterior lower legs.

IMPRESSION Confluent: My impression is confluent psoriasis which hashad been secondarysecondarily [minus 0.5 for MINOR ERROR] infected.

PLAN
1. The cuplexKeflex should be continued to treat the secondary infection.
2. The psoriasis will be treated with a combination of 10% LCD in L.C.D. and [minus 0.5 for WRONG CONJUNCTION] 0.1% Triamcinolonetriamcinolone [minus 1.5 for CASING OF MEDICATIONS] cream.

line count = 14.70
negative pts. = 6.50 (44%)
ACCURACY = 56%

HEMATOLOGY 8

BMT RED – HEMATOLOGY #8
LOD = 2:16

CONSULTATION

This patient was seen by me with complaints of feeling unusually tired for about two 2 months, of being unable to concentrate, and of having a swollen cervical gland. She denied headache headaches, vertigo, anorexia, bowel irregularities, abdominal pain, skin rashes rash, menstrual irregularities, sore throat, cough, rhinitis, or insomnia.

She had been napping a lot in the day time. daytime. She had had some mild back pain and urinary frequency the week before but none at the time. She denied using tobacco, alcohol, or any drugs, either prescribed or other one.otherwise. [minus 0.5 for GRAMMAR ERROR] There is no family history of diabetes, her diabetes. Her father died of bleeding esophageal varices, she varices. She had some palpitation palpitations before the end of last year, which she saw you about, and she also had a febrile illness a few weeks ago, which she saw you about and which was diagnose diagnosed [minus 0.5 for WRONG TENSE OF VERB] as an acute viral infection or cold flu. “flu.” [minus 0.5 for ADDING WORDS NOT DICTATED]

PHYSICAL EXAMINATION
VITAL SIGN: Temperature On examination she had a temperature of 97 97.4, [minus 3.0 for INCORRECT VALUES] pulse 92, blood pressure 116/70. She was obviously depressed and a little lethargic but cooperative and mentally cleared. clear. Pupils are equally were equal and [minus 1.5 for INCORRECT ENGLISH WORD/s] reactive
FUNDAL: Normal.
HEENT: Unremarkable.. Fundi normal. ENT unremarkable. One or two small anterior cervical nodes, palpable and slightly tendered, tender. [minus 0.5 for MINOR ERROR] Hearing normal bilaterally.
BREAST: Normal.
LUNGS: Clear.
HEART: Regular Breasts normal. Lungs clear. Heart regular without murmurs, clits clicks, [minus 1.5 for INCORRECT ENGLISH WORD] or rubs
ADBOMEN: Soft
SCAPULA: [minus 1.5 for INCORRECT ENGLISH WORD] Non-tendered [minus 1.5 for INCORRECT ENGLISH WORD] rubs. Abdomen soft, scaphoid, nontender, without masses.
EXTREMITIES: Normal.
DEEP TENDON REFLEXES: Normal, bilateral equal.
ROMBERGS TEST: Negative.
Patient was advice [minus 0.5 for WRONG TENSE OF VERB] Extremities normal. Deep tendon reflexes normal, bilaterally equal. Romberg was negative. The patient was advised that she probably had no organic illness but the that laboratory studies willwould be done. To our surprise she showed a 50% lymphocyte count (68 typical) (6 atypical) [minus 1.5 for INCORRECT ENGLISH WORD/s] on her differential and a positive mono test. The hetero file heterophile [minus 1.5 for MISSPELLED MEDTERM] was weekly weakly [minus 1.5 for INCORRECT ENGLISH WORD] positive at 1-56, total 1:56. Total [minus 1.5 for INCORRECT ENGLISH WORD] white count was 9,762. 9762. [minus 0.5 for STYLES ERROR] Urinalysis and chemistry profiles were negative. When I saw the patient today, I told her that the laboratory studies are compatible with either an [minus 1.0 for OMITTED DICTATED WORDs] incipient case of mononucleosis or one that is just wearing down. In the light of her history, the later latter [minus 1.5 for INCORRECT ENGLISH WORD] is surely more likely. I told her mother this two, already this, too. Already [minus 1.5 for INCORRECT ENGLISH WORD] today the patient looks more cheerer chipper and alert and in better spiritspirits, even though I gave her no medicine.

line count = 32.20
negative pts. = 20 (62%)
ACCURACY = 38%

Thursday, May 7, 2009

01 BMT Dermatology 8 Consultation

BMT – DERMATOLOGY #8
LOD = 1:40

CONSULTATION REPORT

The patient was admitted to the hospital for treatment of Leg (a leg) ulceration. Consultation was requested specifically for an eruption on the back and legs, which (the) patient (state) states [minus 0.5 for GRAMMAR ERROR] has been present (in) [minus 0.5 for ADDING WORDS NOT DICTATED] 3 months. No treatment has been given for this. The nurses report that the area had been oozing aton the back, but since the start of oral cuplex (Keflex), [minus 3.0 for INCORRECT MEDICINE NAME] the oozing has stopped. The patient is not a good historian, state (and states) only that the eruption started about 3 months ago(,) and (it) is occasionally pruritic.

(PHYSICAL EXAMINATION)
Physical Examination(examination) showed, covering most of the back and also the medial central buttocks, confluent, erythematous, scaly plaque(plaques) with some crusting, similar plaque. (Similar plaques)were also present on the anterior lower legs.

IMPRESSION (Confluent): My impression is confluent psoriasis which has(had) been secondary(secondarily) [minus 0.5 for MINOR ERROR] infected.

PLAN
1. The cuplex(Keflex) should be continued to treat the secondary infection.
2. The psoriasis will be treated with a combination of 10% (LCD in L.C.D. and) [minus 0.5 for WRONG CONJUNCTION] 0.1% Triamcinolone(triamcinolone) [minus 1.5 for CASING OF MEDICATIONS] cream.

line count = 14.70
negative pts. = 6.50 (44%)
ACCURACY = 56%

Thursday, April 23, 2009

OB 4 DISCHARGE SUMMARY

ADMITTING DIAGNOSIS: Cystocele with urinary incontinence.

FINAL DIAGNOSIS: Cystocele with urinary incontinence.

PROCEDURE: Anterior repair.

COMPLICATIONS: None

HISTORY: This is a 65-year-old woman who had had a previous hysterectomy, who developed urinary incontinence, and was found to have a large cystocele.

Physical examination was unremarkable except for the cycstocele.

Lab work, including a panel, CBC, EKG, and chest x-ray, was essentially within normal limits. Following surgery the patient has done well. The vaginal pack was removed this date and the Foley catheter. She will be checked for residual. IF the residual is over 150 cc, the Foley will be replaced and the patient taught to use the catheter plug, and she will be discharged. She will be seen in the office in approximately one week for follow-up.

Opta 7 HISTORY AND PHYSICAL EXAMINATION

HISTORY AND PHYSICAL EXAMINATION


PREOPERATIVE DIAGNOSIS:
1. Cataract of left eye.
2. Pseudophakia of the right eye.
3. Dermatomyositis.
4. Rheumatoid arthritis.

HISTORY OF PRESENT ILLNESS: Patient is a 71-year-old woman who had an uncomplicated cataract extraction with lens implant of the right eye and had a good improvement in her visual function. She is also bothered by blurred vision from a cataract in the left eye and enters for a similar procedure on the left eye. She has had dry eyes and uses artificial tears frequently. She had had ectropion repair of the right lower lid. She has had dermatomyositis and rheumatoid arthritis for many years and has used cortisone for this. She is presently taking Persantine twice daily and Inderal 40 mg twice daily. She is allergic to penicillin, aspirin, codeine, and does not tolerate Tylenol because of constipation.

PHYSICAL FINDINGS:
VITAL SIGNS: Blood pressure 110/80, pulse 76 and regular.
HEENT: Eyes; Recent eye examination showed best vision of 20/50+ in the right eye and 20/200 in the left. Pupils and extraocular motility were normal. Intraocular pressures where 18. Slit-lamp exam showed the eyelids in good position with weakness of the orbicularis and facial muscles. There was a clear corneal epithelium and the normal pseudophakia of the right eye and a dense nuclear cataract on the left. Fundus examination in each eye was normal.
EARS, NOSE, AND THROAT: Tympanic membranes are normal. The oral cavity showed dentures in place, and the pharynx had no lesions.
NECK: The neck showed a slight right carotid bruit, and the left was normal.
CHEST: The chest was clear to auscultation.
HEART: Heart had a regular sinus rhythm without murmur.
EXTREMITIES: Extremities showed ulnar deviations of the hands and mild ecchymoses in the legs.

PLAN: Plan is a cataract extraction with lens implant of the left eye under local anesthetic as an outpatient. The risks of the procedure, including possible loss of the eye, were discussed.

Pulmo 5 EMERGENCY ROOM REPORT

EMERGENCY ROOM REPORT

HISTORY OF PRESENT ILLNESS: Patient is a one-year-old female that has been congested for several days. The child has sounded hoarse, has had a croupy cough, and was seen 2 days ago. Since that time she has been on Alupent breathing treatments via machine, amoxicillin, Ventolin, cough syrup, and Slo-bid 100 mg b.i.d. but is not improving. Today the child is not taking food or fluids, has been unable to rest, and has been struggling in her respirations.

PHYSICAL EXAMINATION
GENERAL: Physical exam in the ER showed an alert child in moderate respirator distress.
VITAL SIGNS: Respiratory rate was 40, pulse 20, temperature 99.6.
HEENT: Within normal limits.
NECK: Positive for mild to moderate stridor.
CHEST: Chest showed a diffuse inspirator and expiratory wheezing. No rales were noted. Viewing the chest wall, patient had subcostal-intercostal retractions.
HEART: Regular rhythm without murmur, gallop, or rub.
ABDOMEN: Soft, nontender, bowel sounds normal.
EXTREMITIES: Within normal limits.

The child was sent for a PA and lateral chest x-rays to rule out pneumonia. No pneumonia was seen on the films.
It was agreed to admit the patient to the pediatric unit for placement in a croup tent with respiratory therapy treatments q.3 h. The child was also placed on Decadron besides the amoxicillin and continuation of the Slo-bid.

EMERGENCY ROOM DIAGNOSES
1. Acute laryngotracheobronchitis.
2. Bronchial asthma.

Pulmo 8 CONSULTATION

CONSULTATION

This is a 32-year-old white male, lifelong nonsmoker, referred to me. He complains of a less than 2-weeks history of dry cough associated with dull substernal discomfort and dyspnea, particularly on exertion. Otherwise, he has been remarkably free of any other associated symptoms. In particular, he denies any preceding cold or flu or allergic exposure, and denies any associated fevers, chills, sweats, or weight loss. He does admit to having childhood asthma but felt he grew out this by the time he was a teenager. He was traveled extensively outside the U.S., including travel to the California deserts and Central Valley. He has not had pneumonia vaccine. He did have TB skin test 10 years ago and did have flue vaccine 3 years ago.

PAST MEDICAL HISTORY: Past medical history is remarkably negative.

PHYSICAL EXAMINATION: Blood pressure 140/80, pulse 85, respiratory rate 22, temperature 99.3.Chest exam is complete normal. There are no rales, wheezes, rhonchi, rubs. Even on forced exhalation, there was no cough or prolongation. Cardiac exam showed a regular rate and rhythm with no murmur or gallop.

LABORATORY DATA: PA chest x-ray is striking for a new interstitial infiltrate seen on both midlung zones with some shagging of the cardiac borders, indicating involvement of the lingual and right middle lobe. Surprisingly, the lowest part of the lung fields and the apices appear to be spared. Spirometry before and after bronchodilator performed in my office show a vital capacity of 3.79 or 69% after an 11% improvement with bronchodilator. FEV-1 achieves 3.24 L or 72% of predicted after 12% improvement wih bronchodilator. FEV-1/FVC ratio was mildly increased at 85 instead of predicted 82.

ASSESSMENT AND PLAN: Differential diagnosis includes the following:
1. Hypersensitivity pneumonitis.
2. Mycoplasma pneumonia.
3. Less likely candidates appear to be Wegener’s granulomatosis, Goodpasture’s syndrome, sarcoidosis, alveolar proteinosis, and allergic bronchopulmonary aspergillosis.

RECOMMENDATIONS:
1. CBC, differential, chemistry-20, Wintrobe sed rate, angiotensin converting enzyme, urinalysis, and Mycoplasma titers.
2. Full pulmonary function test within 2 weeks
3. Vibramycin 100 mg q. day for 14 days. If he still has significant symptoms and restriction on PFTs within 2 weeks, he will have to be evaluated for one of the more chronic diagnoses, which may ultimately require open lung biopsy. Otherwise we should hope that within 2 weeks the patient will be improved and his x-ray will have cleared.

ENT7 EMERGENCY ROOM REPORT

EMERGENCY ROOM REPORT

He was brought to the emergency room with a right epistaxis with clots in the nose. Patient is on Coumadin.

EXAMINATION: Clots were removed from the right nostril, and an active venous bleeder on the right anterior septum was identified. This was cauterized with silver nitrate and an anterior pack placed. The left side appeared to have no active bleeding. He was observed for a few minutes, and no further bleeding of an active nature was identified. Some tape as couterpressure was applied to the nose, and the throat checked also. There is just an old clot posterior that’s sticking down just enough so that you can see it but cannot reach it with an instrument. This was left in place. I recommend that we leave the pack in until Wednesday morning if patient tolerates it. He is apparently already on antibiotics, pain medicines, and oxygen, so no additional orders are indicated at this time.

Thursday, February 19, 2009

EMERGENCY ROOM REPORT

He was brought to the emergency room with a right epistaxis with clots in the nose. Patient is on Coumadin.

EXAMINATION: Clots were removed from the right nostril, and an active venous bleeder on the right anterior septum was identified. This was cauterized with silver nitrate and an anterior pack placed. The left side appeared to have no active bleeding. He was observed for a few minutes, and no further bleeding of an active nature was identified. Some tape as couterpressure was applied to the nose, and the throat checked also. There is just an old clot posterior that’s sticking down just enough so that you can see it but cannot reach it with an instrument. This was left in place. I recommend that we leave the pack in until Wednesday morning if patient tolerates it. He is apparently already on antibiotics, pain medicines, and oxygen, so no additional orders are indicated at this time.

MEDICAL REPORTS

EMERGENCY SERVICES ADMISSION

PATIENT: Brenda Seggerman
Hospital Number: 903321
DATE OF ADMISSION: March 27, 2008
ADMITTING PHYSICIAN: Linda L. Kingston, DO
ADMITTING DIAGNOSIS: Ectopic pregnancy

CHIEF COMPLAINTS: The patient presents to the emergency room this morning complaining of lower abdominal pain.

HISTORY OF PRESENT ILLNESS: The patient states that she has been having vaginal bleeding more like spotting over the past month. She denies the chance of pregnancy although she state that she is sexually active and using no birth control.

GYNECOLOGIC HISTORY: Patient is gravida 2, para 1, abortus 1. Her only child is a 15-year-old daughter who lives in Texas with her grandmother.

PAST MEDICAL HISTORY: Positive for Hepatitis-B.

PAST SURGICAL HISTORY: Pilonidal cyst, remove in the remote past. Had plastic surgery on her ears as a child.

SOCIAL HISTORY: Married, has one daughter, patient works as a substitute teacher. Smokes one pack of cigarettes on a daily basis. Denies ETOH. Smoked marijuana last night. No IV drug abuse.

ALLERGIES: Tightness.

MEDICATION: None.

REVIEW OF SYSTEM
Patient complaints of a lower abdominal pain for the past week that apparently got much worst last night and by this morning was intolerable. The patient is also having some nausea and vomiting. Denies hematemesis, hematokesia and melena. The patient has had vaginal spotting over the past month with questionable vaginal discharge as well. Denies urinary frequency, urgency, and hematuria. Denies arthralgias. Review of system is otherwise essentially negative.

PHYSICAL EXAMINATION
VITAL SIGNS: Shows temperature 97degrees, pulse 53, respirations 22, blood pressure 108/60.
GENERAL: Physical examination reveals a well developed, well-nourish, 35-year-old white female in a moderate amount of distress at the time of the examinations.
HEENT: Unremarkable except for poor dentition.
NECK: Soft and supple.
CHEST: Lungs are clear in all fields.
HEART: Regular rate and Rhythm.
ABDOMEN: Soft with positive tenderness of her lower abdominal area. Fundus was not palpable above the pubic area. Left adnexa are more tender than the right.
VAGINAL EXAMINATION: The cervix is close. A moderate amount of mucopurulent vaginal discharge is noted. The patient would not allow me to perform a bi-manual examination due to the patient pain. So the speculum was withdrawn.
EXTREMITIES: No clot. No edema.
NEUROLOGIC EXAMINATION: Intact. Oriented x3, No neurologic deficits.

DIAGNOSTIC DATA
ADMISSION: Hemoglobin 12.8 g and Hematocrit 36.6%.
URINALYSIS: Essentially Negative.
BETA HCG: Positive with WBC count of 23,278.

RADIOLOGY
Pelvic Ultrasound shows a 7 week 4 day old viable ectopic pregnancy per radiology. The patient was given Demerol 25 mg, and Phenergan 25 mg. IV for the pain after her report was obtained. The patient also given claperan 1g IV.

I page Dr. Gerard, patient’s GYN, physician, as soon as I receive the ultra-sound report at approximately 10a.m. He was not in North Miami office. I page the South Miami office and reach Dr. Gerard’s office at approximately 10:15a.m. His office personnel advice me that he is not on call, Dr. Bomback is on call. I spoke with Dr. Bomback at approximately 10:25a.m. and she will be here to take the patient to the operating room.

ADMITTING DIAGNOSIS: Left ectopic first trimester pregnancy.
Disposition: The patient receive and IV of lactated ringer upon arrival at the emergency room. This was switch to normal saline while we were awaiting Dr. Bomback’s arrival. The surgical procedure was explained to the patient and her husband. All risk and benefits were discussed. They understand the necessity for immediate surgery and informed consent was signed. No old records are available for review.

84

Evaluation

Score: 72

PSYCHOLOGICAL ASSESSMENT

PATIENT NAME: Leslie DeVito

HOSPITAL NO.: 1728456

DATE OF BIRTH: October 25, 1985

DATE OF TRANSFER: November 24, _____

DATE OF ADMISSION: November 25, _____

AGE: 12

ASSESSMENT PROCEDURES
Wechsler Intelligence Scale for Children, III
Woodcock-Johnson Individual Achievement Test
(administered by hospital personnel)
Bender-Gestalt Test of Visual Motor Integration
House-Tree-Person Drawing
Thematic Apperception Test
Rorschach Inkblot Technique
REASON FOR REFERRAL
The patient was referred for assessment by Dr. Rosemary Lowenthal, child psychiatrist, Johnston Recovery Center. Specific information was requested regarding intellectual potential, achievement, and current personality features.

REASON FOR ADMISSION
The patient is a 12-year-old black female who was admitted to the Children's Treatment Unit at Johnston Recovery Center on November 25 because of severe behavioral problems, school problems, low self-esteem, physical aggression toward others, and problems related to past sexual abuse. The patient was brought to Johnston Recovery Center by her grandmother who has physical custody of her at this time. The patient denied suicidal/homicidal ideations as well as visual and auditory hallucinations. She was reportedly severely sexually molested and abused by her older brothers when she was 6 years of age. It is reported that her brothers shoved sticks and bottles up her vagina and that one of her brothers sodomized her. This individual is currently incarcerated at Barchfield Training School. The patient comes from a family of 6 siblings, and all siblings are separated from the home of their parents other than 1. The patient was removed from the home subsequent to the discovery of the abuse and remained in a shelter until age 9 when she was moved and placed in the custody of her grandmother. The patient currently lives within 2 miles of her natural parents' home. She is said to be involved with both her parents and to get along with them adequately. A conflictual relationship is said to exist between the patient and her grandfather who reportedly resents her presence. The patient reportedly failed the first grade and attends "LD classes." The patient began walking at about 13 months of age and had difficulty with speaking until the age of three. She had difficulty with toilet training and continued to wet her pants until she was 4 years of age.
The patient is said to have difficulties at school including inattention and poor listening skills. She has attacked another student at school physically. She has also displayed herself inappropriately in front of men and boys. The patient is said to have dental problems and is currently receiving treatment for her problems. She is said to have chest pain frequently when she exercises. Frequent headaches are reported. The patient is said to eat too frequently and gains weight easily. She is said to binge on food if the food is available. She complains of stomachaches frequently. The patient has few sleep difficulties at this time but is reported to have had nightmares frequently in the past. The patient is said to have one friend at school who is 9 years of age. Others have reported that she has low self-esteem. She has reportedly received treatment at a mental health center at Atkins.

OBSERVATION OF BEHAVIOR
The patient presented as an obese 12-year-old black female with black hair and brown eyes. She was dressed appropriately on the day of the evaluation, and she did not wear glasses or hearing aids. The patient reported to the examiner that "I did this 2 years ago at
Miss Amanda's office," in reference to the assessment tasks given her. The patient's fingernails were bitten and chewed to the quick. The patient seemed to have problems listening on occasions during the assessment, and she frequently asked to have items repeated to her. During several difficult assessment tasks, the patient looked at the examiner with a shy smile as she was completing the items as if to express pride that she had completed difficult items. She engaged in self-deprecatory comments from time to time, and she had to be encouraged to work on difficult items. She was very flat initially but began to smile occasionally toward the latter part of the assessment. She turned her chair away from the examiner and refused to maintain eye contact while elements of her past history were discussed. She clearly felt uncomfortable and was unresponsive. The test results obtained during this assessment appear to be valid estimates of her functioning.

TEST RESULTS
WECHSLER INTELLIGENCE SCALE FOR CHILDREN III
VERBAL TESTS PERFORMANCE TESTS
Information 4 Picture Completion 7
Similarities 5 Coding 5
Arithmetic 7 Picture Arrangement 5
Vocabulary 6 Block Design 8
Comprehension 1 Object Assembly 9
VERBAL IQ 70 Factor Scores:
PERFORMANCE IQ 80 Verbal Comprehension 68
FULL SCALE IQ 73 Perceptual Organization 85
Freedom from Distractibility 78
Based on the scores obtained by the patient on this instrument, she is apparently functioning overall within the borderline range of potential. A nonsignificant 10-point difference between verbal and performance scores was noted. The difference between the patient's perceptual organization factor score and her verbal comprehension factor score, however, was statistically significant. This suggests that the patient may be more efficient in completing tasks which require her to use visual or performance abilities. The patient scored highest on the subtest measuring her ability to put together puzzles of familiar objects. She scored lowest on the subtest measuring common sense reasoning about everyday problems and concerns.
WOODCOCK-JOHNSON ACHIEVEMENT TEST—REVISED
GRADE
RAW SCALE EQUIV. SS %ILE
Letter Word Identification: 18 1.2 58 3
Passage Comprehension: 10 1.6 71 3
Math Calculation: 10 2.2 64 1
Applied Calculation: 27 2.6 85 16
Dictation: 17 1.6 72 3
Writing: 15 2.4 84 15
Based on the scores obtained by the patient on this instrument, she is apparently functioning within the low-average range in math reasoning and writing, within the borderline range in reading comprehension and spelling, and within the deficient range in math calculation. Very deficient functioning was noted in letter word identification.

BENDER GESTALT TEST OF VISUAL MOTOR INTEGRATION
The patient completed the Bender task in 2 minutes 50 seconds, which is somewhat quicker than typical for task completion. She earned 2 errors using the Koppitz scoring system. This score is roughly age-appropriate and suggests adequate visual motor integration skills for her age.

HOUSE-TREE-PERSON DRAWING
The patient completed a drawing with the required picture elements. Her picture elements were very large and dominated the page. They were drawn in a quick manner with broad sweeping strokes. Several picture elements were heavily shaded while others were drawn with no apparent regard for boundaries. There were multiple windows in the house. Her drawing suggests poor behavioral controls as well as poor boundaries and limits. Aggressive behavior appears to be likely. The story told by the patient accompanies her picture suggests that she prefers to relate to her mother at times and that she is likely to display regressive needs. It appears that the patient is attempting to meet needs for support and care which she does not feel were satisfied at appropriate developmental levels.
THEMATIC APPERCEPTION TEST
Stories told by the patient to accompany the TAT material suggests the 5 following clinical hypotheses: The patient seems to see relationships as conflictual and untrustworthy. She seems to see the world as a threatening and dangerous place for her. She told stories which suggest that there is strong conflict among members of her family. She seems to be quite concerned regarding issues which were raised when she was removed from the care of her mother. There seem to be several unresolved matters which may date from the incidents or series of incidents. There were some indications of possible suicidal thought as well as likelihood that she demonstrates oppositional behavior toward her mother and her influence over her. She seems to understand the relationship problems in her family are solved by violence and has been solved by violence or aggression between individuals. Consequently, she seems to be maintaining only a superficial control over considerable anger and aggression.

RORSCHACH INKBLOT TECHNIQUE
The responses provided by the patient to the Rorschach suggest the following clinical hypotheses. The patient appears to look at the world in somewhat unusual ways. She does tend to focus on concrete and practical matters and is considered to be psychologically conservative. She probably exhibits poorly controlled emotions and is somewhat activated by emotionally charged events in her surroundings. She probably is defensive and has relatively poor intellectual and psychological resources to cope with complex surrounding events. Her reality testing and perceptual accuracy were poor.

SUGGESTED DIAGNOSIS
AXIS I: Oppositional defiant disorder, dysthymia, grandparent/child problem, and sexual abuse.
AXIS II: Reading disorder and rule out mathematics disorder.

SUMMARY & RECOMMENDATIONS
The patient is a 12-year-old black female who was admitted to the Children's Treatment Unit at Johnston Recovery Center on November 25 because of increasing behavioral problems, school problems, low self-esteem, increasing physical aggression, and past sexual abuse. The patient is currently being cared for by her grandmother who has physical custody of her. The patient was removed from her home when she was 6 years of age after molestation and sexual abuse was discovered. It is reported that several of the patient's brothers were engaging in sexual activities including inserting objects in her vagina and sodomizing her. One of her older brothers is currently incarcerated in Barchfield Training School. Other male siblings are not living in the home of their natural parents at this time. The patient reportedly lived in a shelter for several years after being removed from her home and was only recently placed in her grandmother's custody. The patient has had difficulty at school including poor attention focus and aggression toward other children. She has had academic problems from the first grade and is reportedly attending learning disability classes at this time. The patient walked at 13 months of age and had problems speaking until the age of 3. She also had delayed toilet training. The patient is obese, complains of chest pains during exercise, and has dental problems. She has frequent headaches, binges on food if it is available, and has no sleep difficulty. She has been treated at the mental health center at Atkins.
Based on the information gathered during this assessment, the patient apparently functions intellectually overall within the borderline range. Her score patterns suggest that deficient skills are present in verbal language areas and that low-average skills are present in visual perceptual areas. The patient scored within the low- average range in math reasoning and writing, within the borderline range in treading comprehension and spelling, and within the deficient range in math calculation. Reading recognition was measured within the very deficient range. Visual motor integration skills were measured as being commensurate with current intellectual potential. Personality features identified during the assessment include a concrete and practical or psychological conservative approach to surrounding events with little psychological sophistication. Defensiveness and an atypical way of looking at her surroundings was also noted. Poorly controlled emotions and significant underlying aggression was identified. Significant issues related to family issues and relationships appear to be present.

Based on the information gathered during this assessment, the following recommendations appear to be appropriate:

1. The patient appears to need continued hospitalization in the Children's Treatment Unit at the Johnston Recovery Center in order to take full advantage of the treatment milieu provided there.

2. The patient appears to have learning disabilities in reading and possible math calculations. The current test results may be submitted to the special education program developer in the school district where she currently attends school so that a proper educational program may be planned for her after discharge.

3. The patient will probably be a superficially cooperative participant in therapeutic activities. If she is pressed to discuss issues regarding her past which she considers to be personal, then she may become noncompliant and even combative. She should
respond well to behavioral management approaches which emphasize rewards and secondary reinforcers such as praises and verbal accolades. Further investigation of family functioning should be undertaken with an attempt to provide the patient with a
nonconflictual environment. The patient will likely continue to have difficulties with adjustment if the apparently dysfunctional relationships displayed for her by significant family members are not addressed directly.

Pulmo 8

CONSULTATION

This is a 32-year-old white male, lifelong nonsmoker, referred to me. He complains of a less than 2-weeks history of dry cough associated with dull substernal discomfort and dyspnea, particularly on exertion. Otherwise, he has been remarkably free of any other associated symptoms. In particular, he denies any preceding cold or flu or allergic exposure, and denies any associated fevers, chills, sweats, or weight loss. He does admit to having childhood asthma but felt he grew out this by the time he was a teenager. He was traveled extensively outside the U.S., including travel to the California deserts and Central Valley. He has not had pneumonia vaccine. He did have TB skin test 10 years ago and did have flue vaccine 3 years ago.

PAST MEDICAL HISTORY: Past medical history is remarkably negative.

PHYSICAL EXAMINATION: Blood pressure 140/80, pulse 85, respiratory rate 22, temperature 99.3.Chest exam is complete normal. There are no rales, wheezes, rhonchi, rubs. Even on forced exhalation, there was no cough or prolongation. Cardiac exam showed a regular rate and rhythm with no murmur or gallop.

LABORATORY DATA: PA chest x-ray is striking for a new interstitial infiltrate seen on both midlung zones with some shagging of the cardiac borders, indicating involvement of the lingual and right middle lobe. Surprisingly, the lowest part of the lung fields and the apices appear to be spared. Spirometry before and after bronchodilator performed in my office show a vital capacity of 3.79 or 69% after an 11% improvement with bronchodilator. FEV-1 achieves 3.24 L or 72% of predicted after 12% improvement wih bronchodilator. FEV-1/FVC ratio was mildly increased at 85 instead of predicted 82.

ASSESSMENT AND PLAN: Differential diagnosis includes the following:
1. Hypersensitivity pneumonitis.
2. Mycoplasma pneumonia.
3. Less likely candidates appear to be Wegener’s granulomatosis, Goodpasture’s syndrome, sarcoidosis, alveolar proteinosis, and allergic bronchopulmonary aspergillosis.

RECOMMENDATIONS:
1. CBC, differential, chemistry-20, Wintrobe sed rate, angiotensin converting enzyme, urinalysis, and Mycoplasma titers.
2. Full pulmonary function test within 2 weeks
3. Vibramycin 100 mg q. day for 14 days. If he still has significant symptoms and restriction on PFTs within 2 weeks, he will have to be evaluated for one of the more chronic diagnoses, which may ultimately require open lung biopsy. Otherwise we should hope that within 2 weeks the patient will be improved and his x-ray will have cleared.

Pulmo 5

EMERGENCY ROOM REPORT

HISTORY OF PRESENT ILLNESS: Patient is a one-year-old female that has been congested for several days. The child has sounded hoarse, has had a croupy cough, and was seen 2 days ago. Since that time she has been on Alupent breathing treatments via machine, amoxicillin, Ventolin, cough syrup, and Slo-bid 100 mg b.i.d. but is not improving. Today the child is not taking food or fluids, has been unable to rest, and has been struggling in her respirations.

PHYSICAL EXAMINATION
GENERAL: Physical exam in the ER showed an alert child in moderate respirator distress.
VITAL SIGNS: Respiratory rate was 40, pulse 20, temperature 99.6.
HEENT: Within normal limits.
NECK: Positive for mild to moderate stridor.
CHEST: Chest showed a diffuse inspirator and expiratory wheezing. No rales were noted. Viewing the chest wall, patient had subcostal-intercostal retractions.
HEART: Regular rhythm without murmur, gallop, or rub.
ABDOMEN: Soft, nontender, bowel sounds normal.
EXTREMITIES: Within normal limits.

The child was sent for a PA and lateral chest x-rays to rule out pneumonia. No pneumonia was seen on the films.
It was agreed to admit the patient to the pediatric unit for placement in a croup tent with respiratory therapy treatments q.3 h. The child was also placed on Decadron besides the amoxicillin and continuation of the Slo-bid.

EMERGENCY ROOM DIAGNOSES
1. Acute laryngotracheobronchitis.
2. Bronchial asthma.

Introduction to MS Word

Getting Started with Microsoft Word
This handout provides an introduction to the fundamentals of Microsoft Word. It covers starting Word, the Word interface, creating a Word document, editing a Word document, selection techniques, paragraph and character formatting, spell checking, printing, graphics and tables.
Starting Word
________________________________________
1. On the PC, select Start, Programs, and Microsoft Word from the Start list.

2 Double-click on the icon of any Word document. Word documents can be anywhere. Word opens with the selected document already loaded.

Exploring the Word Interface

Components of the Word Window
Besides the usual PC window components (close box, title bar, scroll bars, etc.), a Word window has other elements, as shown in the following figure.



Component Functionality or Purpose of the Component
Menu Bar Contains File,Edit, View, Insert, Format, Tools, Table, Window and Help menus
Standard Toolbar Contains icons for shortcuts to menu commands.
Formatting Tool Bar Contains pop-up menus for style, font, and font size; icons for boldface, italic, and underline; alignment icons; number and bullet list icons; indention icons, the border icon, highlight, and font color icons.
Ruler Ruler on which you can set tabs, paragraph alignment, and other formats.
Insertion Point Blinking vertical bar that indicates where text you type will be inserted. Don't confuse the insertion point with the mouse I-beam. To move the insertion point, just click the mouse where you want the point moved.
End-of-File Marker Non-printing symbol that marks the end of the file. You cannot insert text after this mark.
Selection Bar (Gutter) Invisible narrow strip along the left edge of the window. Your mouse pointer changes to a right-pointing arrow when it is in this area. It is used to select a line, a paragraph, or the entire document.
Split Handle Double-click to split the window in two (to view different portions of the same file). Double-click to return to one window
Status Bar Displays page number, section number, and total number of pages, pointer position on page and time of day.
Task Pane Displays and groups commonly used features for convenience.
Office Assistant An animated character that can provide help and suggestions. There are multiple characters to choose from, and it is possible to turn the Office Assistant off.


Creating and Saving a Document
Opening and Closing A Document
To open a file, select Open... from the File menu. In the dialog box, click on the filename and then on the Open button. If your file is not in the opened folder, click on the down arrow (next to folder name) to see a directory listing. The Up One Level button icon on the right enables you to move up one level. You can then switch to the floppy disk, hard drive or Desktop where the appropriate file or folder is located.

For example, to open a file from a floppy disk, select Open... from the File menu. If the disk's name does not appear on the left side of the dialog box, click on the down arrow. Select its name in the box at the left or if it is not displayed, click the Up One Level button to see a different display of files and folders. When you locate the desired diskette or file, click Open. (Double-clicking on the name will also open it).
To close a document, click its close box in the upper right of the title bar (box with the large X on it) or select Close from the File menu. The keyboard shortcut is .
Saving a Document
Your document and changes you make to a document are not saved to disk until you issue a save command. Saving is quick and easy. You should save often to minimize the loss of your work. Word has two save commands - Save and Save As. - that work similarly. Both are under the File menu.
Save Save As
When you save a new document for the first time, Word displays a dialog box (see figure, below). Select where you want to save your document and give it a name. When you save an existing document that you have been editing, the newly saved version is written over the older version. This command always displays a dialog box where you can choose a document name and disk (see figure, below). Use the Save As. command whenever you want to save a copy of the current document under a different name or in a different folder (or disk). The newly saved copy becomes the active document.
Adding and Modifying Text
Entering Text
To enter text, just start typing. Word inserts the text you type at the insertion point. If you press a wrong key, use the Delete key to erase the mistake. Word automatically starts a new line when you reach the end of the current line. This is called "word wrap". Do not press Enter at the end of a line. Press Enter only at the end of paragraphs.


Type the following paragraph. Remember, don't press Enter at the end of the line.
Microsoft Word is part of the Microsoft Office software. It allows you to create, edit, modify and enhance documents. Word is not a simple text processor. It is a document production system.
To move the insertion point with the mouse, click the mouse in the desired location. If the location you want is not visible, use the scroll bars to move up or down in the document. To move the insertion point to the top of the document, press . To move to the end of the document, press < Ctrl + End >.
To insert new text, just click the mouse at the point where you want to insert the additional text and start typing. Existing text moves to accommodate your additions.
Click the mouse pointer after the word, "enhance" and type:
beautiful
Click the mouse pointer before the word, "not" in the second line and type:
just
Type to move to the very beginning of your document and type:
Your name and press Enter .
Today's date and press Enter
The name of the school where you teach and press Enter, Enter.
Deleting Text
The Backspace key deletes one character to the left of the insertion point. The Delete key deletes one character to the right of the insertion point. You can use these keys any time. To delete more than just a few characters, select the text and press the Delete key. Selecting text is covered below.
Undoing Mistakes
If you make a terrible mistake-you accidentally delete an important paragraph, for example-use the Undo command under the Edit menu immediately (The keyboard shortcut is < Ctrl + Z >). Do not issue any other command until after you have undone your mistake.
Selecting Text to Bold, Italicize, and Underline
You select a portion of text in order to perform some operation on it. You can then delete, replace, copy, move, or format it. The Selection Bar is located to the left of the document window. When you put your mouse pointer, which is a left pointing arrow in that area, the arrow swings to the right. The following table explains how to select various blocks of text.


To Select this... Do this...
Word Double click anywhere on the word.
Line Click right-pointing arrow in the selection bar to left of line.
Sentence anywhere in sentence.
Paragraph Double-click the right-pointing arrow in the selection bar to the left of the paragraph, or triple-click in paragraph.
A block of text of any size Click at one end of the block and shift-click at the other end of the block. Or click at one end of block and drag to the other end of the block.
Entire document Press < Ctrl + A> or hold down the Ctrl key and click in the selection bar.
And to... Do this...
Deselect text Click anywhere outside the selection.
Extend a selection Shift-click an additional block. For example, if you have selected a paragraph and you shift-click on another paragraph, it will be added to the selection.
Copy and Paste Text
You can copy selected text from one place to another with the Copy and Paste commands or with the Drag and Drop procedure. You can move selected text from one place to another with the Cut and Paste commands, and with the Drag and Drop procedure. These commands and procedures are described below.
Cut - The Cut command extracts the selected text and puts it on the Clipboard (a temporary storage area). The contents of the Clipboard are overwritten with each copy or cut.
Copy - The Copy command puts a copy of the selected text on the Clipboard.
Paste - The Paste command inserts the Clipboard's contents at the insertion point. Existing text moves to accommodate pasted text. If text is selected, it is replaced by the pasted text.
Drag and Drop - This procedure does not involve the Clipboard and works best when moving text a short distance. To move text, select the text and drag it to its new location. To copy text; hold down the key while you drag the text.
Check the Spelling
________________________________________
Word has a built-in spelling checker. You can have Word check a selected portion of your document (one word, a paragraph, etc.) or the entire document. If you select text before starting the spelling checker, Word checks the selection, then asks whether it should stop or check the rest of the document. To check the entire document, move the insertion point to the top of the document ( Ctrl + Home) before you select the spelling checker.
To start the spelling checker, select Spelling and Grammar from the Tools menu. Word will begin to check for misspellings. If Word finds a word that is not in its dictionaries, it pauses, displays the word, and if possible, suggests alternatives (see figure below).
You have several choices at this point described in the table below. If the word is spelled correctly, you can have Word ignore it or add it to a custom dictionary. If the word is incorrect, you can have Word replace it with one of its suggestions or with a spelling you supply in the Change To: box.


If the word is spelled correctly...
To ignore only this occurrence of the word, click Ignore
To ignore all occurrences of the word, click Ignore All
To add the word to a custom dictionary, click Add
If the word is misspelled...
First, click correct spelling in Suggestions list or type the correction in the Change To: box. Then...
To change only this occurrence of the word, click Change
To change all occurrence of the word, click Change All
After you make your choice, Word continues checking spelling. Remember to save your document after using the spelling checker in order to retain the changes.
Formatting Text and Paragraphs
Formatting Text
You can format text that you are about to type or text that already exists. To format new text, turn on the formatting features you want, type the text, and then turn off the features (select them again or select new features). To format existing text, select the text and choose the formatting features. For example, to create a heading that is Helvetica, bold, 18-point text, select the font and size from the pop-up menus on the Tool Bar (see below). Then, click on the B button to turn on bold.
Formatting Paragraphs
In Microsoft Word , a paragraph is any amount of text followed by a paragraph symbol (¶). A one-word heading is a paragraph. A 100-word job description is a paragraph. Even a blank line terminated by a ¶ is a paragraph.
You can perform paragraph formatting from the Format menu.

You can also choose icons from the Formatting Tool Bar to format paragraphs.
1. Font and font sizes,
2. Paragraph alignment icons, and
3. Indention icons.
4. Numbered and Bulleted lists.
Using Word’s Multiple Clipboard:
Word uses the MS Office clipboard which allows for multiple items to be stored at the same time (unlike Windows clipboard which only allows 1 item at a time). Word 2000 will store up to 12 items, Word 2002 and 2003 will store up to 24 items. The same clipboard is used in all Office programs (Word, Excel, Outlook, Power Point, etc.), so you can copy from one program and paste into a different program.
1. To place items on the clipboard
a. select the item and copy it as you would to the Windows clipboard
b. to open the multiple clipboard in Office 2002 or 2003 click on the Edit menu Office Clipboard, in Office 2000 click on the View menu  Toolbars  Clipboard
c. Repeat item 2 above until you have several items on the clipboard


2. To paste the items on the clipboard, place your insertion point in the proper position on your document and click on the item to be pasted
Removing formatting
• Click on Undo button (if you just made the change)
• Select the text, and use the formatting commands again to remove formatting
Applying Formatting With The Format Painter
Use the format painter to quickly apply formatting to several pieces of text. Example -- you
have 15 titles within a document and you have just formatted one as Arial, Bold, Centered, 14. It
would be time consuming to select every title then apply the same 4 formatting features. If you use the
Format Painter you apply formatting once and then copy the formatting to the rest of the titles!
Steps:
1. Select the formatted text
2. Double click on the Format Painter button
3. The mouse pointer turns into an I-beam with a paint brush
4. Select the text through out the document that you want to apply the formatting to.
5. Click once on the Format Painter to turn it off.
ALIGNMENT
Use buttons on the formatting toolbar or the following keyboard combinations to adjust paragraph alignment.
The default alignment for every new Word document is left justified, single spaced.
To change alignment, click within the paragraph (or line of text) then use one of the following methods:

Buttons Keyboard Result


Using The Find And Replace Command
FIND TEXT

• Edit, Find

FIND TEXT AND REPLACE IT WITH DIFFERENT TEXT

1. Edit, Replace
2. Type in the text you are searching for, then strike the Tab key.
3. Type in the replacement text exactly as you want it to appear in the document.
4. Choose Replace All to replace all instances or Find Next and Replace to replace an instance at a time.

Numbering Pages With the Header and Footer
Headers and footers typically contain titles and page numbers for a document. A header is text that appears within the top margin on each page, whereas a footer appears in the bottom margin. You can set a different header and footer on the first page by selecting Page Setup from the File menu, clicking the Layout tab from the open dialog box and then selecting Different First Page from the available options.
To create a header (or footer) in a document, select Header and Footer from the View menu. Type the header or footer text in the header or footer window (see below). The default text is left aligned with a centered tab set at 3 " and a right tab at 6. You can format Header and Footer text using the Ribbon and Ruler similar to a paragraph in your document. Click on the Header and Footer tool bar buttons to insert a page number, the current date, the time, and to switch between the Header and Footer template.

Bullets And Numbering

Automatic Bullets Or Numbers
To create a numbered or bulleted list automatically: Go to Tools AutoCorrect, Choose the AutoFormat As You Type tab. Confirm that Automatic bulleted lists and Automatic numbered lists are checked. Press OK. Position the cursor where you want the list to begin. Enter a number or an asterisk, Press Tab, type the first item in the list, press Enter, Word 2000 automatically starts a bulleted or numbered list for you. To end the list, press enter twice.
Using Proofing Tools
STARTING SPELLING & GRAMMAR CHECK

• Move your cursor to the top of the document (ctrl + home)
• Click on either the spell and grammar check button or click Tools, Spelling and Grammar

THESAURUS
1. Highlight the word you want to look up.
2. Click on Tools, Language, Thesaurus.
3. Click on a word from the list
4. Select Replace


Understanding the Different Types of Indents
There are 4 different types of indents:
• A Left Indent moves the left margin of a paragraph to the right.
• A First Line Indent moves only the first line of a paragraph to the right
• With a Hanging Indent, the first line aligns on the left and the rest of the paragraph "hangs" from the first line.
• A Right Indent moves the right margin of a paragraph to the left
Indenting Paragraphs Using the Formatting Toolbar
The Indenting buttons on the Formatting toolbar moves the Left Indent Marker in increments of 5 spaces.
1. Select the paragraph(s) you wish to indent.
2. On the Formatting toolbar, do one of the following:

To indent a paragraph: Click:
To the right:

To the left:

Indenting Paragraphs Using the Ruler
1. Select the paragraph(s) that you wish to indent.
2. Drag the Indent Marker (found on the ruler) to indent the paragraph by the appropriate value:

1. To create a First Line Indent, click and drag the First-Line Indent Marker to the right to the desired value.
2. To create a Left Indent, click and drag the Left Indent Marker (the bottom square) to the right.
The entire "hourglass" should move. If it splits as in the photo above, carefully move the marker back to the original position and try again, moving the cursor down slightly to select ONLY the bottom square.
1. To create a Hanging Indent, click carefully on the bottom triangle and drag the Hanging Indent Marker to the right. The"hourglass" will split, as in the photo above.
2. To create a Right Indent, drag the Right Indent Marker to the left of the right margin.
Sometimes unintentional indents are set that go way beyond the left margin. If this should happen, click in the paragraph that is out of line and look at the Ruler. It will probably look something like this.

Try to determine what kind of indent was set. If one part of the indent marker cannot be seen, Click on the left horizontal scroll arrow until the indent marker shows on the ruler. At this point, move the triangle that is out of line so that it lines up with the other at the margin.
Clicking on the right horizontal scroll arrow will realign the page on the screen. If all else fails, click on the Undo arrow until your margins are realigned.
Understanding tabs
When you press the TAB key, the insertion point moves to the next tab stop position and the space is filled with a tab character. By default, tab stops are set at 0.5-inch intervals from the left margin. You can set and change the alignment of tab stops in selected paragraphs. When you set a new tab stop, Word clears any default tab stops to the left of the new tab stop.
1. Decide which tab you would like to insert.
2. There are 2 components of tabs. A tab is inserted into text by pressing the TAB key. Secondly, a tab stop must be set, using either the Ruler or Menu. If there are no tabs set, the cursor will move to the next default tab setting (set at 1/2 inch intervals). Leaders (... between text) can also be set using the Tabs menu.

Although the tab character is always inserted when you press TAB, it can only be viewed when the Show Paragraph command from the Toolbar is turned on. Word has four types of tab stops that can be used to format information more effectively: The diagram below illustrates these tab styles.
3.
4. To insert a tab in your text, click in the text where you wish to insert the tab, press the TAB key.
Setting tab stops and tab leaders using the Tabs menu
1. Select the paragraph(s) that you wish to format with tabs.
2. From the Format Menu, choose Tabs. This will open the Tabs dialog box.
3. At Tab Stop Position:, type the position at which you want to set the tab.
4. At Alignment, click the alignment option.
5. At Leader, click type of leader character, if desired.
1. Leaders are the dashed, dotted, or solid lines that follow the tab. They are used to add visual clarity to text.
6. Click Set.
7. Click OK to close the Tabs dialog box. You should see the tab stop in the Ruler.
Clearing tab stops using the Tabs menu
1. Select paragraph you wish to format.
2. From the Format menu, choose Tabs.
3. To Clear a stop, click on the Tab stop that you wish to clear and click the Clear button. New stops can
4. Click OK.


Setting tab stops using the Horizontal Ruler
1. If the Ruler is not visible in the document window, from the View menu, choose Ruler.
2. Select the paragraphs you wish to set stops.
3. Click the desired tab style from the Tab Alignment button on the Ruler. It will switch between tab styles with each click.
4. On the ruler, place your pointer where you wish to have a tab stop and click. It will leave a tab in that spot. You will also see a vertical dotted line for visual use down your page.
Deleting and moving tab stops using the Horizontal Ruler
1. To move a tab, click on tab mark and drag to desired spot on ruler.
2. To delete a tab, click on tab and drag off the horizontal ruler.
Create Tables in Word
Using tables in Word can be a very convenient way to easily display and organize information in a document.
Microsoft Word offers a number of ways to make a table. The best way depends on how you like to work, and on how simple or complex the table needs to be.
Use the Insert Table Command
Use this procedure to make choices about the table dimensions and format before the table is inserted into a document.
1. Click where you want to create a table.
2. From the Table menu choose Insert, and slide right to Table.
3. Under Table size, select the number of columns and rows.
4. Optional: Under AutoFit behavior, choose options to adjust table size.
5. Optional: To use a built-in table format, click AutoFormat.
6. Select the options you want.
7. Click OK.
Word positions the insertion point in the first cell of the table. You can immediately type text in the table.
Use the Insert Table toolbar button
Use this procedure to make choices about the table dimensions ONLY before the table is inserted into a document.
1. Position the cursor where you want to create a table.
2. On the Standard toolbar, click and hold on the Insert Table button.
a. A grid appears below the button.
3. Drag over the grid until you've selected the number of rows and columns you want.
4. Release the mouse button.

Draw a more complex table
You can draw a complex table — for example, one that contains cells of different heights or a varying number of columns per row.
1. Click where you want to create the table.
2. From the Table menu, choose Draw Table.
a. The Tables and Borders toolbar appears.
b. The pointer changes to a pencil.
3. Click, hold, and drag to define the outer table boundaries.
a. You would want to draw a rectangle.
4. Draw the column and row lines inside the rectangle.
5. When you finish creating the table, click a cell and start typing or insert a graphic.
Note: Hold down CTRL to automatically apply text wrapping while you draw the table.
To erase a line or block of lines:
1. Click Eraser on the Tables and Borders toolbar.
2. Click the line you want to erase.
Text Borders and Shading
You can set apart paragraphs or selected text from the rest of a document by adding borders. You can also highlight text by applying shading.
1. Do one of the following:
a. To add a border to a paragraph, click anywhere in the paragraph.
b. To add a border only to specific text, select the text.
2. On the Format menu, click Borders and Shading, and then click the Borders tab.
a. Select the options you want, and make sure the correct option — Paragraph or Text — is selected under Apply to.
i. To specify that only particular sides get borders, click Custom under Setting. Under Preview, click the diagram's sides, or use the buttons to apply and remove borders.
b. To specify the exact position of the border relative to the text, click Paragraph under Apply to, click Options, and then select the options you want.
Add shading to a table, a paragraph, or selected text
1. To add shading to a table, click anywhere in the table.
a. From the Format menu, choose Borders & Shading.
b. Click on the Shading tab.
c. Select the shade you want. Remember that your text needs to be legible
d. Under Apply to, click the part of the document you want to apply shading to.
i. For example, if you clicked a cell without selecting it in step 1, click Cell. Otherwise, Word applies the shading to the entire table.
2. To add shading to specific cells, select the cells, including the end-of-cell marks.
a. From the Format menu, choose Borders & Shading.
b. Click on the Shading tab.
c. Select the shade you want. Remember that your text needs to be legible
d. Under Apply to, click the part of the document you want to apply shading to.
i. For example, if you clicked a cell without selecting it in step 1, click Cell. Otherwise, Word applies the shading to the entire table.
3. To add shading to a paragraph, click anywhere in the paragraph.
a. From the Format menu, choose Borders & Shading.
b. Click on the Shading tab.
c. Select the shade you want. Remember that your text needs to be legible
d. Under Apply to, click the part of the document you want to apply shading to.



e. For example, if you clicked a cell without selecting it in step 1, click Cell. Otherwise, Word applies the shading to the entire table.
4. To add shading to specific text, such as a word, select the text.
a. From the Format menu, choose Borders & Shading.
b. Click on the Shading tab.
c. Select the shade you want. Remember that your text needs to be legible
d. Under Apply to, click the part of the document you want to apply shading to.
i. For example, if you clicked a cell without selecting it in step 1, click Cell. Otherwise, Word applies the shading to the entire table
Printing
Select File, Print to print your document. Save the document before selecting the Print command to avoid losing your work. You can also click on the Print icon to print the active document.
Review and Summary
To... Do This...
Open a Word document. Double-click on the icon.
Open any document within Word Select Open... from the File menu or press < Ctrl + O > . In the dialog box, click on the filename and then on the Open button.
Close a document Click its close box, select Close from the File menu, or press < Ctrl + W>.
Save a document Select Save from the File menu or press < Ctrl + S > . Type a name for the document and select a disk in which to save it.
Move text Select the text. Choose Cut from the Edit menu or press < Ctrl + X>.
Copy text Select the text and choose Copy from the Edit menu or press .
Insert text from the clipboard Choose Paste from the Edit menu or press < Ctrl + V >
Set the margins Choose Page Setup from the File menu.
Change the font or size of text Select the text and choose from the Font or Size boxes on the Ribbon.
Create bold , italic or underlined text Select the text and choose the formatting features from the Ribbon.
Change the alignment or spacing of paragraphs Select the paragraphs and click on the alignment and spacing icons on the Ruler.
Add page numbers Choose Header and Footer from the View menu. Click on the page number icon.
Start the spelling checker Move the insertion point to the top of the document or press < Ctrl + Home>. Select Spelling and Grammar from the Tools menu.
Preview the document Choose Print Preview from the File menu.
Print the document Choose Print from the File menu or press < Ctrl + P >.


Create a Template in Microsoft Word
A template is a form in which the person entering the information is only allowed to manipulate areas that you allow. For instance, the student can type in their name, and the answers to a question, but not edit other text on the page such as a grading rubric.
Some good uses for templates:
• To limit the length of an essay response.
• To save time for your students by allowing them to choose responses from a drop-down box.
• To receive the information you desire in a clean, formatted, consistent manner from every respondent.
To create a Word Template, open Microsoft Word and follow these instructions.
1. You need to create a form, and in order to add form fields, you must have the Forms toolbar available. To view any toolbar, click on the View menu and go down to the Toolbars menu, slide over and select the menu you want to view, in this case Forms.


By selecting a menu there will be a check mark next to it if it is currently open and visible in Word. So, if there is already a check mark next to Forms, then it is already open, you just have to find it. The Forms toolbar looks like this:
Note: The toolbar may be docked, or connected to the typical toolbars that you see in Word, or it might be floating around in the workspace.
2. Type your text into Word, and add form fields where necessary. There are three basic options, a text form field, a drop-down form field, and a check box form field.
To add a text form field:
A text form field is used when you want to allow the user to type in text, as in their name, a paragraph answer to a question, or any other text.
For example, if you want to make a space for your students to enter their names, type Name and then click on the text form field - - on the Forms toolbar. A gray area will show up where your cursor was when you clicked on this button. If you double click on this gray area, the Text Form Field Options window will pop up allowing you to customize the field. The top four fields will be the ones you are most interested in and are explained more below.

• The Type field allows you to choose whether the text entered is regular text, a number, a date, or another specifically formatted type of text.
• The Default text field is where you type in text that will appear in the gray area, giving instruction to the person filling out the template; in this example if you were making a name field you might type in 'enter your name here'.
• The Maximum length field is used if you want to limit how many characters can be entered in the field you are creating. Keep in mind that a space is considered a character.
• The Text format field allows you to specify how you want the text to look after it is entered, you can leave this field blank and the text will appear how it is typed. However, if you choose, Uppercase then no matter what the user types in, the text will appear in uppercase. The other options are lowercase, first capital and title case.
So, if I typed Name and then created a text field next to it for user to type in their name, and set up the default text to read 'enter your name here', and the text format field to first capital, the result in Word would look as follows:

BMT DERMA8

CONSULTATION REPORT

The patient was admitted to the hospital for treatment of Leg ulceration. Consultation was requested specifically for an eruption on the back and legs which patient state has been present in 3 months. No treatment has been given for this. The nurses report that the area had been oozing at the back but since the start of oral cuplex, the oozing has stopped. The patient is not a good historian, state only that the eruption started about 3 months ago and is occasionally pruritic.

PHYSICAL EXAMINATION
Physical Examination showed covering most of the back and also the medial central buttocks, confluent, erythematous, scaly plaque with some crusting, similar plaque were also present on the anterior lower legs.

IMPRESSION
Confluent psoriasis which has been secondary infected.

PLAN
1. The cuplex should be continued to treat the secondary infection.
2. The psoriasis will be treated with a combination of 10% LCD in 0.1% Triamcinolone cream.

Transcriptions Exercise 2_ch10

OPERATIVE REPORT



PATIENT NAME: Jenel Bordelan

HOSPITAL NO.: 5049247

DATE OF PROCEDURE: May 15, ----

SURGEON: Dr. John C. Howard, M.D.

PREOPERATIVE DIAGNOSIS
By-lateral subdural hematomas.

POST OPERATIVE DIAGNOSIS
By-lateral subdural hematomas.

PROCEDURES:
By-lateral burr holes frontal and parietal for drainage of subdural hematomas.

ANESTHESIA
General Endotracheal.

ANESTHESIOLOGIST
Sean Swellow, M.D.


PROCEDURE IN DETAIL
The patient was brought into the operating room and after induction of general endotracheal anesthesia. The head was completely shaved, prepped and draped in the usual manner. An incision was made over the frontal areas approximately 3.0 cm from the midline on both sides. The incision was carried down through the scalp, rainy clips where applied for homeostasis, self retaining retractor were placed, burr holes has been made with common perforator. Bleeding from bone was then controlled with bone wax. The left flexed of bone where taken out with a curette and the dura underneath was coagulated in a cruciate fashion. The dura was open widely and copuis amount of all the crankcase colored blood should form. This was irrigated copiously on both side and blake 7millimitter drain where advance under the scalp and into this hole and to this subdural space. Both wounds where close then with zero vicruse who close the gailio layer and 30 nylon to close the skin. Zero form dressing where applied and both drain where secured with 20 silk The patient was recovered from anesthesia and taken to the recovery room in satisfactory condition.

ACRONYMS & INITIALISIMS

- formed when intial letters of each of the successive words or major parts of a compound term or of selected term or selected letters of words or phrase. Acronyms are pronounced as words. Initialisim are not.

Capitalization
• All caps letters of acronyms but when extended Do not Caps the word from w/c they formed unless its proper names.
E.g. AIDS, BiPaP
• Lower case form when acronyms become word
E.g. laser
Unusual Abbreviations
Eg. pO2, aVL, PhD
Plural Form
• Form the plural capitalized acronyms & initialisims by using lowercase s.
Eg: RBCs, WBCs
• Form the plural lowercase acronyms & initialisims by using lower case ‘s.
Eg: rbc’s, wbc’s
• Form the plural of single-letter abbreviations by using ‘s
E.g: X’s or serial K’s.
Periods
• No periods w/in or end of most abbreviations, including acronyms, abbreviated unit of measure, and brief forms.
• No periods w/ academic degrees and professional credentials
• Periods in lowercase drug-rel abv.
• No double period on lower case.
Brief forms
• Transcrib as is…if they are commonly used, but extend on HEADINGS, DIAGNOSIS, & OPERATIVE TITLES.
• No ending periods
Eg: phone-telephone, Pap smear – Papanicolaou smear
Unit of Measure
• Abbreviate if accopmpanied by numeral even dictated in full.
Eg: 2.5mg 3 g/dL , 5 cc
• Avoid separating numeral from its associated unit of measure.
Sentence
• Never begin in lowercase letter such as pH.
• Sentence may begin w/ dictated abbreviation, acronym or brief form (except unit of measure)
Diagnoses & Operative Titles
• Write abbreviation or acronym in full if it is used in the
Eg. Admission, Discharge, Preoperative, Postoperative Diagnosis, Consultative Consultation, or Operative Title.
Accent Marks
• Omitted in MT w/c are not essential to communication.