Terminology challenge – interpret medical transcriptions

 

Instructions: Read the paragraph below. Submit the paragraph with definitions and common language replaced with medical terms where it is appropriate.

A 56-year-old gentleman presents to the emergency room after awakening at 2:30 a.m. this morning with trouble swallowing, trouble breathing, and left-sided numbness and weakness. His wife said that he had trouble speaking as well, but gradually the symptoms resolved but he was still complaining of a headache and at that point, he was brought to the emergency room. He underwent workup including a scan that equates to thousands of x-rays, which was negative, and his symptoms slowly began to resolve. He was initially admitted, placed on Plavix and aspirin. However, a few hours later, his symptoms returned, and he had increasing weakness of his left arm and left leg as well as slurred speech. He also underwent an ultrasound test that shows blood passing through the heart, valves, and chambers to assess heart function as well as lab work in the emergency room. Wife is at the bedside and denies he had any other symptoms previous to this. He denied any chest pain or irregular heartbeats. She does report that he is on a Z-Pak, got a cortisone shot, and some medicine that relieves stuffiness in the nose. He also currently takes Ibuprofen as needed. He has history of a disk that was removed from his lower back. The identification of the illness or disease was determined to be a brain attack from lack of blood to the brain.

Sample was taken from mtsamples.com (Links to an external site.). It was changed considerably for this assignment.







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