CHIEF COMPLAINT: Global Aphasia, Right Sided Weakness

PRESENT ILLNESS: Ms. [**Known lastname 111870**] is a 69 year-old right handed woman with past
medical history of hypertension, chronic back pain and a left
shoulder fracture one month prior who presented as an OSH
transfer Code Stroke for reported sudden onset aphasia and right
sided weakness.  She was last reported without symptoms (as
noted by husband) at 1700hrs on [**2115-6-5**].  After finding her at
1730hrs on the floor not speaking, he called EMS who on arrival
noted right sided weakness and a left gaze deviation.  Her GCS
per EMS was 3, and on evaluating her, witnessed a systolic blood
pressure drop to 89 with respiratory rate decrease.  EMS
intubated the patient in the field and brought her to [**Hospital1 5979**].  A CT scan obtained at [**Hospital3 **] was negative
for hemorrhage or acute process (comfirmed upon [**Hospital1 18**] review),
but because she was intubated [**Hospital1 487**] reported inability to
obtain a clear exam to warrant tPA administration.

MEDICAL HISTORY: - HTN
- chronic back pain
- tripped down stairs 1 month ago resulting in L shoulder fx
- Thyroid cancer s/p lobectomy
- COPD
- chronic leukocytosis

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from  PCP.
1. Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q6H prn pain
2. Citalopram 40 mg PO DAILY
3. BuPROPion (Sustained Release) 100 mg PO BID
4. Verapamil SR 180 mg PO Q24H
5. Simvastatin 20 mg PO DAILY
6. Tiotropium Bromide 1 CAP IH DAILY
7. Lisinopril 40 mg PO DAILY
8. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
9. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
10. Hydrochlorothiazide 25 mg PO DAILY
11. Cyclobenzaprine 10 mg PO HS
12. Lorazepam 0.5 mg PO HS
13. Aspirin 81 mg PO DAILY

ALLERGIES: Iodine

PHYSICAL EXAM: Vitals: T: 98.0  P: 68  R: 20  BP: 110/62 SaO2: 98% on ETT
General: somnolent, intubated, even off sedation, slow to arouse
to sternal rub
HEENT: NC/AT, no scleral icterus noted, ETT in place
Neck: Supple, no carotid bruits appreciated.
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted, old surgiucal scar notes in RLQ
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: no history of neurologic diseases

SOCIAL HISTORY: lives with husband, independent
quit smoking 1 year ago
Cerebral embolism with cerebral infarction,Urinary tract infection, site not specified,Closed fracture of multiple ribs, unspecified,Aphasia,Other musculoskeletal symptoms referable to limbs,Other dissociated deviation of eye movements,Unspecified essential hypertension,Backache, unspecified,Other chronic pain,Aftercare for healing traumatic fracture of upper arm,Late effects of accidental fall,Other specified hypotension,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Dysphagia, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],History of fall,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Personal history of traumatic fracture,Anemia of other chronic disease,Genetic anomalies of leukocytes,Essential thrombocythemia,Personal history of malignant neoplasm of thyroid,Other specified complications of procedures not elsewhere classified,Injury of face and neck,Accidental cut, puncture, perforation or hemorrhage during other specified medical care,Unspecified disorder of kidney and ureter
Crbl emblsm w infrct,Urin tract infection NOS,Fx mult ribs NOS-closed,Aphasia,Muscskel sympt limb NEC,Skew deviation, eye,Hypertension NOS,Backache NOS,Chronic pain NEC,Aftrcare traum fx up arm,Late eff accidental fall,Hypotension NEC,Hyperlipidemia NEC/NOS,Chr airway obstruct NEC,Dysphagia NOS,Enterococcus group d,Personal history of fall,Anxiety state NOS,Depressive disorder NEC,Hx traumatic fracture,Anemia-other chronic dis,Genetic anomaly leukocyt,Essntial thrombocythemia,Hx of thyroid malignancy,Oth spcf cmplc procd NEC,Face & neck injury,Acc cut in med care NEC,Renal & ureteral dis NOS
Admission Date:  [**2115-6-5**]              Discharge Date:   [**2115-6-21**]

Date of Birth:  [**2045-11-21**]             Sex:   F

Service: NEUROLOGY

Allergies:
Iodine

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Global Aphasia, Right Sided Weakness

Major Surgical or Invasive Procedure:
Intra-arterial tPA administration
PEG tube placement


History of Present Illness:
Ms. [**Known lastname 111870**] is a 69 year-old right handed woman with past
medical history of hypertension, chronic back pain and a left
shoulder fracture one month prior who presented as an OSH
transfer Code Stroke for reported sudden onset aphasia and right
sided weakness.  She was last reported without symptoms (as
noted by husband) at 1700hrs on [**2115-6-5**].  After finding her at
1730hrs on the floor not speaking, he called EMS who on arrival
noted right sided weakness and a left gaze deviation.  Her GCS
per EMS was 3, and on evaluating her, witnessed a systolic blood
pressure drop to 89 with respiratory rate decrease.  EMS
intubated the patient in the field and brought her to [**Hospital1 5979**].  A CT scan obtained at [**Hospital3 **] was negative
for hemorrhage or acute process (comfirmed upon [**Hospital1 18**] review),
but because she was intubated [**Hospital1 487**] reported inability to
obtain a clear exam to warrant tPA administration.

Therefore, the patient was transferred to [**Hospital1 18**] for possible tPA
and/or intervention. She arrived intubated and sedated at [**Hospital1 18**]
ED, with right-sided weakness when weaned off of sedation.
However, given the shortcomings inherent with an intubated
examination and her difficulty arousing from sedation, she went
to CT/CTA/CTP, which showed a left MCA clot at the bifurcation
and left MCA stroke with perfusion mismatch on imaging.  She was
started on tPA and taken to the neurointerventional suite where
intraarterial tPA was administered.

Past Medical History:
- HTN
- chronic back pain
- tripped down stairs 1 month ago resulting in L shoulder fx
- Thyroid cancer s/p lobectomy
- COPD
- chronic leukocytosis

Social History:
lives with husband, independent
quit smoking 1 year ago

Family History:
no history of neurologic diseases

Physical Exam:
Vitals: T: 98.0  P: 68  R: 20  BP: 110/62 SaO2: 98% on ETT
General: somnolent, intubated, even off sedation, slow to arouse
to sternal rub
HEENT: NC/AT, no scleral icterus noted, ETT in place
Neck: Supple, no carotid bruits appreciated.
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted, old surgiucal scar notes in RLQ
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

Neurologic:

NIH Stroke Scale score was 11 or greater:
1a. Level of Consciousness: 1
1b. LOC Question: 1
1c. LOC Commands: 1
2. Best gaze: 0
3. Visual fields: 0
4. Facial palsy: (unable to test, intubated)
5a. Motor arm, left: 0
5b. Motor arm, right: 4
6a. Motor leg, left: 0
6b. Motor leg, right: 2
7. Limb Ataxia: 0
8. Sensory: 2
9. Language: (unable to test, intubated)
10. Dysarthria: 0
11. Extinction and Neglect: 0

-Mental Status: Alert, intubated, sedated initially and
unarousable.  With propofol held was slow to respond to sternal
rub, grimaced to pain.  Was able to briefly follow commands to
squeeze and let go on her L hand and to wiggle her L toes.  Was
able to wiggle her R toes minimally to command, and could not
move her RUE to command.

-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk.  VFF to confrontation.  Decreased
corneal reflex response on the R. Funduscopic exam revealed no
papilledema, exudates, or hemorrhages.
III, IV, VI: pt with midline gaze, able to overcome midline in
both directions when head was moved.
V: unable to test
VII: unable to test.
VIII: Hearing intact to loud voice bilaterally as followed
commands
IX, X: unable to test
[**Doctor First Name 81**]: [**4-6**] unable to test
XII: unable to test

-Motor: Normal bulk, tone throughout. No adventitious movements,
such as tremor, noted. No asterixis noted. Patient withdrew LUE
and LLE briskly to noxious.  She withdrew her RLE slowly to
noxious, with no triple flexion noted. She did not withdraw her
RUE to noxious.

-Sensory: withdrawal to noxious as above
-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    2    2   1
R  2  2    2    2   1
Plantar response was flexor on the left and very minimally
upgoing on the R.

-Coordination: reached for ETT accurately with RUE until she was
placed in restraints

-Gait: Deferred, pt intubated


Pertinent Results:
[**2115-6-5**] 07:54PM   PH-7.41 COMMENTS-GREEN TOP
[**2115-6-5**] 07:54PM   GLUCOSE-110* LACTATE-1.1 NA+-139 K+-4.9
CL--111* TCO2-19*
[**2115-6-5**] 07:54PM   HGB-9.1* calcHCT-27 O2 SAT-95 CARBOXYHB-4 MET
HGB-0
[**2115-6-5**] 07:40PM   PT-11.0 PTT-25.2 INR(PT)-1.0
[**2115-6-5**] 07:40PM   FIBRINOGE-540*

CT Perfusion:
1.  Evolving infarct in the left MCA territory with
hypoattenuation and
effacement in the left insular ribbon.
2.  Occlusion of the left distal M1 segment before the
bifurcation.
3.  Mismatch on CT perfusion suggesting penumbra in the left MCA
territory.
4.  Thyroid asymmetry with right lobe coarse calcification. This
could be
further evaluated with nonurgent thyroid ultrasound if
clinically indicated.

CTA head and Neck:
1.  Evolving infarct in the left MCA territory with
hypoattenuation and
effacement in the left insular ribbon.
2.  Occlusion of the left distal M1 segment before the
bifurcation.
3.  Mismatch on CT perfusion suggesting penumbra in the left MCA
territory.
4.  Thyroid asymmetry with right lobe coarse calcification. This
could be
further evaluated with nonurgent thyroid ultrasound if
clinically indicated.

TTE: No ASD or PFO seen. Normal global and regional
biventricular systolic function.

[**6-6**] CT Head:1.  Intraparenchymal hemorrhage at the site of prior
left MCA infarct.
2.  Small left subdural hematoma layering on the tentorium, new
from prior.
3.  No midline shift or evidence of transtentorial herniation.
4.  No evidence of obstructive hydrocephalus.

[**6-6**] CT Head
Hyperdensity in the left frontal lobe with mild sulcal
effacement, likely represents diffusion of permeated contrast
after
angiography rather than hemorrhagic transformation in an area of
left MCA
stroke.  Continued followup is recommended.

[**6-7**] CT abd and pelvis:
1. No evidence of intra-abdominal or pelvic hemorrhage. Trace
free simple
appearing fluid in the pelvis.

2. Multiple bilateral rib fractures at various stages of healing
from acute to
remote.

3.  Moderate complex right pleural effusion, likely hemorrhagic
and related to
rib fractures. Trace left pleural effusion. Small intramuscular
hemmorhage
related to fourth right rib fracture.

4.  Small hyperdense rounded lesion in the upper pole of the
right kidney, may
represent hemorrhagic cyst, though cannot exclude malignancy.
Recommend
further evaluation with ultrasound.

5.  Nodular thickening of medial limb of left adrenal gland may
represent
underlying nodule, or given recent trauma, a small hemmorrhage.
Attention on
follow-up

6. Diverticulosis without diverticulitis.

7. Enteric catheter terminates in the distal esophagus and
should be advanced.

[**6-7**] MRI brain
1.Acute infarct noted within the left frontal, insular cortex
extending to involve majority of the left temporal cortex with
preservation of the left basal ganglia.
2.  Vasculature not completely evaluated on this study, as an
MRA of the brain was not performed due to patient's
deteriorating condition.  Within this limitation, the mean M1
segment of the left MCA demonstrates normal
intracranial flow void; however, the distal M2 segments could
not be
evaluated.  Once the patient's condition is stable then an MRA
of the brain and a GRE sequence is recommended.
3.  Sphenoid sinus disease.
4.  Sequelae of chronic small vessel ischemic disease.

[**6-8**] MRA brain
Resolution of occlusion of the left M1 segment of the left
middle
cerebral artery, with persistent diminished flow in its branches
compared to the right.


Brief Hospital Course:
Neuro:
The patient presented with sudden onset aphasia and right sided
weakness at
approximately 1730 on [**2115-6-5**].  EMS was called, and patient was
intubated secondary to GCS = 3 and poor respiratory drive.  At
[**Hospital6 3105**], patient noted to have right-sided
weakness and left eye deviation.  Initial OSH CT scan was
negative for hemorrhage or acute process.  Patient transferred
to the [**Hospital1 18**]; OSH concerned with administering thrombolytics in
setting of sedated patient without
conclusive exam.  Per ED Evaluation of patient, right sided
weakness and left gaze preference were evident when weaned from
sedation.  Emergent CT/CTA performed revealing left MCA clot at
bifurcation with perfusion mismatch consistent with territory
stroke.  Initial NIHSS stroke scale was 11. Thrombolytics were
administered
at [**2111**] on [**6-5**] and patient sent to interventional suite where
intraarterial thrombolytics were administered.

On [**6-6**], pt was noted to have improved right handed function, and
was responsive to commands.  Pt was extubated in AM without
complication and transferred to the stroke service on [**6-7**].
Since leaving the ICU the patient was less inattentive, and
globally aphasic with minimal response to commands.  Her
strength has improved on the right side in upper and lower
extremities.  The patient was seen to have failed several speech
and swallow evaluations for which her family authorized the
placement of a PEG tube, accomplished on [**6-13**].  During this
procedure, anesthesia noted a traumatic intubation and as a
result the patient could not be immediately extubated and
required mechanical ventilation in the ICU with plans to attempt
later extubation.  The patient was sedated with seroquel and
propofol for a short course and was able to be successfully
extubated on [**6-16**], at which point repeat neurologic evaluation
revealed her to remain globally aphasic with minimal
responsiveness to command, but showed increased strength in her
right extremities.

On [**6-18**] the patient was observed to have right facial twitching
as well as decreased alertness. She was placed on long term EEG
monitoring. No epileptic activity was noted.

Cardiac:
The patient on admission was allowed to autoregulate blood
pressure with anti-hypertensives prescribed on an as needed
basis for more severe hypertension. We did start lower doses of
her home antihypertensives after the acute post-stroke period
and titrated up for goal blood pressure less than 140. Workup
for this cerebrovascular event included a transthoracic
echocardiogram which revealed no atrial septal defect or patent
foramen ovale, and normal global and regional biventricular
systolic function.  However, due to the limitations of the
study, a thrombus could not be excluded.  Due to the traumatic
intubation, a transesophageal echocardiogram was deferred and a
cardiac MR was obtained. This was a poor study due to patient
movement but it did not reveal any thrombus in the atrium or
aorta.

Heme:
The patient was noted to have anemia with hematocrit to the
mid-low 20s so CT abdomen and pelvis was obtained to assess for
source of bleed but none was noted. The CT did note "Small
hyperdense rounded lesion in the upper pole of the right kidney"
which will need to be followed up. Concurrent with this anemia
was a thrombocytosis and elevated WBC in the 20s with the only
infection nidus from a pan-culture found to be a positive urine
culture.  Per the patient's PCP, [**Name10 (NameIs) **] patient has had a chronic
leukocytosis and had refused previous outpatient workup.  A
hematologic malignancy consult was placed which noted an
unremarkable peripheral smear. They felt the patient's
leukocytosis and thrombocytosis are most likely reactive,
perhaps due to continued aspiration while she was in the
hospital. They recommend a repeat CBC after discharge.

ID:
A urine culture was obtained grew enterococcus requiring a
course of Amoxicillin therapy. Repeat urine cultures grew no
further bacteria. Her oxygen saturation remained stable and she
remained afebrile despite elevated WBC counts.

Endocrine:
The patient was covered with sliding scale insulin, and an HgB
A1c was obtained measuring 5.6%.

GI:
The patient was started on prophylaxis against gastroesophageal
acid reflux and after several failed attempts at swallow
evaluation, a PEG tube was placed for enteral feeding
successfully.

PENDING Results: Repeat urine culture

Transition of care issues:
Needs repeat CBC in [**1-5**] weeks to ensure downtrending platelets
and WBCs

1. Dysphagia screening before any PO intake? (x) Yes - () No
2. DVT Prophylaxis administered? (x) Yes - () No
3. Antithrombotic therapy administered by end of hospital day 2?
(x) Yes - () No
4. LDL documented? (x) Yes (LDL = 77) - () No
5. Intensive statin therapy administered? (for LDL > 100) () Yes
- (x) No (if LDL >100, Reason Not Given: )
6. Smoking cessation counseling given? () Yes - (x) No (Reason
() non-smoker - (x) unable to participate)
7. Stroke education given? (x) Yes - () No
8. Assessment for rehabilitation? (x) Yes - () No
9. Discharged on statin therapy? (x) Yes - () No (if LDL >100,
Reason Not Given: )
10. Discharged on antithrombotic therapy? (x) Yes
11. Discharged on oral anticoagulation for patients with atrial
fibrillation/flutter? () Yes - () No - (x) N/A

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from  PCP.
1. Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q6H prn pain
2. Citalopram 40 mg PO DAILY
3. BuPROPion (Sustained Release) 100 mg PO BID
4. Verapamil SR 180 mg PO Q24H
5. Simvastatin 20 mg PO DAILY
6. Tiotropium Bromide 1 CAP IH DAILY
7. Lisinopril 40 mg PO DAILY
8. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
9. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
10. Hydrochlorothiazide 25 mg PO DAILY
11. Cyclobenzaprine 10 mg PO HS
12. Lorazepam 0.5 mg PO HS
13. Aspirin 81 mg PO DAILY


Discharge Medications:
1. Simvastatin 20 mg PO DAILY
2. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN wheezing
3. Aspirin 325 mg PO DAILY
4. Tiotropium Bromide 1 CAP IH DAILY
5. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
6. Lisinopril 20 mg PO DAILY
7. OxycoDONE (Immediate Release)  2.5 mg PO TID


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 1293**] - [**Location (un) 8957**]

Discharge Diagnosis:
Left sided Stoke (left frontal, insular cortex extending into
left temporal lobe)


Discharge Condition:
spontaneously moves both right and left UE/LE.  Remains Globally
aphasic.  no clear gaze preference. Does not follow commands.
Withdrawals both legs to scratch. now with social wave.


Discharge Instructions:
Dear Ms [**Known lastname 111870**],

You were admitted for an ischemic stroke.  It is unclear what
the cause of this was. You were continued on Aspirin for stroke
protection.   Your stroke risk factors were checked.  You should
continue to not smoke.  Your cholesterol was 77 You were
continued on a statin.      You had a cardiac echocardiogram
which demonstrated no cardioembolic source. You were checked for
blood glucose control with a HgB A1c.   The level was 5.6 which
is normal. Because you were unable to swallow safely you
received nutrition through a tube in your mouth and then a PEG
tube was placed directly in your stomach through the skin. You
also had some abnormal blood tests for which we consulted the
hematology service. They feel that this is most likely due to a
reaction of your body to acute illness but you will need to
follow up with them when you are better. You need to continue
your blood pressure control.

It was a pleasure taking care of you.


Followup Instructions:
You should follow up with Dr. [**Last Name (STitle) **] on [**8-20**] 4:30pm

call to register ASAP [**Telephone/Fax (1) 87261**]

Call Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] office of Hematology  [**Telephone/Fax (1) 9645**] if you
decide to persue further evaluation for your elevated white
blood cells and platelet or if CBC in 1 month is still not
normal.


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]
{'Cerebral embolism with cerebral infarction,Urinary tract infection, site not specified,Closed fracture of multiple ribs, unspecified,Aphasia,Other musculoskeletal symptoms referable to limbs,Other dissociated deviation of eye movements,Unspecified essential hypertension,Backache, unspecified,Other chronic pain,Aftercare for healing traumatic fracture of upper arm,Late effects of accidental fall,Other specified hypotension,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Dysphagia, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],History of fall,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Personal history of traumatic fracture,Anemia of other chronic disease,Genetic anomalies of leukocytes,Essential thrombocythemia,Personal history of malignant neoplasm of thyroid,Other specified complications of procedures not elsewhere classified,Injury of face and neck,Accidental cut, puncture, perforation or hemorrhage during other specified medical care,Unspecified disorder of kidney and ureter'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Global Aphasia, Right Sided Weakness

PRESENT ILLNESS: Ms. [**Known lastname 111870**] is a 69 year-old right handed woman with past
medical history of hypertension, chronic back pain and a left
shoulder fracture one month prior who presented as an OSH
transfer Code Stroke for reported sudden onset aphasia and right
sided weakness.  She was last reported without symptoms (as
noted by husband) at 1700hrs on [**2115-6-5**].  After finding her at
1730hrs on the floor not speaking, he called EMS who on arrival
noted right sided weakness and a left gaze deviation.  Her GCS
per EMS was 3, and on evaluating her, witnessed a systolic blood
pressure drop to 89 with respiratory rate decrease.  EMS
intubated the patient in the field and brought her to [**Hospital1 5979**].  A CT scan obtained at [**Hospital3 **] was negative
for hemorrhage or acute process (comfirmed upon [**Hospital1 18**] review),
but because she was intubated [**Hospital1 487**] reported inability to
obtain a clear exam to warrant tPA administration.

MEDICAL HISTORY: - HTN
- chronic back pain
- tripped down stairs 1 month ago resulting in L shoulder fx
- Thyroid cancer s/p lobectomy
- COPD
- chronic leukocytosis

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from  PCP.
1. Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q6H prn pain
2. Citalopram 40 mg PO DAILY
3. BuPROPion (Sustained Release) 100 mg PO BID
4. Verapamil SR 180 mg PO Q24H
5. Simvastatin 20 mg PO DAILY
6. Tiotropium Bromide 1 CAP IH DAILY
7. Lisinopril 40 mg PO DAILY
8. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
9. Fluticasone Propionate 110mcg 2 PUFF IH [**Hospital1 **]
10. Hydrochlorothiazide 25 mg PO DAILY
11. Cyclobenzaprine 10 mg PO HS
12. Lorazepam 0.5 mg PO HS
13. Aspirin 81 mg PO DAILY

ALLERGIES: Iodine

PHYSICAL EXAM: Vitals: T: 98.0  P: 68  R: 20  BP: 110/62 SaO2: 98% on ETT
General: somnolent, intubated, even off sedation, slow to arouse
to sternal rub
HEENT: NC/AT, no scleral icterus noted, ETT in place
Neck: Supple, no carotid bruits appreciated.
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted, old surgiucal scar notes in RLQ
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: no history of neurologic diseases

SOCIAL HISTORY: lives with husband, independent
quit smoking 1 year ago 

### Response:
{'Cerebral embolism with cerebral infarction,Urinary tract infection, site not specified,Closed fracture of multiple ribs, unspecified,Aphasia,Other musculoskeletal symptoms referable to limbs,Other dissociated deviation of eye movements,Unspecified essential hypertension,Backache, unspecified,Other chronic pain,Aftercare for healing traumatic fracture of upper arm,Late effects of accidental fall,Other specified hypotension,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Dysphagia, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],History of fall,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Personal history of traumatic fracture,Anemia of other chronic disease,Genetic anomalies of leukocytes,Essential thrombocythemia,Personal history of malignant neoplasm of thyroid,Other specified complications of procedures not elsewhere classified,Injury of face and neck,Accidental cut, puncture, perforation or hemorrhage during other specified medical care,Unspecified disorder of kidney and ureter'}
