CHIEF COMPLAINT: Syncope and fall

PRESENT ILLNESS: This is an 86 year old man who was moving mattresses with his
wife yesterday. [**Name2 (NI) **] he was was seated in a chair and he had
the sudden onset of blurred vision, and felt "as if [his] head
was swimming".  He stood up, then fell backwards, striking his
head on the floor.  He does not remember anything from just
prior to fall until EMS arrived.  He complained of  neck
stiffness and pain.  He takes coumadin for carotid stenosis with
prior cerebral infarct and he was given vitamin-K and FFP x 2
units upon arrival to [**Hospital1 18**].  CT head done showed blood inleft
lateral ventricle and neurosurgery was called for consult.

MEDICAL HISTORY: - Left carotid stenosis (99%)
- Stroke [**2121**] (coumadin d/c'd for bladder surgery)
- atrial fibrillation/atrial flutter
- HTN
- Intraventicular hemorrhage ([**2123**])
- s/p cholecystectomy
- Angina
- [**7-/2123**] EF 65% from OSH

MEDICATION ON ADMISSION: asa
coumadin
atenolol 25 mg daily
simvastatin 20 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM:
Temp: 98.3 HR: 86 BP: 150/100 Resp: 20 O(2)Sat: 95 Normal
Pupils equally round and reactive to light
Visual fields are full to confrontation
Extraocular movements intact bilaterally
no abnormal nystagmus
Facial strength and sensation intact and symmetric
Palatal elevation symmetrical
Tongue midline without fasciculations
C-collar in place
No pronator drift
Grip strength full bil
IP full bilateral
Coordination nl on finger-nose, rapid alternating movements

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: - Tobacco: 60 pack year history
- Alcohol: unknown
- Illicits: unknown
Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute diastolic heart failure,Atrial flutter,Intestinal infection due to Clostridium difficile,Delirium due to conditions classified elsewhere,Unspecified hypertensive heart disease with heart failure,Other late effects of cerebrovascular disease,Muscle weakness (generalized),Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Dysphagia, oropharyngeal phase,Hypoxemia,Leukocytosis, unspecified,Tobacco use disorder,Pure hypercholesterolemia,Other fall,Do not resuscitate status,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of bladder
Brain hem NEC w/o coma,Pneumonia, organism NOS,Food/vomit pneumonitis,Ac diastolic hrt failure,Atrial flutter,Int inf clstrdium dfcile,Delirium d/t other cond,Hyp ht dis NOS w ht fail,Late effect CV dis NEC,Muscle weakness-general,Ocl mlt bi art wo infrct,Chr airway obstruct NEC,Dysphagia, oropharyngeal,Hypoxemia,Leukocytosis NOS,Tobacco use disorder,Pure hypercholesterolem,Fall NEC,Do not resusctate status,Long-term use anticoagul,Hx of bladder malignancy
Admission Date:  [**2123-12-27**]              Discharge Date:   [**2124-1-11**]

Date of Birth:  [**2037-1-30**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 603**]
Chief Complaint:
Syncope and fall

Major Surgical or Invasive Procedure:
None

History of Present Illness:
This is an 86 year old man who was moving mattresses with his
wife yesterday. [**Name2 (NI) **] he was was seated in a chair and he had
the sudden onset of blurred vision, and felt "as if [his] head
was swimming".  He stood up, then fell backwards, striking his
head on the floor.  He does not remember anything from just
prior to fall until EMS arrived.  He complained of  neck
stiffness and pain.  He takes coumadin for carotid stenosis with
prior cerebral infarct and he was given vitamin-K and FFP x 2
units upon arrival to [**Hospital1 18**].  CT head done showed blood inleft
lateral ventricle and neurosurgery was called for consult.


Past Medical History:
- Left carotid stenosis (99%)
- Stroke [**2121**] (coumadin d/c'd for bladder surgery)
- atrial fibrillation/atrial flutter
- HTN
- Intraventicular hemorrhage ([**2123**])
- s/p cholecystectomy
- Angina
- [**7-/2123**] EF 65% from OSH


Social History:
- Tobacco: 60 pack year history
- Alcohol: unknown
- Illicits: unknown


Family History:
Non-contributory

Physical Exam:
ADMISSION EXAM:
Temp: 98.3 HR: 86 BP: 150/100 Resp: 20 O(2)Sat: 95 Normal
Pupils equally round and reactive to light
Visual fields are full to confrontation
Extraocular movements intact bilaterally
no abnormal nystagmus
Facial strength and sensation intact and symmetric
Palatal elevation symmetrical
Tongue midline without fasciculations
C-collar in place
No pronator drift
Grip strength full bil
IP full bilateral
Coordination nl on finger-nose, rapid alternating movements

DISCHARGE EXAM - Unchanged from above, except as below:


Pertinent Results:
Labs on admission:
[**2123-12-27**] 05:30PM BLOOD WBC-13.3* RBC-4.41* Hgb-13.7* Hct-41.4
MCV-94 MCH-31.1 MCHC-33.2 RDW-12.9 Plt Ct-152
[**2123-12-27**] 05:30PM BLOOD Neuts-88.6* Lymphs-7.2* Monos-3.3 Eos-0.4
Baso-0.4
[**2123-12-27**] 05:30PM BLOOD PT-19.5* PTT-34.2 INR(PT)-1.8*
[**2123-12-27**] 05:30PM BLOOD Glucose-91 UreaN-28* Creat-1.0 Na-145
K-4.0 Cl-107 HCO3-26 AnGap-16
[**2123-12-27**] 05:30PM BLOOD Calcium-8.9 Phos-2.3* Mg-1.9
[**2123-12-30**] 09:08AM BLOOD Type-ART pO2-58* pCO2-36 pH-7.44
calTCO2-25 Base XS-0 Intubat-NOT INTUBA
[**2123-12-30**] 09:08AM BLOOD Lactate-1.2
[**2123-12-30**] 09:08AM BLOOD O2 Sat-90
[**2123-12-27**] 07:55PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.015
[**2123-12-27**] 07:55PM URINE Blood-NEG Nitrite-NEG Protein-TR
Glucose-NEG Ketone-40 Bilirub-NEG Urobiln-2* pH-6.5 Leuks-TR
[**2123-12-27**] 07:55PM URINE RBC-1 WBC-2 Bacteri-NONE Yeast-NONE Epi-0

IMAGING:

CT Head ([**2123-12-28**]):
IMPRESSION:
1. Increased intraventricular hemorrhage, involving the
occipital ventricular horns.
2. In comparison with the prior examination, the ventricular
frontal horns
appear slightly larger, with evidence of new areas of hemorrhage
along the
interventricular septum

MRA neck ([**2123-12-27**]):
1. Severe left common carotid artery bifurcation disease with
high grade
stenosis and long string sign of the left internal carotid
artery. There is reconstitution of the supraclinoid left ICA.
CTA is recommended for further  evaluation. The V4 segment of
the left subclavian is tortuous and narrow which may
hypoplastic with possible atherosclerotic disease.
3. Atherosclerosis of the right CCA and origin of the bilateral
vertebral
arteries but no significant stenosis.

MRI c-spine ([**2123-12-27**])
1. No evidence of fracture.
2. Multilevel degenerative changes of the cervical spine as
described in
detail above.
3. At C6-C7, there is a disc osteophyte complex flattening the
spinal cord and causing mild spinal canal stenosis as well as
bilateral uncovertebral and facet arthrosis causing mild
bilateral neural foraminal narrowing

Carotid Duplex ([**2123-12-28**]):
1. Extensive homogenous plaque along the left ICA, with a very
high-grade
stenosis or near occlusion (99%). These findings are consistent
with MRI
findings from [**2123-12-27**].
2. 0 to 40% stenosis in the right ICA

CT head ([**2123-12-29**]):
Stable appearance of large intraventricular hemorrhage, with no
evidence of obstructive hydrocephalus or new bleed.

CTA chest ([**2123-12-29**]):
IMPRESSION:
1. No definite pulmonary embolism. Smaller subsegmental branches
of the
lower lobes are slightly limited secondary to respiratory
motion.
2. Secretions in the left mainstem bronchus as well as bilateral
small lower
lobe consolidations, which are likely related to aspiration.
3. Emphysema, and a 3 mm lingular nodule. Given these findings,
a repeat
chest CT is recommended in 12 months in order to document
stability.
4. Small bilateral pleural effusions.
5. Minimal mediastinal lymphadenopathy.
6. Extensive atherosclerosis.

CXR ([**2123-12-30**]):
IMPRESSION:
1) Dense right lower lobe opacity and left lower lobe
consolidation concerning
for pneumonia.
2) Bilateral pleural effusions and bibasilar atelectasis.
3) Mild vascular congestion compatible with previous CT imaging.


CT Head ([**2123-12-30**]):
IMPRESSION:
1. No significant change in the size or extent of the
intraventricular
hemorrhage.
2. No evidence of obstructing hydrocephalus.

CT Head ([**2124-1-1**]): Little change in size or extent of
intraventricular hemorrhage.

CXR ([**2124-1-6**]): The current study demonstrates resolution of
previously demonstrated pulmonary edema. Heart size is mildly
enlarged, unchanged. Mediastinum is unremarkable. Left pleural
effusion is noted, at least partially loculated.  As compared to
chest CT from [**2123-12-29**], the amount of the pleural
effusion has substantially increased. Anterior consolidation,
better appreciated on the lateral view relate to left anterior
upper lobe pleural calcification.

CT Head ([**2124-1-7**]):
1. Appropriate evolution of the intraventricular hemorrhage.
2. No new foci of hemorrhage.

CXR ([**2124-1-8**]): Compared to the prior study there has been
interval decrease in the bilateral pleural effusions. These are
now only visualized on the lateral film and are poorly seen on
the frontal film. There is a subsegmental atelectasis in both
lower lungs. A 10-mm opacity seen in the left mid lung that was
not present on the film from two days prior or chest CT likely
represents confluence of shadows but attention should be paid to
this region on followup.

Discharge labs:

Brief Hospital Course:
86 year old male with history of Afib/flutter on coumadin, HTN,
stroke in [**2121**], and known carotid stenosis s/p fall on [**12-27**]
where he suffered a left intraventricular hemmorhage with a
hospital course c/b HCAP, atrial flutter with RVR and presumed
C. diff.

Active Issues:

#Intraventricular hemorrhage: Pt's INR was corrected to 1.2 with
FFP and Vitamin K for 3 days total after admission. A Cervical
MRI was obtained and ruled out ligamentous injury and his collar
was removed on [**2123-12-28**]. On that morning he was alert but had
emesis and went to CT for a repeat study which showed an
increase in ventricular hemorrhage with extension to the right
venticle. He was examined afterwards while he was getting his
carotid duplex as part of the syncope work up. He was lethargic
and had nausea but was otherwise stable. He was transfered to
the Trauma ICU for Q1 hr neuro checks. He remained
neurologically intact.  CT on [**12-29**] was without change and he was
trasnfered to the floor with Q2 hr neuro checks. He had a repeat
CT on [**2123-12-30**] which ruled out hydrocephalus prior to transfer to
the medicine service. Subsequent head CT on [**2124-1-7**], which was
ordered because Mr. [**Known lastname **] complained of worsening headache,
showed interval improvement of intraventricular hemorrhage.  He
was continued on Aspirin 325mg daily and heparin for DVT
prophylaxis, which was acceptable according to the neurosurgery
service.  His warfarin was held during this admission and will
be stopped at discharge.  We attempted to maintain his blood
pressure below 160 given the bleed.  He will follow-up with
neurosurgery as an outpatient.

#HCAP with parapneumonic effusion: Pt was found to be hypoxic
with a desaturation to 87% on wednesday [**12-29**], collaborated with
ABG thursday morning showing p02 of 58.  On exam he continued to
have poor air entry and showed evidence of bibasilar
consolidations.  No PE was seen on CTA.  Patient was mentating
clearly and was otherwise HD stable.  There was concern for
aspiration and speech&swallow was consulted and there was note
of silent aspiration with thin liquids on subsequent video
swallow.  He received an 8 day course of vancomycin and Zosyn
for hospital acquired pneumonia given that he was int he
hospital over 72 hours when the pneumonia was diagnosed.  A
parapneumonic effusion was noted on CXR, more prominent on the
left than the right.  This improved on subsequent CXR with
antibiotics and did not require thoracentesis or drainage.  At
discharge, his hypoxia had resolved and he was maintaining O2
saturation on room air.

#Atrial flutter with:  Patient has known atrial flutter prior to
admission for which he was anticoagulated with warfarin.  On the
afternoon of [**12-29**] he developed HTN with SBP>170 and tachycardia
not responsive to metoprolol IV or fluid boluses.  He was
subsequently transferred to the MICU and started on a Diltiazem
drip, which effectively decreased his HR to the 70's.  After
transfer to the medicine his HR remained difficult to control
while on PO diltiazem and PO metoprolol, HR was consistently in
the 120-130s with flutter in 2:1 block.  Electrophysiology was
consulted who felt that in the setting of medical illness, his
atrial flutter would be difficult to control and he was
transtioned to metoprolol XL 200mg daily, diltiazem was
discontinued.  At discharge, his HR remained in the 100-120s.
He may be a candidate for an ablation procedure in the future
once he is able to be anticoagulated.

#Hypertension: Goal SBP after his intraventricular hemorrhage
was 90-160.  This was initially managed with
metoprolol/diltiazem which was later switched to metoprolol
XL/lisinopril after EP consult.  His BP remained elevated, with
SBP ranging from 120s up to 210s at one point.  He had one
episode of hypertensive emergency, SBP was in the 210s with
chest pain, headache and pulmonary edema.  He was trasnferred to
the MICU at this time when he was placed on a diltiazem drip and
subsequently transitioned to the PO metoprolol/PO diltiazem with
improvement in SBP to <160 and resolution of symptoms.  He was
also gently diuresed with Lasix for his pulmonary edema.  At
discharge, BP remained intermittently elevated to the 170-180s
with some readings in the 120s as well.  He will be discharged
on metoprolol XL 200mg daily and lisinopril 10mg daily.

#Carotid stenosis: MRA and carotid ultrasound was performed for
syncope work up. There was note of a 95-99% stenosis in the left
ICA and 50% stenosis of the right ICA. Vascular surgery was
consulted who felt that he might benefit for an intervention
once he was able to tolerate anticoagulation. He received
aspirin 325mg daily during this admission, which was acceptable
to the neurosurgery service.  He should have a follow-up CTA in
one month from discharge and will be seen by vascular surgery as
an outpatient.

#Concern for C. diff: After finishing his 8 day course of
vanc/Zosyn, he was noted to have a worsening leukocytosis and
began to have loose stool.  Given that he had recently received
broad spectrum antibiotics, he was empirically started on oral
vancomycin 125mg PO q6h.  The first C. diff toxin EIA was
negative.  His abdominal exam remained benign with no rebound or
tenderness.  He will continue a total 14 day course of PO
vancomycin after discharge.

#Dysphagia: Patient was evaluated by speech and swallow who
noted silent aspiration on two video swallow evaluations.  He
was maintained on a puree solid diet with thickeed liquids.

#leukocytosis: Patient was noted to have increasing leukocytosis
over days prior to discharge.  He was not febrile and his
pneumonia resolved. Given increased stooling he was started on
treatment for clostridium difficile. Urinalysis was checked on
[**1-11**] and was negative. Urine and blood cultures were also sent at
that time and were pending at time of discharge.  Most likely
this is due to clostridium dificile and/or intraventricular
hemorrhage.

#Code status this admission: DNR, OK to intubate (confirmed with
patient and daughter/HCP)

#Transitional Issues:
-Goal systolic BP is 90-160, if SBP consistently >160, he will
need uptitration of lisinopril or an additional antihypertensive
-Pt will follow up with neurosurgery in one month, at which time
CT scan of the head should be done and he should be considered
for re-initiation of anti-coagulation therapy
-Pt will follow up with vascular surgery regarding his carotid
stenosis
-Will need repeat CTA of neck in 1 month from discharge to
reassess carotid stenosis
-Control of his heart rate and atrial flutter should be
re-evaluated as an outpatient, he may benefit from a A.flutter
ablation once he is able to be anticoagulated
-At discharge, he will remain on ASA 325mg daily but his
warfarin has been stopped until he is seen by neurosurgery in
follow-up
-Lisinopril was changed to 10mg PO daily at discharge, this will
need further titration at rehab according to his BP
-Patient had urinary retention on day of discharge. Last void
with straight catheterization at approximately 4pm on [**1-11**]. If
does not urinate by midnight [**1-11**], consider bladder scan and
further straight catheterization. Insertion of foley catheter
and urology follow-up may be necessary.

Medications on Admission:
asa
coumadin
atenolol 25 mg daily
simvastatin 20 mg daily


Discharge Medications:
1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. acetaminophen 650 mg Tablet Sig: One (1) Tablet PO every four
(4) hours as needed for fever or pain.
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
6. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
7. ipratropium bromide 0.02 % Solution Sig: One (1) neb
Inhalation Q6H (every 6 hours) as needed for shortness of breath
or wheezing.
8. levalbuterol HCl 0.63 mg/3 mL Solution for Nebulization Sig:
One (1) neb Inhalation Q6H (every 6 hours) as needed for
wheezing or SOB.
9. vancomycin 125 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 10 days: Last dose on [**2124-1-21**].
10. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day) as needed for itching/redness.
11. metoprolol succinate 100 mg Tablet Extended Release 24 hr
Sig: Two (2) Tablet Extended Release 24 hr PO DAILY (Daily).
12. lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 5682**] Rehabilitation and Skilled Nursing Center - [**Hospital1 **]

Discharge Diagnosis:
Primary diagnoses:
Intraventricular hemorrhage
Hospital acquired pneumonia
Atrial fltuter with rapid ventricular rate
Presumed clostridium difficile infection

Secondary diagnoses:
Carotid Stenosis
Hypertension


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Lethargic but arousable.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Dear Mr. [**Known lastname **],

     It was a pleasure taking care of you during your
hospitalization at [**Hospital1 69**].  You
were admitted to the hospital after you fell at home.  We
discovered that you had developed a bleed within your head.  We
therefore stopped your Coumadin and monitored you closely in the
neurosurgery intensive care unit.  The bleed in your head
remained stable on imaging and you were transferred to the
neurology and then medical floor.
     However, you developed a fast heart rate and worsened
breathing.  We controlled your heart rate with medications and
treated you for pneumonia with IV antibiotics.  Slowly we were
able to control your heart rate and treat your infection and
your condition improved.
    You were also seen by Vascular surgery for a narrowing in
the carotid artery that supplies blood to your brain.  They
recommended that you follow up with vascular surgery in four
weeks to discuss the possibility of a surgery to open up this
vessel.
     There was also concern for a GI tract infection called C.
diff, which can occur after treatment with powerful antibiotics.
 We treated this with an oral antibiotic. At discharge, you will
continue to take this oral antibiotic for a total of 14 days.

You should not take any coumadin until you are evaluated in one
month by neurosurgery.

PLEASE NOTE THE FOLLOWING MEDICATION CHANGES:
-STOP Coumadin
-STOP Atenolol
-START metoprolol XL 200mg daily
-START lisinopril 10mg by mouth daily
-START vancomycin 125mg by mough every 6 hours for 10 more days

Followup Instructions:
Name: [**Last Name (LF) **],[**First Name3 (LF) 674**]
Specialty: INTERNAL MEDICINE
Location: [**Location (un) 2274**] [**Location (un) **]
Address: 2 [**Location (un) **] CENTER DR, [**Location (un) **],[**Numeric Identifier 29936**]
Phone: [**Telephone/Fax (1) 79695**]
**Please discuss with the staff at the facility the need for a
follow up appointment with your PCP when you are ready for
discharge.**
**Please make an appointment with vascular surgery at
[**Hospital1 2025**]-[**Location (un) 4047**] within 4 weeks of leaving the hospital regarding
your carotid stenosis, their phone number is [**Telephone/Fax (1) 92481**]**

Location: [**Hospital1 18**]-DIVISION OF NEUROSURGERY
Address: [**Doctor First Name **], STE 3B, [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 1669**]
**We are working on a follow up appointment with Neurosurgery
within 2 weeks . You will be called at the facility with the
appointment. If you have not heard from the office within 2 days
or have any questions, please call the number above.**
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute diastolic heart failure,Atrial flutter,Intestinal infection due to Clostridium difficile,Delirium due to conditions classified elsewhere,Unspecified hypertensive heart disease with heart failure,Other late effects of cerebrovascular disease,Muscle weakness (generalized),Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Dysphagia, oropharyngeal phase,Hypoxemia,Leukocytosis, unspecified,Tobacco use disorder,Pure hypercholesterolemia,Other fall,Do not resuscitate status,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of bladder'}


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: Syncope and fall

PRESENT ILLNESS: This is an 86 year old man who was moving mattresses with his
wife yesterday. [**Name2 (NI) **] he was was seated in a chair and he had
the sudden onset of blurred vision, and felt "as if [his] head
was swimming".  He stood up, then fell backwards, striking his
head on the floor.  He does not remember anything from just
prior to fall until EMS arrived.  He complained of  neck
stiffness and pain.  He takes coumadin for carotid stenosis with
prior cerebral infarct and he was given vitamin-K and FFP x 2
units upon arrival to [**Hospital1 18**].  CT head done showed blood inleft
lateral ventricle and neurosurgery was called for consult.

MEDICAL HISTORY: - Left carotid stenosis (99%)
- Stroke [**2121**] (coumadin d/c'd for bladder surgery)
- atrial fibrillation/atrial flutter
- HTN
- Intraventicular hemorrhage ([**2123**])
- s/p cholecystectomy
- Angina
- [**7-/2123**] EF 65% from OSH

MEDICATION ON ADMISSION: asa
coumadin
atenolol 25 mg daily
simvastatin 20 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM:
Temp: 98.3 HR: 86 BP: 150/100 Resp: 20 O(2)Sat: 95 Normal
Pupils equally round and reactive to light
Visual fields are full to confrontation
Extraocular movements intact bilaterally
no abnormal nystagmus
Facial strength and sensation intact and symmetric
Palatal elevation symmetrical
Tongue midline without fasciculations
C-collar in place
No pronator drift
Grip strength full bil
IP full bilateral
Coordination nl on finger-nose, rapid alternating movements

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: - Tobacco: 60 pack year history
- Alcohol: unknown
- Illicits: unknown 

### Response:
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute diastolic heart failure,Atrial flutter,Intestinal infection due to Clostridium difficile,Delirium due to conditions classified elsewhere,Unspecified hypertensive heart disease with heart failure,Other late effects of cerebrovascular disease,Muscle weakness (generalized),Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Dysphagia, oropharyngeal phase,Hypoxemia,Leukocytosis, unspecified,Tobacco use disorder,Pure hypercholesterolemia,Other fall,Do not resuscitate status,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of bladder'}
