CHIEF COMPLAINT: Dizziness

PRESENT ILLNESS: 80 F who presented from home with sudden onset of weakness and
dizziness and tremors last night. No LOC. almost fainted. No CP,
slight SOB and abd pain. +N/no vomiting. No D/back pain. States
she has had an "awful cold" for 1 week. Mild HA 2 days ago, none
now. No neck pain. Fevers. +cough, non productive. Denies any
changed in vision. Similar admission in [**Month (only) 216**], thought to be
[**12-21**] infection and hypoglycemia. BG 218. BM QOD. also with some
diaphroesis at that time.
.
In the ED, 102.7-->99.5, 105,  197/81, 16, 99 % RA.
Vanco/bactrim given (PCN all) for meningitis. Decadron 10 mg as
well (unclear why). LP done which did not suggest infection.
.
Initially, thought was to d/c home if LP negative however
attending uncomfortable as pt appears dry, WBC, with fever.
.
Admitted for fever.

MEDICAL HISTORY: 1. Coronary artery disease; status post myocardial
infarction in [**2102**] (silent). cath [**4-21**]: 2-vessel
disease, stent in the LCx and angioplasty of OM1, EF=19%.
2. Congestive heart failure (reported EF 20%, but more recent
echo states ?30% with difficult visualization).
3. flash pulmonary edema
4. recent UTI (dx'ed [**2130-5-22**]) on levofloxacin
5. s/p fall [**3-23**] without trauma in setting of lasix increase
6. PVD: s/p R fem-[**Doctor Last Name **] and L fem-DP bypass grafts. s/p R 5 toe
amputation and L one toe amputation.
7. DM2
8. HTN
9. Heparin-induced thrombocytopenia.
10. DJD/osteoarthritis B knees
11. s/p both hip fx, shoulder fx and ?proximal humerus fx (pt
denies).
12. R foot cellulitis.
13. (COPD - pt denies).
14. appendectomy.
15. cholecystectomy.
16. hysterectomy.
17. R eye cataract surgery [**4-23**]
18. anemia - baseline Hct 30-33
19. ARF - baseline Cr 1.1

MEDICATION ON ADMISSION: ASPIRIN 325MG qd
ATORVASTATIN CALCIUM 10MG qd
AZELASTINE HCL 137 mcg/SPRAY--[**11-20**] squirts in each nostril up to
twice a day as needed for nasal congestion
CLOPIDOGREL BISULFATE 75MG qd
DIGOXIN 125MCG qd
FUROSEMIDE 60 mg qd
ISOSORBIDE MONONITRATE 30MG qd
LISINOPRIL 20MG qd
METOPROLOL SUCCINATE 50MG-- qd
MULTIVITAMINS
NPH (HUMAN) 20 units qam, 13 units qpm

ALLERGIES: Penicillins / Terbutaline / Egg/Pro / Atenolol / Nifedipine /
Tetracyclines / Heparin Agents

PHYSICAL EXAM: On Admission:
Temp 98.5
BP 140/86
Pulse 68
Resp 18
O2 sat 99% RA
Gen - Alert, no acute distress, sleeping but arousable
HEENT - post surgical pupil, extraocular motions intact,
anicteric, mucous membranes dry
Neck - hard to assess as pt with lip trmeor, no cervical
lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, [**12-25**] SE murmur across precordium, no
rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally

FAMILY HISTORY: twin sister died last year of colon cancer. otherwise
unremarkable

SOCIAL HISTORY: The patient lives at home with her sister. She has a VNA qweek
that helps to draw up her insulin. She is able to complete daily
ADLs. She walks with a cane. She denies tobacco and alcohol use.
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Bacteremia,Other pulmonary insufficiency, not elsewhere classified,Acute kidney failure, unspecified,Ulcer of heel and midfoot,Dehydration,Blood in stool,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Anticoagulants causing adverse effects in therapeutic use,Long-term (current) use of insulin
Subendo infarct, initial,CHF NOS,Bacteremia,Other pulmonary insuff,Acute kidney failure NOS,Ulcer of heel & midfoot,Dehydration,Blood in stool,Hypertension NOS,Periph vascular dis NOS,Other staphylococcus,Adv eff anticoagulants,Long-term use of insulin
Admission Date:  [**2130-9-17**]              Discharge Date:   [**2130-9-22**]


Service: MEDICINE

Allergies:
Penicillins / Terbutaline / Egg/Pro / Atenolol / Nifedipine /
Tetracyclines / Heparin Agents

Attending:[**First Name3 (LF) 45**]
Chief Complaint:
Dizziness

Major Surgical or Invasive Procedure:
Cath?

History of Present Illness:
80 F who presented from home with sudden onset of weakness and
dizziness and tremors last night. No LOC. almost fainted. No CP,
slight SOB and abd pain. +N/no vomiting. No D/back pain. States
she has had an "awful cold" for 1 week. Mild HA 2 days ago, none
now. No neck pain. Fevers. +cough, non productive. Denies any
changed in vision. Similar admission in [**Month (only) 216**], thought to be
[**12-21**] infection and hypoglycemia. BG 218. BM QOD. also with some
diaphroesis at that time.
.
In the ED, 102.7-->99.5, 105,  197/81, 16, 99 % RA.
Vanco/bactrim given (PCN all) for meningitis. Decadron 10 mg as
well (unclear why). LP done which did not suggest infection.
.
Initially, thought was to d/c home if LP negative however
attending uncomfortable as pt appears dry, WBC, with fever.
.
Admitted for fever.

Past Medical History:
1. Coronary artery disease; status post myocardial
infarction in [**2102**] (silent). cath [**4-21**]: 2-vessel
disease, stent in the LCx and angioplasty of OM1, EF=19%.
2. Congestive heart failure (reported EF 20%, but more recent
echo states ?30% with difficult visualization).
3. flash pulmonary edema
4. recent UTI (dx'ed [**2130-5-22**]) on levofloxacin
5. s/p fall [**3-23**] without trauma in setting of lasix increase
6. PVD: s/p R fem-[**Doctor Last Name **] and L fem-DP bypass grafts. s/p R 5 toe
amputation and L one toe amputation.
7. DM2
8. HTN
9. Heparin-induced thrombocytopenia.
10. DJD/osteoarthritis B knees
11. s/p both hip fx, shoulder fx and ?proximal humerus fx (pt
denies).
12. R foot cellulitis.
13. (COPD - pt denies).
14. appendectomy.
15. cholecystectomy.
16. hysterectomy.
17. R eye cataract surgery [**4-23**]
18. anemia - baseline Hct 30-33
19. ARF - baseline Cr 1.1

Social History:
The patient lives at home with her sister. She has a VNA qweek
that helps to draw up her insulin. She is able to complete daily
ADLs. She walks with a cane. She denies tobacco and alcohol use.



Family History:
twin sister died last year of colon cancer. otherwise
unremarkable

Physical Exam:
On Admission:
Temp 98.5
BP 140/86
Pulse 68
Resp 18
O2 sat 99% RA
Gen - Alert, no acute distress, sleeping but arousable
HEENT - post surgical pupil, extraocular motions intact,
anicteric, mucous membranes dry
Neck - hard to assess as pt with lip trmeor, no cervical
lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, [**12-25**] SE murmur across precordium, no
rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally

Neuro - Alert and oriented x 3, cranial nerves [**12-31**] intact,
upper and lower extremity strength 5/5 bilaterally, sensation
grossly intact
Skin - No rash

Pertinent Results:
[**2130-9-16**] 06:45PM BLOOD WBC-18.8*# RBC-4.33# Hgb-13.6# Hct-38.9
MCV-90 MCH-31.4 MCHC-34.9 RDW-13.1 Plt Ct-153
[**2130-9-16**] 06:45PM BLOOD Neuts-93.9* Bands-0 Lymphs-3.7*
Monos-1.8* Eos-0.5 Baso-0.1
[**2130-9-16**] 06:45PM BLOOD Glucose-204* UreaN-33* Creat-1.2* Na-140
K-4.6 Cl-100 HCO3-28 AnGap-17
[**2130-9-16**] 06:45PM BLOOD ALT-14 AST-20 LD(LDH)-249 CK(CPK)-77
AlkPhos-113 Amylase-50 TotBili-0.6
[**2130-9-16**] 06:45PM BLOOD CK-MB-4 cTropnT-0.01
[**2130-9-16**] 06:45PM BLOOD Albumin-4.1 Calcium-9.6 Phos-2.5* Mg-1.7
[**2130-9-16**] 07:03PM BLOOD Glucose-207* Lactate-2.1* K-4.7
*
[**2130-9-17**] 07:55PM BLOOD Lactate-1.8
[**2130-9-17**] 11:20AM BLOOD WBC-15.8* RBC-3.71* Hgb-11.4* Hct-33.9*
MCV-91 MCH-30.9 MCHC-33.8 RDW-13.3 Plt Ct-119*
[**2130-9-17**] 05:10PM BLOOD Hct-31.3*
[**2130-9-17**] 05:10PM BLOOD PT-13.3 PTT-26.9 INR(PT)-1.2
[**2130-9-17**] 11:20AM BLOOD Glucose-469* UreaN-35* Creat-1.4* Na-138
K-4.1 Cl-101 HCO3-24 AnGap-17
[**2130-9-17**] 07:41PM BLOOD Glucose-269* UreaN-34* Creat-1.3* Na-139
K-4.1 Cl-103 HCO3-24 AnGap-16
[**2130-9-17**] 11:20AM BLOOD CK(CPK)-161*
[**2130-9-17**] 03:15PM BLOOD CK(CPK)-143*
[**2130-9-17**] 09:30PM BLOOD CK(CPK)-119
[**2130-9-17**] 11:20AM BLOOD CK-MB-17* MB Indx-10.6* cTropnT-0.39*
[**2130-9-17**] 03:15PM BLOOD CK-MB-13* MB Indx-9.1* cTropnT-0.35*
[**2130-9-17**] 09:30PM BLOOD CK-MB-10 MB Indx-8.4* cTropnT-0.34*
[**2130-9-17**] 11:20AM BLOOD Calcium-8.2* Phos-3.7 Mg-1.8
[**2130-9-17**] 07:41PM BLOOD Calcium-8.4 Phos-2.8 Mg-2.7*
*
[**2130-9-18**] 08:50AM BLOOD WBC-13.2* RBC-3.64* Hgb-11.2* Hct-32.3*
MCV-89 MCH-30.8 MCHC-34.7 RDW-13.1 Plt Ct-130*
[**2130-9-18**] 08:50AM BLOOD Neuts-91.1* Bands-0 Lymphs-6.6* Monos-2.0
Eos-0.3 Baso-0
[**2130-9-18**] 08:50AM BLOOD PT-19.6* PTT-74.4* INR(PT)-2.7
[**2130-9-18**] 08:50AM BLOOD Glucose-115* UreaN-31* Creat-1.2* Na-141
K-4.4 Cl-110* HCO3-23 AnGap-12
[**2130-9-18**] 08:50AM BLOOD Calcium-8.1* Phos-2.6* Mg-2.3
.

.
[**2130-9-18**]: CXR: IMPRESSION: Upper zone redistribution. Prominence
of hila, which may relate to underlying pulmonary hypertension.
Peribronchial cuffing, unchanged. No definite infiltrate.
.
[**9-16**]: Blood Cultures: positive for GPC in pairs and chains in
[**1-20**] bottles
.
[**9-16**]: LP:
ANALYSIS WBC RBC Polys Lymphs Monos
[**2126-9-17**]  1*  92     45    45
Total protein:  67
Glucose: 102
.
[**2130-9-22**]: TEE:
No spontaneous echo contrast is seen in the body of the left
atrium. No atrial septal defect is seen by 2D or color Doppler.
There is severe regional left ventricular systolic dysfunction.
There are complex (>4mm) atheroma in the aortic arch. There are
simple atheroma in the descending thoracic aorta. There are
three aortic valve leaflets. The aortic valve leaflets are
moderately thickened. There are filamentous strands on the
aortic leaflets consistent with Lambl's excresences (normal
variant) as well as a focal calcification on  the left coronary
cusp - no definite vegitation seen. No aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. No mass or
vegetation is seen on the mitral valve. There is a small
pericardial effusion. The absence of a vegetation by 2D
echocardiography does not exclude endocarditis if clinically
suggested.
.
CXR:
IMPRESSION: AP chest compared to [**9-19**]:
Pulmonary edema has largely cleared. A mild degree of residual
edema or atelectasis persists at the lung bases and there may be
a small right pleural effusion. The heart is top normal size and
unchanged. Slight rightward displacement of the trachea at the
thoracic inlet is longstanding, most likely due to an enlarged
left lobe of the thyroid gland
.
[**2130-9-16**]:
HEAD CT WITHOUT IV CONTRAST: No intra- or extra-axial
hemorrhage, mass effect, or shift of midline structures is
demonstrated. Differentiation of [**Doctor Last Name 352**] and white matter is
preserved. The sulci, ventricles, and basal cisterns are all
within normal limits. Polypoid mucosal thickening versus a
retention cyst is seen within the left maxillary sinus.
Remaining visualized paranasal sinuses and mastoid air cells are
clear. Calcification of the internal carotid arteries and
vertebral arteries bilaterally are again noted.

IMPRESSION: Stable appearance of the brain parenchyma without
evidence of intracranial hemorrhage or mass effect.
.


Brief Hospital Course:
80 F with multiple medical problems, including CAD, CHF, PVD,
DM2, who presented with a near syncopal episode, fever, elevated
WBC, some nausea today with poor PO intake who was found to have
GPC bacteremia and NSTEMI on [**9-17**].
.
#Fever:
Unclear source. Elevated WBC  with left shift suggesting
infection. viral infection possible (?influenza, although veyr
atypical story without myalgias); CAP (dry, no doesnt show on
CXR), occult bacteremia. Viral Cx (including influenza)
negative.
-UA and LP were negative in ED
-[**12-21**] postive for GPC in pairs and clusters - IDd as Coag
negative Staphlococcus -> started on Vancomycin 1g q 24 -
renally dosed -> then switched to Levofloxacin to one day since
this bacteria was sensitive to levoquin. However, on [**2130-9-21**], an
ID consult recommended that this bacteria was probably not Staph
Epi since its sensitivity spectrum was not typical for Staph
Epidermidis. And thus, convering with Levofloxacin was not
optimal coverage. Hence, it was recommended that the patient
undergo 4 weeks of treatment for this with IV Vancomycin and
undergo a TEE. The TEE was not suggestive of endocarditis or
vegetations. The patient will be followed up by Dr. [**First Name (STitle) 2505**] in the
[**Hospital **] clinic at [**Hospital1 18**] and he will arrange for patient's follow up.
Please check weekly CBC with diff, BUN and Cr and Vancomycin
troughs. Please fax to [**Telephone/Fax (1) 1419**].
.
- Newly diagnosed NSTEMI
- Cardiology aware and she was placed on bivalirudin and pre
cath hydration - in expectation of cath on [**2130-9-18**].
- had Plymorphic VTach, NSVT x 3 other episodes - all
aymptomatic - no EKG changes, except for once incident of PVC
- CEs stabilized (i.e. not rising)
- On [**2130-9-18**] - Pt had been getting pre-cath hydration and was
more than 1L positive over the past day. Pt had been afebrile x
2 days but had begun having large amounts of diarrhea over the
past 12 hours. Guaiac positive. She developed respiratory
distress and was not able to maintain O2 saturations. She is
DNR/DNI and was brought to the CCU for BiPap and possible
diuresis. CXR showed diffuse whitening of the R lung and
enlarged heart border without obvious cephalization of vessels.
In the unit, she was diuresed heavily until being transferred
back to the medical floor.
- at this time there is no plan for a cath as the impression is
that these events were secondary to demand from her infection.
Can consider outpatient stress workup - however, likely
situation was that patient had demand ischemia and risks would
outweigh benefits of any intervention.
.
#Nausea/tremor/LH: near syncope: likely secondary to infectious
sources. Patient febrile on arrival.
.
#CHF: dry by exam. Titrated to keep even/net negative to prevent
further occurrences of pleural effusions.
-cont digoxin. Monitored dig levels
.
#DM2: cont outpt regimen, SS insulin, NPH at home regimen
.
#FEN: [**Doctor First Name **], Lasix 20mg PO.
.
#Ppx: no heparin as HIT, PPI, bowel, pneumboots
.
#Code: Full
.
# Patient was educated on necessity of the antibiotic regimen
prescribed for her bacteremia. Since the TEE was not suggestive
of endocarditis/vegetations, patient will be treted for 4 weeks;
however, this will be further elucidated by Dr. [**First Name (STitle) 2505**] whom the
patient will follow up with in the [**Hospital **] clinic at [**Hospital1 18**]. The
patient was given a PICC line for the administration of
Vancomycin.

Medications on Admission:
ASPIRIN 325MG qd
ATORVASTATIN CALCIUM 10MG qd
AZELASTINE HCL 137 mcg/SPRAY--[**11-20**] squirts in each nostril up to
twice a day as needed for nasal congestion
CLOPIDOGREL BISULFATE 75MG qd
DIGOXIN 125MCG qd
FUROSEMIDE 60 mg qd
ISOSORBIDE MONONITRATE 30MG qd
LISINOPRIL 20MG qd
METOPROLOL SUCCINATE 50MG-- qd
MULTIVITAMINS
NPH (HUMAN) 20 units qam, 13 units qpm

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
5. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig:
One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
6. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
9. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
10. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
11. Ketorolac Tromethamine 0.5 % Drops Sig: One (1) drop
 Ophthalmic  nightly ().
12. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1)
Intravenous  Q 24H (Every 24 Hours) for 27 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 599**] of [**Location (un) 55**]

Discharge Diagnosis:
1. NSTEMI
2. Coagulase Negative Staph Bacteremia


Discharge Condition:
AAOx3
Ambulating
In good spirits, and conversant
Afebrile and hemodynamically stable


Discharge Instructions:
Weigh yourself every morning, call your doctor if your weight >
3 lbs.
*
Adhere to 2 gm sodium diet.
*
Please call your doctor if you start to de

Followup Instructions:
You have the following prescheduled appointments:

1. Provider: [**First Name8 (NamePattern2) 5257**] [**Last Name (NamePattern1) 5258**], [**Name12 (NameIs) 280**] Date/Time:[**2130-9-27**] 12:00
2. Provider: [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1849**], M.D. Date/Time:[**2130-10-24**] 1:40
3. Provider: [**First Name11 (Name Pattern1) 354**] [**Last Name (NamePattern4) 3013**], M.D. Date/Time:[**2130-10-25**] 11:00


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**Doctor First Name 63**]

Completed by:[**2130-9-22**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Bacteremia,Other pulmonary insufficiency, not elsewhere classified,Acute kidney failure, unspecified,Ulcer of heel and midfoot,Dehydration,Blood in stool,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Anticoagulants causing adverse effects in therapeutic use,Long-term (current) use of insulin'}


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: Dizziness

PRESENT ILLNESS: 80 F who presented from home with sudden onset of weakness and
dizziness and tremors last night. No LOC. almost fainted. No CP,
slight SOB and abd pain. +N/no vomiting. No D/back pain. States
she has had an "awful cold" for 1 week. Mild HA 2 days ago, none
now. No neck pain. Fevers. +cough, non productive. Denies any
changed in vision. Similar admission in [**Month (only) 216**], thought to be
[**12-21**] infection and hypoglycemia. BG 218. BM QOD. also with some
diaphroesis at that time.
.
In the ED, 102.7-->99.5, 105,  197/81, 16, 99 % RA.
Vanco/bactrim given (PCN all) for meningitis. Decadron 10 mg as
well (unclear why). LP done which did not suggest infection.
.
Initially, thought was to d/c home if LP negative however
attending uncomfortable as pt appears dry, WBC, with fever.
.
Admitted for fever.

MEDICAL HISTORY: 1. Coronary artery disease; status post myocardial
infarction in [**2102**] (silent). cath [**4-21**]: 2-vessel
disease, stent in the LCx and angioplasty of OM1, EF=19%.
2. Congestive heart failure (reported EF 20%, but more recent
echo states ?30% with difficult visualization).
3. flash pulmonary edema
4. recent UTI (dx'ed [**2130-5-22**]) on levofloxacin
5. s/p fall [**3-23**] without trauma in setting of lasix increase
6. PVD: s/p R fem-[**Doctor Last Name **] and L fem-DP bypass grafts. s/p R 5 toe
amputation and L one toe amputation.
7. DM2
8. HTN
9. Heparin-induced thrombocytopenia.
10. DJD/osteoarthritis B knees
11. s/p both hip fx, shoulder fx and ?proximal humerus fx (pt
denies).
12. R foot cellulitis.
13. (COPD - pt denies).
14. appendectomy.
15. cholecystectomy.
16. hysterectomy.
17. R eye cataract surgery [**4-23**]
18. anemia - baseline Hct 30-33
19. ARF - baseline Cr 1.1

MEDICATION ON ADMISSION: ASPIRIN 325MG qd
ATORVASTATIN CALCIUM 10MG qd
AZELASTINE HCL 137 mcg/SPRAY--[**11-20**] squirts in each nostril up to
twice a day as needed for nasal congestion
CLOPIDOGREL BISULFATE 75MG qd
DIGOXIN 125MCG qd
FUROSEMIDE 60 mg qd
ISOSORBIDE MONONITRATE 30MG qd
LISINOPRIL 20MG qd
METOPROLOL SUCCINATE 50MG-- qd
MULTIVITAMINS
NPH (HUMAN) 20 units qam, 13 units qpm

ALLERGIES: Penicillins / Terbutaline / Egg/Pro / Atenolol / Nifedipine /
Tetracyclines / Heparin Agents

PHYSICAL EXAM: On Admission:
Temp 98.5
BP 140/86
Pulse 68
Resp 18
O2 sat 99% RA
Gen - Alert, no acute distress, sleeping but arousable
HEENT - post surgical pupil, extraocular motions intact,
anicteric, mucous membranes dry
Neck - hard to assess as pt with lip trmeor, no cervical
lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, [**12-25**] SE murmur across precordium, no
rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally

FAMILY HISTORY: twin sister died last year of colon cancer. otherwise
unremarkable

SOCIAL HISTORY: The patient lives at home with her sister. She has a VNA qweek
that helps to draw up her insulin. She is able to complete daily
ADLs. She walks with a cane. She denies tobacco and alcohol use. 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Bacteremia,Other pulmonary insufficiency, not elsewhere classified,Acute kidney failure, unspecified,Ulcer of heel and midfoot,Dehydration,Blood in stool,Unspecified essential hypertension,Peripheral vascular disease, unspecified,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Anticoagulants causing adverse effects in therapeutic use,Long-term (current) use of insulin'}
