CHIEF COMPLAINT: Lower Extremity Weakness

PRESENT ILLNESS: This is a 23 year old female transgender to male, mild CP,
neurogenic bladder, in a wheelchair at times at baseline, with
HIV (CD4-308) and HCV with recent GBS bacteremia admitted
[**2197-4-20**] presents to the ED with headache.  Patient had been
treated with IV ceftriaxone, which was dicontinued on the 4th of
this month (course was supossed to be finished [**5-13**]).  Patient
had L-side PICC with erythema and pain in site and therefore was
pulled.  Patient had return of N/V/D, headache, and weakness two
days after stopping IV antibiotics.  The patient had a fever to
100.5 at home, nausea, diarrhea and new back pain.  The patient
reports the lower back pain started the morning of admission.
He also reports new worsening of lower extremity weakness as
well as worsening dysethesia of the right lower extremity.
.
In the ED, initial vs were 98.6 104 136/70 20 99.  Exam with
supra-spinal tenderness in L2-L3, normal sphincter tone, normal
straight-leg-raise. No papilledema. CN 2-12 intact, normal
sensation to touch in chest abdomen and lower extremities.  Labs
in the ED were unremarkable including lactate of 1.2.  Blood
cultures x2 were sent, however not pending.  An MRI of the T and
L spine without DWI images revealed no evidence of epidural
abscess.  The patient was given ceftriaxone to empirically treat
his prior bacteremia.  The patient was called out to the
medicine floor, then had episode of SVT to 160s, got agitated,
thought was going to require intubation.  The team attempted
vagal maneuver, BP down to 70s.  Blood pressure returned to
baseline without intervention.  Received dilaudid, lorazepam and
versed for pain and agitation, as well as 1L IV fluids.  The
patient got a CTA to evaluate for PE, which was negative, but
showed evidence of new infiltrate.  On transfer VS were 98.2 120
-145 132/55 16 99% on RA, dropped to 92% on RA.  Prior to
transfer the patient's temp increased to 101.7 in the ED.
.
In the MICU, the patient continues to complain of headache and
back pain.  He is intermittently somnolent, but reports did not
sleep well overnight.  The patient reports decreased sensation
of his right leg and weakness of bilateral lower extremities.
The patient does have a history of CP and requires a wheelchair
at times, but reports this is worse than baseline.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
- HIV ([**Month/Year (2) 2775**] started [**2197-2-21**]: Truvada, atazanavir, ritonavir;
diagnosed approx [**2191**], took PMTCT 1 yr ago; [**2197-2-7**]: VL 931, cd4
318; no history OI)
- Hepatitis C diagnosed in [**9-6**], no IFN therapy, last Hep C VL
558,000 [**2197-2-25**]
- Cerebral Palsy, s/p multiple surgeries, persistent leg
spasticity requiring use of wheelchair for long distances, mild
urinary retention at times.
- Asthma, mild intermittent
- Prior thrush due to Advair for asthma
- h/o multiple UTIs secondary to neurogenic bladder

MEDICATION ON ADMISSION: Truvada (Emtricitabine NRTI, Tenofovir nRTI)
Reyataz (Atazanavir protease inhibitor)
Norvir (Ritonavir protease inhibitor)
Cymbalta
Adderall
Trileptal

ALLERGIES: Latex / Fentanyl / Risperidone

PHYSICAL EXAM: Vitals: T 100.9 HR 128 BP 113/57 RR 18 O2 98% on RA
General: Alert but falls asleep while speaking, oriented,
appears comfortable
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD, unable to cooperate to
assess meningismus
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachycardic, otherwise normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foley in place
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: No evidence of vesicles, erythema or crusting. Areas on
left upper extremities that may be former vesicles, now bland
appearing with no erythema
Neuro: A+Ox3, CN II-XII intact
Motor: [**4-5**] Upper and Lower extremities
Sensation: Intact
Gait assessment deferred

FAMILY HISTORY: Grandmother: Gallbladder issues
Aunt: Diabetes
Mother Cervical, ovarian, uterine cancer

SOCIAL HISTORY: Female-to-male gender, has all female organs, does not take
hormones. Currently lives in [**Location 17065**] with 1 yo son. Hx of
crystal meth per his report -- states has been clean for 4
years, though past records indicate more recent use and prior
use of heroin, cocaine use. Occasional EtOH, last drink 1 wk ago
(40oz beer daily). 1/2ppd tobacco.
Urinary tract infection, site not specified,Pneumonia, organism unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Infantile cerebral palsy, unspecified,Asymptomatic human immunodeficiency virus [HIV] infection status,Neurogenic bladder NOS,Depressive disorder, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Hypopotassemia,Disorders of magnesium metabolism,Posttraumatic stress disorder,Attention deficit disorder with hyperactivity,Trans-sexualism with unspecified sexual history,Obsessive-compulsive disorders,Tobacco use disorder,Muscle weakness (generalized),Anemia of other chronic disease,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,History of physical abuse,Personal history, urinary (tract) infection
Urin tract infection NOS,Pneumonia, organism NOS,Enterococcus group d,Cerebral palsy NOS,Asymp hiv infectn status,Neurogenic bladder NOS,Depressive disorder NEC,Chrnc hpt C wo hpat coma,Hypopotassemia,Dis magnesium metabolism,Posttraumatic stress dis,Attn deficit w hyperact,Trans-sexualism NOS,Obsessive-compulsive dis,Tobacco use disorder,Muscle weakness-general,Anemia-other chronic dis,Migrne unsp wo ntrc mgrn,Hx of physical abuse,Personal history UTI
Admission Date:  [**2197-5-14**]              Discharge Date:   [**2197-5-18**]

Date of Birth:  [**2173-9-6**]             Sex:   F

Service: MEDICINE

Allergies:
Latex / Fentanyl / Risperidone

Attending:[**First Name3 (LF) 1257**]
Chief Complaint:
Lower Extremity Weakness

Major Surgical or Invasive Procedure:
Lumbar puncture


History of Present Illness:
This is a 23 year old female transgender to male, mild CP,
neurogenic bladder, in a wheelchair at times at baseline, with
HIV (CD4-308) and HCV with recent GBS bacteremia admitted
[**2197-4-20**] presents to the ED with headache.  Patient had been
treated with IV ceftriaxone, which was dicontinued on the 4th of
this month (course was supossed to be finished [**5-13**]).  Patient
had L-side PICC with erythema and pain in site and therefore was
pulled.  Patient had return of N/V/D, headache, and weakness two
days after stopping IV antibiotics.  The patient had a fever to
100.5 at home, nausea, diarrhea and new back pain.  The patient
reports the lower back pain started the morning of admission.
He also reports new worsening of lower extremity weakness as
well as worsening dysethesia of the right lower extremity.
.
In the ED, initial vs were 98.6 104 136/70 20 99.  Exam with
supra-spinal tenderness in L2-L3, normal sphincter tone, normal
straight-leg-raise. No papilledema. CN 2-12 intact, normal
sensation to touch in chest abdomen and lower extremities.  Labs
in the ED were unremarkable including lactate of 1.2.  Blood
cultures x2 were sent, however not pending.  An MRI of the T and
L spine without DWI images revealed no evidence of epidural
abscess.  The patient was given ceftriaxone to empirically treat
his prior bacteremia.  The patient was called out to the
medicine floor, then had episode of SVT to 160s, got agitated,
thought was going to require intubation.  The team attempted
vagal maneuver, BP down to 70s.  Blood pressure returned to
baseline without intervention.  Received dilaudid, lorazepam and
versed for pain and agitation, as well as 1L IV fluids.  The
patient got a CTA to evaluate for PE, which was negative, but
showed evidence of new infiltrate.  On transfer VS were 98.2 120
-145 132/55 16 99% on RA, dropped to 92% on RA.  Prior to
transfer the patient's temp increased to 101.7 in the ED.
.
In the MICU, the patient continues to complain of headache and
back pain.  He is intermittently somnolent, but reports did not
sleep well overnight.  The patient reports decreased sensation
of his right leg and weakness of bilateral lower extremities.
The patient does have a history of CP and requires a wheelchair
at times, but reports this is worse than baseline.

Past Medical History:
PAST MEDICAL HISTORY:
- HIV ([**Month/Year (2) 2775**] started [**2197-2-21**]: Truvada, atazanavir, ritonavir;
diagnosed approx [**2191**], took PMTCT 1 yr ago; [**2197-2-7**]: VL 931, cd4
318; no history OI)
- Hepatitis C diagnosed in [**9-6**], no IFN therapy, last Hep C VL
558,000 [**2197-2-25**]
- Cerebral Palsy, s/p multiple surgeries, persistent leg
spasticity requiring use of wheelchair for long distances, mild
urinary retention at times.
- Asthma, mild intermittent
- Prior thrush due to Advair for asthma
- h/o multiple UTIs secondary to neurogenic bladder

PSH:
- s/p appendectomy [**12-7**]
- c-section [**2194**]

PAST PSYCHIATRIC HISTORY:
- Depression: Sees Dr. [**Last Name (STitle) 57035**] at [**Hospital3 55848**] Health Center,
taking Cymbalta.
- History of suicide attempts: last SA was in [**10-8**], requiring
ICU admission at [**Hospital 8**] Hospital. Pt overdosed on his
medications at that point (Prozac, Trileptal, Seroquel). Reports
hx of 2 SA by OD, and 2 SA by cutting. First SA at age 13-14.
- History of self cutting, last circa [**2191**], self reports near
fatal cut.
- History of anorexia/bulimia, currently with active behaviors
including restricting and purging.
- PTSD - rape survivor
- ADHD - on Concerta
- OCD
- Trauma/Abuse


Social History:
Female-to-male gender, has all female organs, does not take
hormones. Currently lives in [**Location 17065**] with 1 yo son. Hx of
crystal meth per his report -- states has been clean for 4
years, though past records indicate more recent use and prior
use of heroin, cocaine use. Occasional EtOH, last drink 1 wk ago
(40oz beer daily). 1/2ppd tobacco.

Family History:
Grandmother: Gallbladder issues
Aunt: Diabetes
Mother Cervical, ovarian, uterine cancer

Physical Exam:
Vitals: T 100.9 HR 128 BP 113/57 RR 18 O2 98% on RA
General: Alert but falls asleep while speaking, oriented,
appears comfortable
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD, unable to cooperate to
assess meningismus
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachycardic, otherwise normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foley in place
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: No evidence of vesicles, erythema or crusting. Areas on
left upper extremities that may be former vesicles, now bland
appearing with no erythema
Neuro: A+Ox3, CN II-XII intact
Motor: [**4-5**] Upper and Lower extremities
Sensation: Intact
Gait assessment deferred

Pertinent Results:
[**2197-5-13**] 09:59PM BLOOD WBC-5.0 RBC-4.17* Hgb-11.1* Hct-33.0*
MCV-79* MCH-26.5* MCHC-33.4 RDW-14.6 Plt Ct-355
[**2197-5-14**] 10:23AM BLOOD WBC-4.9 RBC-3.55* Hgb-9.2* Hct-28.2*
MCV-80* MCH-26.0* MCHC-32.7 RDW-14.5 Plt Ct-228
[**2197-5-14**] 10:23AM BLOOD PT-13.6* PTT-29.2 INR(PT)-1.2*
[**2197-5-13**] 09:59PM BLOOD Glucose-93 UreaN-3* Creat-0.7 Na-139
K-3.7 Cl-102 HCO3-24 AnGap-17
[**2197-5-14**] 10:23AM BLOOD Glucose-99 UreaN-3* Creat-0.6 Na-138
K-3.2* Cl-110* HCO3-22 AnGap-9
[**2197-5-14**] 10:23AM BLOOD Calcium-7.3* Phos-2.4* Mg-1.3*

Brief Hospital Course:
23 year old female to male transgendered patient with a history
of HIV, Hepatitis C, and recent admission for GBS bacteremia
incompletely treated presents with HA, NVD, back pain and
worsening lower extremity weakness.
.
MICU Course- Patient admitted to the MICU after becoming
tachycardic to 160 and transiently dropping BP to the 70s.
Pressure normalized without intervention but he remained
tachycardic to 120s on admission to the floor.  While here, he
received 4.5 L of IV fluids (NS and D5-1/2NS) and did well.
Tachycardia resolved overnight and he remained hemodynamically
stable the next day.  Regarding his weakness, it seemed to be
related to his CP and not to an CNS infection as imaging was
negative for any acute infectious process.  Given the low
likelihood for meningitis, an LP was deferred.  He was treated
empirically with vancomycin/cefepime/azithromycin.  ID team
followed.  Given that he was stable, he was called out to the
floor on [**2197-5-15**].
.
.# Fever:  Likely related to UTI and new LLL infiltrate (suspect
CAP).  No signs of intraabdominal or pelvic process. The patient
was maintained on vanc/cefepime/azithro for several days then
switched to augmentin and azithromycin for a 7 day total course
per ID recomendatoins.  His fevers resolved as soon as he hit
the floor.  CTA did show new LLL infiltrate compared to films
from [**2197-4-1**].
.
# Back Pain/lower extremity weakness:  Improved throughout his
stay.  MRI did not show any acute process.  Serum RPR was
non-reactive.  LP showed no sign of transverse myelitis.
Neurology felt that this would be an exacerbation of his
underlying CP in the setting of acute illness. He was discharged
to rehab, to help regain his lower extermity strength.
.
.
# Headache:  The patient has migraines at baseline, but this
headache is different from baseline.  The patient has had recent
workup for similar symptoms with head CT and LP in [**4-10**] which
did not reveal etiology.  This resolved with the treatment of
his PNA.

# Tachycardia:  Resolved with IV fluids.  Now in sinus rhythm
with a rate of 81.  BP also within normal limits.  Most likely
secondary to fever, pain, infection and dehydration.  Improving
with IV fluids.  Pt denies chest pain, palpitations, shortness
of breath.  Will monitor on telemetry.     Never recurred.

.
# HIV: The patient was diagnosed with HIV several years ago,
recently started on [**Date Range 2775**]. Most recent labs showed VL: 931, CD4:
318. Repeat in house was 418.  Patient's PCP/ID doc to follow-up
myriad CSF studies.
.


Medications on Admission:
Truvada (Emtricitabine NRTI, Tenofovir nRTI)
Reyataz (Atazanavir protease inhibitor)
Norvir (Ritonavir protease inhibitor)
Cymbalta
Adderall
Trileptal

Discharge Medications:
1. Ritonavir 100 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
2. Atazanavir 150 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
3. Emtricitabine-Tenofovir 200-300 mg Tablet Sig: One (1) Tablet
PO DAILY (Daily).
4. Oxcarbazepine 150 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
5. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
6. Azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 3 days.
7. Methylphenidate 20 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO DAILY (Daily).
8. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
until BM .
10. Amoxicillin-Pot Clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 3 days.
11. Cortisone 1 % Cream Sig: One (1) Appl Topical QID (4 times a
day) as needed for itchiness.
12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
14. Polyethylene Glycol 3350 17 gram/dose Powder Sig: Seventeen
(17) grams PO DAILY (Daily) as needed for constipation.
15. ZOFRAN ODT 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO every eight (8) hours as needed for nausea.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Primary:
Urinary tract infection
Pneumonia
Cerebral palsy exacerbation

Secondary:
HIV
HCV


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
It was a pleasure caring for you during your hospitalization.
You came into the hospital because you had a fever, headache,
nausea and leg weakness.  Your fever has resolved.  Your nausea
is getting better and you are able to eat and drink small
amounts.  Your headaches are also getting better.

You had bacteria in your urine and a possible pneumonia when you
arrived.  You are taking antibiotics for these infections.
There was NO bacteria in your blood.

Your leg weakness may be due to worsening of your cerebral palsy
due to your UTI and possible pneumonia.  Based on MRI and CT
scans, the weakness and sensory changes were NOT due to anything
pressing on your spinal [**Last Name (LF) **], [**First Name3 (LF) **] abscess, a fracture or other
problems with your spine.  Your lumbar puncture did not show an
infection, but not all of the results are available yet.  You
should follow up with your primary care doctor about these
results.  You will be going to a rehab facility to help improve
the strength in your legs.

You were constipated in the hospital.  You should continue
taking stool softeners to prevent more constipation.

These are the changes to your medications:
1. Take Amoxicillin-Clavulanic Acid (Augmentin) 875 mg twice
daily
2. Take Azithromycin 250 mg every 24 hours

Followup Instructions:
Department: SURGICAL SPECIALTIES
When: MONDAY [**2197-5-29**] at 4:00 PM
With: [**First Name8 (NamePattern2) 161**] [**Name6 (MD) 162**] [**Name8 (MD) 163**], MD [**Telephone/Fax (1) 921**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST    Best Parking: [**Hospital Ward Name 23**] Garage

Click Add Appointment to add this appointment to Recommended
Follow-Up.
Department: NEUROLOGY
When: WEDNESDAY [**2197-5-31**] at 1:30 PM
With: [**Name6 (MD) 2341**] [**Last Name (NamePattern4) 2342**], M.D. [**Telephone/Fax (1) 2343**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**]
Campus: EAST    Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2197-5-18**]
{'Urinary tract infection, site not specified,Pneumonia, organism unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Infantile cerebral palsy, unspecified,Asymptomatic human immunodeficiency virus [HIV] infection status,Neurogenic bladder NOS,Depressive disorder, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Hypopotassemia,Disorders of magnesium metabolism,Posttraumatic stress disorder,Attention deficit disorder with hyperactivity,Trans-sexualism with unspecified sexual history,Obsessive-compulsive disorders,Tobacco use disorder,Muscle weakness (generalized),Anemia of other chronic disease,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,History of physical abuse,Personal history, urinary (tract) infection'}


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: Lower Extremity Weakness

PRESENT ILLNESS: This is a 23 year old female transgender to male, mild CP,
neurogenic bladder, in a wheelchair at times at baseline, with
HIV (CD4-308) and HCV with recent GBS bacteremia admitted
[**2197-4-20**] presents to the ED with headache.  Patient had been
treated with IV ceftriaxone, which was dicontinued on the 4th of
this month (course was supossed to be finished [**5-13**]).  Patient
had L-side PICC with erythema and pain in site and therefore was
pulled.  Patient had return of N/V/D, headache, and weakness two
days after stopping IV antibiotics.  The patient had a fever to
100.5 at home, nausea, diarrhea and new back pain.  The patient
reports the lower back pain started the morning of admission.
He also reports new worsening of lower extremity weakness as
well as worsening dysethesia of the right lower extremity.
.
In the ED, initial vs were 98.6 104 136/70 20 99.  Exam with
supra-spinal tenderness in L2-L3, normal sphincter tone, normal
straight-leg-raise. No papilledema. CN 2-12 intact, normal
sensation to touch in chest abdomen and lower extremities.  Labs
in the ED were unremarkable including lactate of 1.2.  Blood
cultures x2 were sent, however not pending.  An MRI of the T and
L spine without DWI images revealed no evidence of epidural
abscess.  The patient was given ceftriaxone to empirically treat
his prior bacteremia.  The patient was called out to the
medicine floor, then had episode of SVT to 160s, got agitated,
thought was going to require intubation.  The team attempted
vagal maneuver, BP down to 70s.  Blood pressure returned to
baseline without intervention.  Received dilaudid, lorazepam and
versed for pain and agitation, as well as 1L IV fluids.  The
patient got a CTA to evaluate for PE, which was negative, but
showed evidence of new infiltrate.  On transfer VS were 98.2 120
-145 132/55 16 99% on RA, dropped to 92% on RA.  Prior to
transfer the patient's temp increased to 101.7 in the ED.
.
In the MICU, the patient continues to complain of headache and
back pain.  He is intermittently somnolent, but reports did not
sleep well overnight.  The patient reports decreased sensation
of his right leg and weakness of bilateral lower extremities.
The patient does have a history of CP and requires a wheelchair
at times, but reports this is worse than baseline.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
- HIV ([**Month/Year (2) 2775**] started [**2197-2-21**]: Truvada, atazanavir, ritonavir;
diagnosed approx [**2191**], took PMTCT 1 yr ago; [**2197-2-7**]: VL 931, cd4
318; no history OI)
- Hepatitis C diagnosed in [**9-6**], no IFN therapy, last Hep C VL
558,000 [**2197-2-25**]
- Cerebral Palsy, s/p multiple surgeries, persistent leg
spasticity requiring use of wheelchair for long distances, mild
urinary retention at times.
- Asthma, mild intermittent
- Prior thrush due to Advair for asthma
- h/o multiple UTIs secondary to neurogenic bladder

MEDICATION ON ADMISSION: Truvada (Emtricitabine NRTI, Tenofovir nRTI)
Reyataz (Atazanavir protease inhibitor)
Norvir (Ritonavir protease inhibitor)
Cymbalta
Adderall
Trileptal

ALLERGIES: Latex / Fentanyl / Risperidone

PHYSICAL EXAM: Vitals: T 100.9 HR 128 BP 113/57 RR 18 O2 98% on RA
General: Alert but falls asleep while speaking, oriented,
appears comfortable
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD, unable to cooperate to
assess meningismus
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachycardic, otherwise normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foley in place
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: No evidence of vesicles, erythema or crusting. Areas on
left upper extremities that may be former vesicles, now bland
appearing with no erythema
Neuro: A+Ox3, CN II-XII intact
Motor: [**4-5**] Upper and Lower extremities
Sensation: Intact
Gait assessment deferred

FAMILY HISTORY: Grandmother: Gallbladder issues
Aunt: Diabetes
Mother Cervical, ovarian, uterine cancer

SOCIAL HISTORY: Female-to-male gender, has all female organs, does not take
hormones. Currently lives in [**Location 17065**] with 1 yo son. Hx of
crystal meth per his report -- states has been clean for 4
years, though past records indicate more recent use and prior
use of heroin, cocaine use. Occasional EtOH, last drink 1 wk ago
(40oz beer daily). 1/2ppd tobacco. 

### Response:
{'Urinary tract infection, site not specified,Pneumonia, organism unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Infantile cerebral palsy, unspecified,Asymptomatic human immunodeficiency virus [HIV] infection status,Neurogenic bladder NOS,Depressive disorder, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Hypopotassemia,Disorders of magnesium metabolism,Posttraumatic stress disorder,Attention deficit disorder with hyperactivity,Trans-sexualism with unspecified sexual history,Obsessive-compulsive disorders,Tobacco use disorder,Muscle weakness (generalized),Anemia of other chronic disease,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,History of physical abuse,Personal history, urinary (tract) infection'}
