CHIEF COMPLAINT: Transient ischemic attack, critical left carotid artery
stenosis.

PRESENT ILLNESS: 57yo F with prior CVA with residual right sided numbness s/p
right CEA on ASA, Plavix as well as DM Type II, HTN, h/o PVD,
who was found down at home with dysarthria, and R sided
weakness.  The pt was last seen at noon in her USOH without any
complaints.  At 13:00, the pt was found down by her daughter.
The daughter found her lying on the bathroom floor with
difficulty moving her right side as well as speaking in short
sentences and she called 911 and the pt was BIBA to [**Hospital1 18**] ED.
As per the pt, she remembers going into the bathroom.  She
slowly lowered herself to the floor as she felt her legs get
weak.  The next thing she remembers is her daughter finding her
on the bathroom floor.  The pt denied any frank LOC, chest pain,
palpitations, shortness of breath, fevers, chills, rigors, night
sweats, weight loss, abdominal pain, n/v/d, LH, dizziness,
urinary incontinence, bowel incontinence, or confusion.  During
transport, the pt had one episode of emesis and two more while
in the ED.  The pt could not describe her emesis.  The pt also
had 4 episodes of "diarrhea" which were new.  The stools were
described as loose, but not watery, unknown what color, or other
characteristics.  The pt does admit to recent travel to Bahamas.
 She returned on [**3-10**], however she denied any sick contact
during or after the trip.  She also denies any exotic food
intake during this trip.  No one else on the trip has gotten ill
as far as she is aware.  She has had difficulty with pain in he
right leg, however this is known and she is scheduled for a
fem-[**Doctor Last Name **] bypass.  The pt has an outpt appointment with her
vascular surgeon for evaluation next Thurs.

MEDICAL HISTORY: 1.  Prior CVA s/p right CEA - treated at [**Hospital1 2025**], presented with
right sided numbness, which is the only residual symptom
2.  Type II Diabetes
3.  Hypertension
4.  Peripheral vascular disease, for right fem-[**Doctor Last Name **] bypass

MEDICATION ON ADMISSION: MEDICATIONS:
1.  Plavix 75mg once daily
2.  Toprol 50mg once daily
3.  Cardizem 240mg once daily
4.  Lipitor 10mg once daily
5.  Metformin 1000mg once daily
6.  Ecotrin
7.  Dilaudid
8.  Prilosec 10mg once daily
9.  Vitamin B12
10.  Vitamin B6
11.  Folic Acid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 98, HR: 106, BP: 150/46, HR: 107, RR: 16, SaO2: 97% on
4L, CVP: 7.
GEN: Well appearing middle aged female in NAD.  Tanned in
distribution of bathing suite but not in any other distribution.
 Pt is conversing fluently in full sentences, no dysarthria or
word finding difficulties.
HEENT: PERRLA, EOMI, anicteric, mm dry, op clear, bilateral
elevation of posterior palate
CV: tachycardic, regular rhythm, ?1/6 SEM best heard at LUSB
CHEST: crackles at bases bilaterally
ABD: obese, soft, NT, ND, BS+ bilaterally
EXT: wwp, no c/c/e, minor abrasions of heels bilaterally, linear
scabbing extending from heel to ankle (pt denies hx of trauma).
NEURO:
CN II-XII grossly intact
Sensation: grossly intact but with [**Month (only) **]. sensation to RLE > LLE
Strength: grossly intact [**6-4**] in UE and LE but slight weakness of
right compared to left.
Reflex: unable to be elicited in LE
Gait: not assessed.

FAMILY HISTORY: Father: CVA in 50s, malignancy?

SOCIAL HISTORY: Pt livers with two daughters at home.
Tob: 0.5ppd x40years (since age 17)
EtOH: social - 2 beers every 2 weeks
Illicit drug use: denies
Unspecified septicemia,Septic shock,Endocarditis, valve unspecified, unspecified cause,Ulcer of other part of foot,Atrial fibrillation,Severe sepsis,Atherosclerosis of native arteries of the extremities with ulceration,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Septicemia NOS,Septic shock,Endocarditis NOS,Ulcer other part of foot,Atrial fibrillation,Severe sepsis,Ath ext ntv art ulcrtion,Ocl crtd art wo infrct,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2173-3-28**]              Discharge Date:   [**2173-4-21**]

Date of Birth:  [**2116-2-19**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2777**]
Chief Complaint:
Transient ischemic attack, critical left carotid artery
stenosis.


Major Surgical or Invasive Procedure:
1. Left carotid endarterectomy via eversion technique.
2. Abdominal aortogram with right lower extremity run-off.
3. Right common femoral to proximal anterior tibial artery
bypass with a lateral superficial tunnel using non reversed
saphenous vein graft, intraoperative angioscopy and valve lysis.


History of Present Illness:
57yo F with prior CVA with residual right sided numbness s/p
right CEA on ASA, Plavix as well as DM Type II, HTN, h/o PVD,
who was found down at home with dysarthria, and R sided
weakness.  The pt was last seen at noon in her USOH without any
complaints.  At 13:00, the pt was found down by her daughter.
The daughter found her lying on the bathroom floor with
difficulty moving her right side as well as speaking in short
sentences and she called 911 and the pt was BIBA to [**Hospital1 18**] ED.
As per the pt, she remembers going into the bathroom.  She
slowly lowered herself to the floor as she felt her legs get
weak.  The next thing she remembers is her daughter finding her
on the bathroom floor.  The pt denied any frank LOC, chest pain,
palpitations, shortness of breath, fevers, chills, rigors, night
sweats, weight loss, abdominal pain, n/v/d, LH, dizziness,
urinary incontinence, bowel incontinence, or confusion.  During
transport, the pt had one episode of emesis and two more while
in the ED.  The pt could not describe her emesis.  The pt also
had 4 episodes of "diarrhea" which were new.  The stools were
described as loose, but not watery, unknown what color, or other
characteristics.  The pt does admit to recent travel to Bahamas.
 She returned on [**3-10**], however she denied any sick contact
during or after the trip.  She also denies any exotic food
intake during this trip.  No one else on the trip has gotten ill
as far as she is aware.  She has had difficulty with pain in he
right leg, however this is known and she is scheduled for a
fem-[**Doctor Last Name **] bypass.  The pt has an outpt appointment with her
vascular surgeon for evaluation next Thurs.

   Initially Code stroke was called due to the history of acute
dysarthria and right sided weakness.  Neuro consult found the pt
to have right pronator drift and right facial and some
comprehension problems (which essentially resolved with
treatment of hypotension.  In the ED, the pt was found to be
initially hypothermic (T: 93) then febrile (T: 100.8),
tachycardic (HR 106), hypotensive (BP: 84/49 -> 60/30) and
Hypoxic (85% on 2L NC -> 97% 2L NC).  Given her hypotension,
fever, as well as elevated WBC 19.4 and elevated lactate 5.4
this was thought to be sepsis and a Code Sepsis was called.  IVF
(total 4L of NS) and pressors (DA then levophed, both off at
time of transfer from ED) were given for hypotension and
cultures were drawn.  CXR was read as infrahilar opacities
concerning for infiltrates.  UA was neg.  A head CT was neg for
bleed, CTA was neg for PE and without frank consolidation, mild
bibasilar atelectasis.  An Abdominal/Pelvic CT demonstrated wall
thickening of transverse-sigmoid colon and scattered
diverticuli.  The neurologic signs were thought to be due to
hypotension from sepsis bringing out old neurologic findings.
Neuro did recommend a head MRI per stroke protocol after
stabilization of pt.  However no acute indication for TPA.
.
MICU Course: While in MICU pt was not initiated or maintained on
pressors throughout her course. The following day in MICU had
episode of BRBPR (No stool, 40cc blood). Noted to have small
external hemorrhoids on DRE with BRB in rectal vault. Per GI
consult, etiology most likely ischemic bowel [**3-4**] episode of
hypotension, but also consider [**Month/Day (2) 1083**] etiology and started
on cipro/flagyl. Deferred [**Last Name (un) **] for outpt and follow serial hct
and manage with supportive care. Her ASA, Plavix have been held.
Pt also had an episode of Tachycardia, HR up to 180s, pt
asymptomatic throughout entire episode. Pt was bolused w/fluids
and HR decreased to 120s-130s, low dose BB re-initiated as
tachycardia thought to be [**3-4**] holding her BB in setting of
initial hypotension. Per Cards fellow, tachycardia thought to be
rate related LBBB and recommended supportive care with IVF
hydration and start low dose BB. Per Neuro, recommended Head
MRI/MRA when stable.


Past Medical History:
1.  Prior CVA s/p right CEA - treated at [**Hospital1 2025**], presented with
right sided numbness, which is the only residual symptom
2.  Type II Diabetes
3.  Hypertension
4.  Peripheral vascular disease, for right fem-[**Doctor Last Name **] bypass

Social History:
Pt livers with two daughters at home.
Tob: 0.5ppd x40years (since age 17)
EtOH: social - 2 beers every 2 weeks
Illicit drug use: denies


Family History:
Father: CVA in 50s, malignancy?

Physical Exam:
VS: T: 98, HR: 106, BP: 150/46, HR: 107, RR: 16, SaO2: 97% on
4L, CVP: 7.
GEN: Well appearing middle aged female in NAD.  Tanned in
distribution of bathing suite but not in any other distribution.
 Pt is conversing fluently in full sentences, no dysarthria or
word finding difficulties.
HEENT: PERRLA, EOMI, anicteric, mm dry, op clear, bilateral
elevation of posterior palate
CV: tachycardic, regular rhythm, ?1/6 SEM best heard at LUSB
CHEST: crackles at bases bilaterally
ABD: obese, soft, NT, ND, BS+ bilaterally
EXT: wwp, no c/c/e, minor abrasions of heels bilaterally, linear
scabbing extending from heel to ankle (pt denies hx of trauma).
NEURO:
CN II-XII grossly intact
Sensation: grossly intact but with [**Month (only) **]. sensation to RLE > LLE
Strength: grossly intact [**6-4**] in UE and LE but slight weakness of
right compared to left.
Reflex: unable to be elicited in LE
Gait: not assessed.


Pertinent Results:
STUDIES:
CXR [**2173-3-28**]: infrahilar patchy opacities concerning for
developing infiltrate vs. aspiration.
.

UA [**2173-3-28**]: Neg
.
ECG [**2173-3-30**]
Compared to the previous tracing of [**2173-3-30**] the rhythm is now
sinus rather than atrial fibrillation. Intermittent left
bundle-branch block persist.
ST segment depressions in lead II and V4-V6 are consistent with
ischemia. There are frequent atrial premature beats with
aberrant conduction.

.
Head CT (non-contrast) [**2173-3-28**]
IMPRESSION: No mass effect or hemorrhage. If brain infarction is
a concern then an MRI and MRA would be a more sensitive
modality.

.
Torso CT [**2173-3-28**] IMPRESSION:
1. No evidence of pulmonary embolism.
2. Pancolitis involving the transverse, descending and sigmoid
colon. This could represent an [**Month/Day/Year 1083**], inflammatory or less
likely an ischemic insult due to the extent of involvement. The
pattern of wall thickening can also be seen in pseudomembranous
colitis. Is there a history of recent antibiotic usage?
3. Small 2-mm nodule in the right middle lobe. In the absence of
a malignancy a one-year followup is recommended to ensure
stability. In the presence of a known malignancy or a high risk
a three to six-month followup is recommended.
4. Prominent mediastinal lymph nodes.
.
LABS:
WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2173-3-31**] 06:00AM    12.2* 4.12* 12.2 35.8* 87 29.7 34.1 14.1
239
[**2173-3-30**] 02:24PM          34.2*
[**2173-3-30**] 06:41AM    12.1* 4.10* 12.5 34.8* 85 30.6 36.0* 14.2
184
[**2173-3-30**] 12:43AM    12.2* 4.08* 12.8 34.8* 85 31.2 36.6* 14.3
207
[**2173-3-29**] 08:33PM          32.5*
[**2173-3-29**] 12:32PM          34.3*
[**2173-3-29**] 04:00AM    16.5* 4.34 13.5 37.0 85 31.0 36.4* 14.3
251
[**2173-3-29**] 01:02AM          35.7*
[**2173-3-28**] 07:59PM    17.0* 4.52 13.5 38.2 85 29.8 35.2* 14.2
198
[**2173-3-28**] 01:50PM    19.4* 5.20 15.8 46.0 89 30.3 34.3 14.5
402
.
Neuts Bands Lymphs Monos Eos Baso Atyps Metas Myelos
[**2173-3-30**] 12:43AM    68 0 18 6 0 1 7* 0 0
[**2173-3-28**] 07:59PM    78*1 18* 0 2 0 0 2* 0 0
.
Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2173-3-31**] 06:00AM    93 9 0.5 137 4.0 104 24 13
[**2173-3-30**] 06:41AM    93 7 0.5 138 4.9 107 22 14
[**2173-3-30**] 12:43AM    111* 8 0.5 139 3.3 106 23 13
[**2173-3-29**] 04:00AM    134* 11 0.7 138 3.9 106 20* 16
[**2173-3-28**] 06:40PM    162* 13 0.8 138 4.0   18*
.
MICRO:
[**2173-3-28**] 4:05 pm STOOL     CONSISTENCY: SOFT

   CLOSTRIDIUM DIFFICILE TOXIN ASSAY (Final [**2173-3-29**]):
      FECES NEGATIVE FOR C. DIFFICILE TOXIN BY EIA.
      Reference Range:  Negative.

   OVA + PARASITES (Final [**2173-3-30**]):
      NO OVA AND PARASITES SEEN.
      This test does not reliably detect Cryptosporidium,
Cyclospora or
      Microsporidium. While most cases of Giardia are detected
by routine
      O+P, the Giardia antigen test may enhance detection when
organisms
      are rare.

   FECAL CULTURE (Pending):

   CAMPYLOBACTER CULTURE (Final [**2173-3-30**]):    NO CAMPYLOBACTER
FOUND.

   FECAL CULTURE - R/O E.COLI 0157:H7 (Final [**2173-3-30**]):
      NO E.COLI 0157:H7 FOUND.

[**2173-3-28**] 01:50PM    181* 13 1.0 136 3.5 93* 23 24
.
Lactate
[**2173-3-29**] 04:16AM    1.5
[**2173-3-28**] 10:33PM    2.1*
[**2173-3-28**] 08:09PM    2.6*
[**2173-3-28**] 06:54PM    3.8*
[**2173-3-28**] 05:08PM    2.2*
[**2173-3-28**] 04:05PM    2.5*
[**2173-3-28**] 02:28PM    5.4


Brief Hospital Course:
A/P: 57yo F with hx of CVA with residual right sided numbness
s/p right CEA on ASA, Plavix as well as DM Type II, HTN, h/o
PVD, who was found down at home with dysarthria and R sided
weakness in setting of SIRS.
.
1.  SIRS/Sepsis: The pt was initially hypothermic with
tachycardia, hypoxia and elevated WBC count.  In addition, the
pt was found to be hypotensive confirming severe SIRS.  However
at this point, a source of infection is not clear and the pt
does not appear toxic making Sepsis less likely.  The more
likely explanation involves possible transient bacteremia
resulting in SIRS and hypotension which elicited sx of prior
CVA.  The source of the bacteremia is most likely GI in origin
given the sx of n/v and diarrhea.  In addition, the CT scan
demonstrated some diffuse wall thickening between the transverse
colon and sigmoid colon.  The findings of scattered diverticuli
are also suspicious as this may also be the source of seeding.
In addition, the pt has a very high WBC count and some history
of possible diarrhea making c.diff a possibility.  Other
etiology including possible cellulitis from the heel wounds is
possible but given its age (from appearance) it is less likely.
Pulm source is also possible, however the CXR and CT are not
convincing and may be better explained by aspiration post
hypotension.  The pt was never continued on pressors when
admitted to the MICU.  Other etiologies including vasovagal,
seizures, stroke, cardiogenic/dysrhythmia, etc. are also
possible. MRI/MRA of head was positive for a new lesion in L
coronaradiata on [**2173-3-31**]. Pt was then worked up for TTE and TEE
echo for assessment of clots as well as carotid U/S. Pt was
restarted on her ASA and plavix, ok'd per GI in setting of no
further BRBPR. She was continued on Cipro/Flagyl for emperic GI
coverage. Although stool studies came back negative, pt
initially presented w/?sepsis, bandemia and no other source
found, will complete 7 day course.
.

2.  GIB: Night of admission, the pt developed GIB with what
appeared to be frank blood in her rectal vault.  Hct [**Month (only) **] from 46
on admission to 35.7.  Undoubtedly there is some component of
hemodilution in this pt, however this [**Month (only) **] seems excessive even
for dilution.  This is most likely due to bowel ischemi from
prolonged hypotension.  Pt only had 1 episode of BRBPR and per
GI deferred scoping at this admission. Will need [**Last Name (un) **] as outpt.
She remained HD stable and did not require blood transfusions.
.

3.  Neuro: The pt initially presented with sx of right sided
weakness and dysarthria which is thought to be due to unmasking
of old defecits in the setting of hypotension/sepsis especially
with possible carotid disease. Her MRI/MRA of head was done on
[**2173-3-31**] since pt was so tenuous w/BP in MICU. Pt no longer had
any neuro signs or symptoms at time of MRI/MRA. However, new
lesion was found in L coronaradiata. She was restarted on
ASA/Plavix/Lipitor. Underwent Carotid U/S, TEE echo for further
evaluation of source for embolic brain lesion. Pt also started
on low dose ACE-I per Neuro rec to prevent furhter ischemic
brain damage with good BP control.
.
4. Tachycardia: Pt developed while in MICU episode of NSVT, HR
180s--Pt was asymptomatic throughout entire episode. While on
the floor pt also had episode of NSVT HR to 130s again
asymptomatic. Etiology thought to be rebound tachycardia in
setting of holding all antihypertensive medications while pt was
initially hypotensive.
.
5. HTN: Pt initially presented with hypotension and all
antihypertensive medications were held. Her BB was also held in
setting of GIB. On [**2173-3-30**] pt was restarted on BB as she was HD
stable and hypertensive. On [**2173-3-31**] pt was persistently
hypertensive and was restarted on her Cardizem at a lower dose.
Per neuro was also started on ACE-I as her BP tolerated well.
.

6.  Diabetes: Pt was well controlled on ISS. Her home metformin
was held as she was NPO, clears and started diet slowly.
.

7.  CV:
A.  Coronaries: Given the known significant PVD as well as DM in
this pt, she most likely has some element of CAD.  ASA, Plavix
initially held due to complication of GIB. Restarted as noted
above. BB and CCB were initially held given recent hypotension,
however after 24 hours she was stable and re-started BB. She was
r/o'd for MI x3 (1st set neg in ED).
.

B.  Rhythm: NSR but pt became tachycardic intermittently over
night with what appears to be a rate related LBBB.
.
8. Vascualar: Pt underwwent the following vascular procedures.
She tolerated the procedures well. From a vascular standpoint pt
stable aftyer all proceudes. Discharged to rehab in stable
condition. Left carotid endarterectomy via eversion technique,
Abdominal aortogram with right lower extremity run-off, Right
common femoral to proximal anterior tibial artery bypass with a
lateral superficial tunnel using non reversed saphenous vein
graft, intraoperative angioscopy and
valve lysis.
.


Medications on Admission:
MEDICATIONS:
1.  Plavix 75mg once daily
2.  Toprol 50mg once daily
3.  Cardizem 240mg once daily
4.  Lipitor 10mg once daily
5.  Metformin 1000mg once daily
6.  Ecotrin
7.  Dilaudid
8.  Prilosec 10mg once daily
9.  Vitamin B12
10.  Vitamin B6
11.  Folic Acid

ALLERGIES: NKDA


Discharge Medications:
1. Ampicillin-Sulbactam 3 g Recon Soln Sig: Three (3) grams
Intravenous  every eight (8) hours for 3 weeks: Please continue
unasyn for three weeks from discharge.
Disp:*500 grams* Refills:*1*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
5. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
Disp:*120 Tablet(s)* Refills:*2*
6. White Petrolatum-Mineral Oil     Cream Sig: One (1) Appl
Topical  QID (4 times a day) as needed.
7. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6
hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
8. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
Disp:*45 Tablet(s)* Refills:*2*
11. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
13. Outpatient Lab Work
Please draw weekly CBC with differential, Liver function tests,
and chem 7. Please fax results to the [**Date Range 1083**] disease clinic:
Fax number [**Telephone/Fax (1) **]
Phone [**Telephone/Fax (1) **]
14. Line care
Per protocol please for the Right-sided picc line. Thank you.
15. Outpatient Physical Therapy


Discharge Disposition:
Home With Service

Facility:
Critical Care Systems

Discharge Diagnosis:
Culture negative endocarditis
Transient ischemic attack, critical left carotid artery
stenosis.
Ischemic right foot with ulceration
Hypertension
Diabetes Mellitus type II


Discharge Condition:
Stable


Discharge Instructions:
Please take all your medications as directed and keep your
follow up appointments.
Please be alert for signs of infection as outlined in the
nursing discharge information.
Please continue the IV antibiotics with weekly lab draws as
directed. Call the office or return to the emergency room if you
have symptoms that you are worried about.

Followup Instructions:
1. 2-mm nodule is visualized in the right middle lobe - in the
abscence of known malignancy 1 year follow-up recommended.
2. Please follow-up with [**Telephone/Fax (1) **] Disease clinic in 3 weeks
from discharge.(Call [**Telephone/Fax (1) **] to make an appointment. They
will see the weekly labs in the meantime.
3. Please follow-up with Dr. [**Last Name (STitle) **] in 2 weeks. Please
call his office ahead of time to schedule an appointment. ([**Telephone/Fax (1) 18152**]
Provider: [**Name10 (NameIs) **],[**First Name3 (LF) **] L.  [**Telephone/Fax (1) 2625**]  Follow-up
appointment should be in 2 weeks
Provider: [**Name10 (NameIs) **] Disease Clinic  [**Telephone/Fax (1) 457**]  Follow-up
appointment should be in 3 weeks



Completed by:[**2173-7-20**]
{'Unspecified septicemia,Septic shock,Endocarditis, valve unspecified, unspecified cause,Ulcer of other part of foot,Atrial fibrillation,Severe sepsis,Atherosclerosis of native arteries of the extremities with ulceration,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}


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: Transient ischemic attack, critical left carotid artery
stenosis.

PRESENT ILLNESS: 57yo F with prior CVA with residual right sided numbness s/p
right CEA on ASA, Plavix as well as DM Type II, HTN, h/o PVD,
who was found down at home with dysarthria, and R sided
weakness.  The pt was last seen at noon in her USOH without any
complaints.  At 13:00, the pt was found down by her daughter.
The daughter found her lying on the bathroom floor with
difficulty moving her right side as well as speaking in short
sentences and she called 911 and the pt was BIBA to [**Hospital1 18**] ED.
As per the pt, she remembers going into the bathroom.  She
slowly lowered herself to the floor as she felt her legs get
weak.  The next thing she remembers is her daughter finding her
on the bathroom floor.  The pt denied any frank LOC, chest pain,
palpitations, shortness of breath, fevers, chills, rigors, night
sweats, weight loss, abdominal pain, n/v/d, LH, dizziness,
urinary incontinence, bowel incontinence, or confusion.  During
transport, the pt had one episode of emesis and two more while
in the ED.  The pt could not describe her emesis.  The pt also
had 4 episodes of "diarrhea" which were new.  The stools were
described as loose, but not watery, unknown what color, or other
characteristics.  The pt does admit to recent travel to Bahamas.
 She returned on [**3-10**], however she denied any sick contact
during or after the trip.  She also denies any exotic food
intake during this trip.  No one else on the trip has gotten ill
as far as she is aware.  She has had difficulty with pain in he
right leg, however this is known and she is scheduled for a
fem-[**Doctor Last Name **] bypass.  The pt has an outpt appointment with her
vascular surgeon for evaluation next Thurs.

MEDICAL HISTORY: 1.  Prior CVA s/p right CEA - treated at [**Hospital1 2025**], presented with
right sided numbness, which is the only residual symptom
2.  Type II Diabetes
3.  Hypertension
4.  Peripheral vascular disease, for right fem-[**Doctor Last Name **] bypass

MEDICATION ON ADMISSION: MEDICATIONS:
1.  Plavix 75mg once daily
2.  Toprol 50mg once daily
3.  Cardizem 240mg once daily
4.  Lipitor 10mg once daily
5.  Metformin 1000mg once daily
6.  Ecotrin
7.  Dilaudid
8.  Prilosec 10mg once daily
9.  Vitamin B12
10.  Vitamin B6
11.  Folic Acid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 98, HR: 106, BP: 150/46, HR: 107, RR: 16, SaO2: 97% on
4L, CVP: 7.
GEN: Well appearing middle aged female in NAD.  Tanned in
distribution of bathing suite but not in any other distribution.
 Pt is conversing fluently in full sentences, no dysarthria or
word finding difficulties.
HEENT: PERRLA, EOMI, anicteric, mm dry, op clear, bilateral
elevation of posterior palate
CV: tachycardic, regular rhythm, ?1/6 SEM best heard at LUSB
CHEST: crackles at bases bilaterally
ABD: obese, soft, NT, ND, BS+ bilaterally
EXT: wwp, no c/c/e, minor abrasions of heels bilaterally, linear
scabbing extending from heel to ankle (pt denies hx of trauma).
NEURO:
CN II-XII grossly intact
Sensation: grossly intact but with [**Month (only) **]. sensation to RLE > LLE
Strength: grossly intact [**6-4**] in UE and LE but slight weakness of
right compared to left.
Reflex: unable to be elicited in LE
Gait: not assessed.

FAMILY HISTORY: Father: CVA in 50s, malignancy?

SOCIAL HISTORY: Pt livers with two daughters at home.
Tob: 0.5ppd x40years (since age 17)
EtOH: social - 2 beers every 2 weeks
Illicit drug use: denies 

### Response:
{'Unspecified septicemia,Septic shock,Endocarditis, valve unspecified, unspecified cause,Ulcer of other part of foot,Atrial fibrillation,Severe sepsis,Atherosclerosis of native arteries of the extremities with ulceration,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
