CHIEF COMPLAINT: SOB/Hypoxemia

PRESENT ILLNESS: 66 yo nursing home resident with h/o obesity, OSA who was
recently diagnosed at [**Hospital3 2737**] with multiple PEs, on
coumadin who presents to [**Hospital1 18**] with worsening hypoxemia.
.
Per [**Name6 (MD) **] home MD, Dr. [**Last Name (STitle) **], patient was diagnosed at OSH with
PEs on [**2197-12-18**] after developing hypoxemia and new oxygen
requirement.  Per report, [**Date Range **] at OSH were negative for DVT,
while CTA chest was positive for PE.  She was started lovenox
bridge to coumadin (lovenox was d/c'd on [**2197-12-23**] when
therapeutic INR) at that time and was discharged back to the
[**Location (un) 2498**] NH.  She reportedly has been therapeutic on coumadin
(last INR at NH was supratherapeutic at 3.7) since her [**Hospital1 **] stay.  She reports that since her d/c from [**Hospital1 **],
however, she has had persistent shortness of breath and has
required constant oxygen.  This am, her PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] was
making rounds at the NH and she informed him of her symptoms as
above.  This morning her 02 sat was 90% on 5L NC.  He was
concerned by lack of improvement and ? worsening hypoxemia and
suggested transfer to [**Hospital1 18**] for further evaluation.
.
Pt. reports no prior h/o DVTs nor PEs either in herself nor
family members. She does, however, report 2 miscarriages.  She
currently denies CP, palpitations.  No cough.
.
In the [**Last Name (LF) **], [**First Name3 (LF) **] sign out, she was found to be tachycardic,
tachypneic (although there is no documentation of tachycardia
nor tachypnea), and hypoxic with SBPs low 100s.  Despite
therapeutic INR (2.7 in ED here), CTPA was performed which
showed e/o multiple partially occlusive 2nd order brand PEs in
both lower lobes and right upper lobe.  She received
levofloxacin x1 for ? of LLL infiltrate on CXR.  She was started
on heparin gtt at this time and was transferred to the ICU given
her questionable HD stability.
.
ROS:  She denies cough, chest pain, palpitations.  She denies
fevers/chills. No lightheadedness/dizziness. No N/V/diarrhea. No
melena/hematochezia, no dysuria/hematuria. No orthopnea,
+intermittent LE edema worse over the past month.  Denies calf
pain currently (had mild calf pain on presentation to [**Hospital1 **],
but [**Hospital1 **] were negative).

MEDICAL HISTORY: 1. Obesity
2. OSA
3. PE
4. s/p b/l knee replacements
5. HTN
6. Fibromyalgia
7. Anxiety
8. Depression c h/o psychosis
9. Bipolar disorder
10. Chronic low back pain
11. Blepharitis
12. CHF (unclear diagnosis, apparently newly diagnosed, EF not
known)
13. OA
14. Cataracts
15. S/P appendectomy
16. S/P hysterectomy
17. Hypothyroidism

MEDICATION ON ADMISSION: 1. Effexor 300mg PO qam
2. Abilify 20mg PO qdaily
3. KCL 20mEq PO qdaily
4. Synthroid 50mcg PO qdaily
5. Lactulose 30mL PO daily prn
6. Cranberry tab 450mg PO qdaily
7. ASA 325mg daily
8. Lacri-lube apply to both eyes qhs
9. Colace 200mg po qhs
10. Coumadin 3mg PO qdaily
11. Seroquel 200mg PO qam
12. Seroquel 600mg qhs
13. Depakote 1gram PO bid
14. Keppra 1500mg PO bid
15. Metoprolol 12.5mg PO bid
16. Buspar 15mg PO tid
17. Flexeril 10mg PO tid
18. Ultracet 37.5mg 2 tabs PO tid
19. Antivert 12.5mg PO q6hours prn for vertigo
20. Artificial tears 1 drop OU qid
21. Trazadone 200mg PO qhs prn insomnia
22. Tylenol 650mg PO q4hours prn
23. Imodium 2mg PO q4hours prn
24. Tums 1000mg PO q4hours prn
25. Lasix 40mg PO qdaily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.1  BP 116/65  HR 85  RR 18  95% 2L NC
Gen:  Speaking in full sentences, no inc. WOB, NAD, pleasant,
cooperative
HEENT: Left pupil slightly larger than right, visible cataracts,
both reactive to light, dry MM
Neck: Unable to assess JVD given habitus
CV: RRR, distant HS, no mrg apprec.
Resp: diffuse crackles throughout
Abd: obese, soft, nontender, +BS
Ext: Trace b/l LE edema, TEDS in place
Neuro:  AAOx3, sensation and CN 2-12 grossly intact

FAMILY HISTORY: No h/o DVTs/PEs, sisters without h/o miscarriages.

SOCIAL HISTORY: Lives at [**Location 2498**] NH locally in room by herself.  She is
functional with ADLs.  She has friends at the [**Name (NI) **] and delivers
the paper daily to the residents.  She quit smoking >10years
ago, but prior to that had approx. 30 packyear h/o tobacco.  She
drinks EtOH socially. No other illicit drugs.
Other pulmonary embolism and infarction,Congestive heart failure, unspecified,Alkalosis,Obstructive sleep apnea (adult)(pediatric),Myalgia and myositis, unspecified,Unspecified acquired hypothyroidism,Dysthymic disorder,Other bipolar disorders
Pulm embol/infarct NEC,CHF NOS,Alkalosis,Obstructive sleep apnea,Myalgia and myositis NOS,Hypothyroidism NOS,Dysthymic disorder,Bipolar disorder NEC
Admission Date:  [**2197-12-25**]              Discharge Date:   [**2197-12-29**]

Date of Birth:  [**2132-5-18**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
SOB/Hypoxemia

Major Surgical or Invasive Procedure:
None

History of Present Illness:
66 yo nursing home resident with h/o obesity, OSA who was
recently diagnosed at [**Hospital3 2737**] with multiple PEs, on
coumadin who presents to [**Hospital1 18**] with worsening hypoxemia.
.
Per [**Name6 (MD) **] home MD, Dr. [**Last Name (STitle) **], patient was diagnosed at OSH with
PEs on [**2197-12-18**] after developing hypoxemia and new oxygen
requirement.  Per report, [**Date Range **] at OSH were negative for DVT,
while CTA chest was positive for PE.  She was started lovenox
bridge to coumadin (lovenox was d/c'd on [**2197-12-23**] when
therapeutic INR) at that time and was discharged back to the
[**Location (un) 2498**] NH.  She reportedly has been therapeutic on coumadin
(last INR at NH was supratherapeutic at 3.7) since her [**Hospital1 **] stay.  She reports that since her d/c from [**Hospital1 **],
however, she has had persistent shortness of breath and has
required constant oxygen.  This am, her PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] was
making rounds at the NH and she informed him of her symptoms as
above.  This morning her 02 sat was 90% on 5L NC.  He was
concerned by lack of improvement and ? worsening hypoxemia and
suggested transfer to [**Hospital1 18**] for further evaluation.
.
Pt. reports no prior h/o DVTs nor PEs either in herself nor
family members. She does, however, report 2 miscarriages.  She
currently denies CP, palpitations.  No cough.
.
In the [**Last Name (LF) **], [**First Name3 (LF) **] sign out, she was found to be tachycardic,
tachypneic (although there is no documentation of tachycardia
nor tachypnea), and hypoxic with SBPs low 100s.  Despite
therapeutic INR (2.7 in ED here), CTPA was performed which
showed e/o multiple partially occlusive 2nd order brand PEs in
both lower lobes and right upper lobe.  She received
levofloxacin x1 for ? of LLL infiltrate on CXR.  She was started
on heparin gtt at this time and was transferred to the ICU given
her questionable HD stability.
.
ROS:  She denies cough, chest pain, palpitations.  She denies
fevers/chills. No lightheadedness/dizziness. No N/V/diarrhea. No
melena/hematochezia, no dysuria/hematuria. No orthopnea,
+intermittent LE edema worse over the past month.  Denies calf
pain currently (had mild calf pain on presentation to [**Hospital1 **],
but [**Hospital1 **] were negative).


Past Medical History:
1. Obesity
2. OSA
3. PE
4. s/p b/l knee replacements
5. HTN
6. Fibromyalgia
7. Anxiety
8. Depression c h/o psychosis
9. Bipolar disorder
10. Chronic low back pain
11. Blepharitis
12. CHF (unclear diagnosis, apparently newly diagnosed, EF not
known)
13. OA
14. Cataracts
15. S/P appendectomy
16. S/P hysterectomy
17. Hypothyroidism


Social History:
Lives at [**Location 2498**] NH locally in room by herself.  She is
functional with ADLs.  She has friends at the [**Name (NI) **] and delivers
the paper daily to the residents.  She quit smoking >10years
ago, but prior to that had approx. 30 packyear h/o tobacco.  She
drinks EtOH socially. No other illicit drugs.


Family History:
No h/o DVTs/PEs, sisters without h/o miscarriages.


Physical Exam:
T 99.1  BP 116/65  HR 85  RR 18  95% 2L NC
Gen:  Speaking in full sentences, no inc. WOB, NAD, pleasant,
cooperative
HEENT: Left pupil slightly larger than right, visible cataracts,
both reactive to light, dry MM
Neck: Unable to assess JVD given habitus
CV: RRR, distant HS, no mrg apprec.
Resp: diffuse crackles throughout
Abd: obese, soft, nontender, +BS
Ext: Trace b/l LE edema, TEDS in place
Neuro:  AAOx3, sensation and CN 2-12 grossly intact


Pertinent Results:
[**2197-12-25**] 01:50PM   PT-26.7* PTT-33.9 INR(PT)-2.7*
[**2197-12-25**] 01:50PM   CK-MB-3 cTropnT-<0.01 proBNP-51
[**2197-12-25**] 02:50PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2197-12-25**] 05:59PM   LACTATE-1.7
[**2197-12-25**] 11:21PM   TYPE-ART PO2-75* PCO2-50* PH-7.44 TOTAL
CO2-35* BASE XS-7
.
CXR: Left lower lobe opacity likely due to atelectasis, although
an
early developing pneumonia or possibly a pulmonary infarction in
light of given history cannot be entirely excluded.
.
CTA chest:
1.  Partially occlusive PEs in second order branches of right
upper and both lower lobes as described.  Comparison with a
prior outside hospital CTA, if available, is recommended to
assess for interval evolution.
2.  Small left pleural effusion.
3.  Dependent atelectatic changes, moderate on the left and mild
on the right.
.
EKG:  NSR 80bpm, nml axis, nml intervals, TWI V1-V3, isolated Q
in III


Brief Hospital Course:
65 yoF w/ h/o HTN, CHF, and recently diagnosed PE presents to
[**Hospital1 18**] from NH with persistent SOB and hypoxemia.
.
# Hypoxemia:  Given recent diagnosis of PE (diagnosed at [**Hospital1 **] on [**2197-12-18**]) and CTA chest findings on admission to
[**Hospital1 18**] positive for PEs, hypoxemia most likely [**1-5**] to this
process.  There was, however, some question as to whether
perhaps an increase in pulmonary pressures in the setting of PEs
caused reversal of intracardiac shunt.  TTE was obtained to rule
out intracardiac defect and shunt as well as CHF and was found
to be normal without e/o RV dysfunction/strain, intracardiac
defect, nor significant systolic/diastolic dysfunction.  She
does carry a new diagnosis of CHF and had crackles on pulmonary
exam, although echocardiogram as above was found to be normal.
Her admission BNP was normal at 51.  Thus, CHF seemed an
unlikely contributor to her hypoxemia; she was continued on her
home dose lasix.  She reported no h/o cough, fever, no elevated
WBC count so underlying infection was not a contributor.
Notably, she does have a history of OSA and had a metabolic
alkalosis on admission so there is some question of chronically
hypercarbic and hypoxic in setting of possible obesity
hypoventilation syndrome (her body habitus would be c/w this).
During her stay in the ICU, she was placed on her home settings
of CPAP for sleep and tolerated 2L of O2 by NC during the day,
maintaining O2 saturations of low to mid 90s.  By time of
discharge she ranged from room air to 2L NC and was maintaining
O2 saturations low to mid 90s at rest and with ambulation.
.
# Pulmonary emboli:  As above, recently diagnosed at OSH
([**2197-12-18**]).  Per nursing home reports, she had been bridged on
therapeutic lovenox to coumadin with therapeutic INR.  Thus, the
question of coumadin failure was entertained.  Given the recent
diagnosis and no clear increased O2 requirement (just persistent
O2 requirement and dyspnea since diagnosis of PE on [**12-18**]), it
seemed less likely coumadin failure as opposed to natural course
of her known PE.  [**Hospital3 2737**] was contact[**Name (NI) **] and actual
images (CTA chest) were obtained so that our radiologists could
review and compare her admission CTA to further evaluate
increased clot burden while therapeutic on lovenox then
coumadin.  [**Hospital1 18**] radiologists reviewed these OSH images and
found that clot burden appeared stable if not slightly improved
on her admission imaging at [**Hospital1 18**].  Heparin gtt started in the
ED was discontinued in the [**Hospital Unit Name 153**] and coumadin was restarted.  Her
INR was subtherapeutic x2 days prior to discharge, however, (1.3
on day of discharge) so she received therapeutic dose of SC
lovenox which she will need to continue until her INR is again
therapeutic.  The etiology of her PEs is unclear.  [**Name2 (NI) **] were
negative at [**Hospital3 2737**].   She has not had age approprate
cancer screening; she reports mammography "many years ago" and
no history of colonoscopy nor recent gynecologic care.  She does
report a history of 2 miscarriages (also had several successful
pregnancies), but no history of clots in her as well as family
members as far as she knows.  She has not had any hypercoaguble
work up so further laboratory testing will need to be obtained.
.
# Metabolic alkalosis:  She had persistent metabolic alkalosis
with serum bicarbonate in the 33-34 range.  There is some
question as outlined above, of obesity hypoventilation syndrome
and thus, development of metabolic alkalosis in the setting of
hypercarbia associated with OHS.  pCO2 was found to be 50 on
ABG.  She does have an approximate 30packyear history of
smoking, but quit 13 years ago and has no diagnosis of COPD.
She should likely follow up to further evaluate for obesity
hypoventilation syndrome.
.
# CHF:  As above, she was recently diagnosed with CHF and
started on lasix.  TTE obtained here, however, showed normal
systolic and only very mild diastolic dysfunction.  BNP was
normal at 51.  She did have bilateral crackles on pulmonary
exam, but otherwise did not appear volume overloaded.  Imaging
was unimpressive for significant pulmonary edema.  She was
continued on her home dose of lasix.
.
# HTN:  Unclear baseline blood pressure, but remained
normotensive while hospitalized.  She was continued on her low
dose beta blocker.
.
# Anxiety/Depression/Bipolar:  She was continued on her multiple
home medications as listed on her admission medication list.
.
# OSA: Continued on CPAP on her home settings.
.
# Hypothyroidism: Continued on her home dose synthroid.
.
# Code:  DNR/DNI per discussion with patient
.
# Comm: HCP [**Name (NI) 5969**] [**Name (NI) 19755**] [**Telephone/Fax (1) 71536**]

Medications on Admission:
1. Effexor 300mg PO qam
2. Abilify 20mg PO qdaily
3. KCL 20mEq PO qdaily
4. Synthroid 50mcg PO qdaily
5. Lactulose 30mL PO daily prn
6. Cranberry tab 450mg PO qdaily
7. ASA 325mg daily
8. Lacri-lube apply to both eyes qhs
9. Colace 200mg po qhs
10. Coumadin 3mg PO qdaily
11. Seroquel 200mg PO qam
12. Seroquel 600mg qhs
13. Depakote 1gram PO bid
14. Keppra 1500mg PO bid
15. Metoprolol 12.5mg PO bid
16. Buspar 15mg PO tid
17. Flexeril 10mg PO tid
18. Ultracet 37.5mg 2 tabs PO tid
19. Antivert 12.5mg PO q6hours prn for vertigo
20. Artificial tears 1 drop OU qid
21. Trazadone 200mg PO qhs prn insomnia
22. Tylenol 650mg PO q4hours prn
23. Imodium 2mg PO q4hours prn
24. Tums 1000mg PO q4hours prn
25. Lasix 40mg PO qdaily


Discharge Medications:
1. Venlafaxine 75 mg Capsule, Sust. Release 24HR Sig: Four (4)
Capsule, Sust. Release 24HR PO QAM (once a day (in the
morning)).
2. Aripiprazole 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Potassium Chloride 20 mEq Packet Sig: One (1)  PO once a day.

4. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO DAILY PRN
() as needed for for constipation.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Quetiapine 200 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
9. Quetiapine 200 mg Tablet Sig: Three (3) Tablet PO QHS (once a
day (at bedtime)).
10. Depakote 500 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO twice a day.
11. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
12. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
13. Buspirone 5 mg Tablet Sig: Three (3) Tablet PO TID (3 times
a day).
14. Cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) as needed.
15. Ultracet 37.5-325 mg Tablet Sig: 1-2 Tablets PO three times
a day.
16. Meclizine 12.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for vertigo.
17. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-5**]
Drops Ophthalmic QHS (once a day (at bedtime)).
18. Trazodone 100 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime) as needed for insomnia.
19. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
20. Outpatient [**Name (NI) **] Work
PT, INR, chem 7 on [**2198-1-1**] and q3 days or frequency after
[**2198-1-1**] to be determined by Dr. [**Last Name (STitle) **].
21. Home oxygen
Portable continuous home oxygen.  Please maintain oxygen
saturation greater than or equal to 92%.
22. Enoxaparin 100 mg/mL Syringe Sig: One Hundred (100) mg
Subcutaneous Q12H (every 12 hours): Subcutaneously.
Disp:*6000 mg* Refills:*0*
23. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital 2498**] Nursing Home

Discharge Diagnosis:
Pulmonary Embolism


Discharge Condition:
Stable with oxygen saturations stable in the low 90s at rest and
with ambulation on room air.


Discharge Instructions:
Please call your doctor or return to the emergency room if you
develop worsening shortness of breath, chest pain, leg
swelling/pain (especially asymmetric), easy bruising or
bleeding, or any other symptoms that concern you.
.
Please continue to take your coumadin as directed.  It will be
very important to keep your INR between 2 and 3 so your blood
will have to be monitored frequently.  Dr. [**Last Name (STitle) **] will guide
your coumadin dosing based on your [**Last Name (STitle) **] results.  You will
receive lovenox injections unitl your INR is in the 2-3 range.
.
Please resume taking your other medications as you were prior to
this admission.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] upon discharge from the
hospital.  You will need to call his office (open 10am to 2pm)
in order to schedule a follow up appointment.  His office number
is [**Telephone/Fax (1) 44870**].
{'Other pulmonary embolism and infarction,Congestive heart failure, unspecified,Alkalosis,Obstructive sleep apnea (adult)(pediatric),Myalgia and myositis, unspecified,Unspecified acquired hypothyroidism,Dysthymic disorder,Other bipolar disorders'}


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: SOB/Hypoxemia

PRESENT ILLNESS: 66 yo nursing home resident with h/o obesity, OSA who was
recently diagnosed at [**Hospital3 2737**] with multiple PEs, on
coumadin who presents to [**Hospital1 18**] with worsening hypoxemia.
.
Per [**Name6 (MD) **] home MD, Dr. [**Last Name (STitle) **], patient was diagnosed at OSH with
PEs on [**2197-12-18**] after developing hypoxemia and new oxygen
requirement.  Per report, [**Date Range **] at OSH were negative for DVT,
while CTA chest was positive for PE.  She was started lovenox
bridge to coumadin (lovenox was d/c'd on [**2197-12-23**] when
therapeutic INR) at that time and was discharged back to the
[**Location (un) 2498**] NH.  She reportedly has been therapeutic on coumadin
(last INR at NH was supratherapeutic at 3.7) since her [**Hospital1 **] stay.  She reports that since her d/c from [**Hospital1 **],
however, she has had persistent shortness of breath and has
required constant oxygen.  This am, her PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] was
making rounds at the NH and she informed him of her symptoms as
above.  This morning her 02 sat was 90% on 5L NC.  He was
concerned by lack of improvement and ? worsening hypoxemia and
suggested transfer to [**Hospital1 18**] for further evaluation.
.
Pt. reports no prior h/o DVTs nor PEs either in herself nor
family members. She does, however, report 2 miscarriages.  She
currently denies CP, palpitations.  No cough.
.
In the [**Last Name (LF) **], [**First Name3 (LF) **] sign out, she was found to be tachycardic,
tachypneic (although there is no documentation of tachycardia
nor tachypnea), and hypoxic with SBPs low 100s.  Despite
therapeutic INR (2.7 in ED here), CTPA was performed which
showed e/o multiple partially occlusive 2nd order brand PEs in
both lower lobes and right upper lobe.  She received
levofloxacin x1 for ? of LLL infiltrate on CXR.  She was started
on heparin gtt at this time and was transferred to the ICU given
her questionable HD stability.
.
ROS:  She denies cough, chest pain, palpitations.  She denies
fevers/chills. No lightheadedness/dizziness. No N/V/diarrhea. No
melena/hematochezia, no dysuria/hematuria. No orthopnea,
+intermittent LE edema worse over the past month.  Denies calf
pain currently (had mild calf pain on presentation to [**Hospital1 **],
but [**Hospital1 **] were negative).

MEDICAL HISTORY: 1. Obesity
2. OSA
3. PE
4. s/p b/l knee replacements
5. HTN
6. Fibromyalgia
7. Anxiety
8. Depression c h/o psychosis
9. Bipolar disorder
10. Chronic low back pain
11. Blepharitis
12. CHF (unclear diagnosis, apparently newly diagnosed, EF not
known)
13. OA
14. Cataracts
15. S/P appendectomy
16. S/P hysterectomy
17. Hypothyroidism

MEDICATION ON ADMISSION: 1. Effexor 300mg PO qam
2. Abilify 20mg PO qdaily
3. KCL 20mEq PO qdaily
4. Synthroid 50mcg PO qdaily
5. Lactulose 30mL PO daily prn
6. Cranberry tab 450mg PO qdaily
7. ASA 325mg daily
8. Lacri-lube apply to both eyes qhs
9. Colace 200mg po qhs
10. Coumadin 3mg PO qdaily
11. Seroquel 200mg PO qam
12. Seroquel 600mg qhs
13. Depakote 1gram PO bid
14. Keppra 1500mg PO bid
15. Metoprolol 12.5mg PO bid
16. Buspar 15mg PO tid
17. Flexeril 10mg PO tid
18. Ultracet 37.5mg 2 tabs PO tid
19. Antivert 12.5mg PO q6hours prn for vertigo
20. Artificial tears 1 drop OU qid
21. Trazadone 200mg PO qhs prn insomnia
22. Tylenol 650mg PO q4hours prn
23. Imodium 2mg PO q4hours prn
24. Tums 1000mg PO q4hours prn
25. Lasix 40mg PO qdaily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.1  BP 116/65  HR 85  RR 18  95% 2L NC
Gen:  Speaking in full sentences, no inc. WOB, NAD, pleasant,
cooperative
HEENT: Left pupil slightly larger than right, visible cataracts,
both reactive to light, dry MM
Neck: Unable to assess JVD given habitus
CV: RRR, distant HS, no mrg apprec.
Resp: diffuse crackles throughout
Abd: obese, soft, nontender, +BS
Ext: Trace b/l LE edema, TEDS in place
Neuro:  AAOx3, sensation and CN 2-12 grossly intact

FAMILY HISTORY: No h/o DVTs/PEs, sisters without h/o miscarriages.

SOCIAL HISTORY: Lives at [**Location 2498**] NH locally in room by herself.  She is
functional with ADLs.  She has friends at the [**Name (NI) **] and delivers
the paper daily to the residents.  She quit smoking >10years
ago, but prior to that had approx. 30 packyear h/o tobacco.  She
drinks EtOH socially. No other illicit drugs. 

### Response:
{'Other pulmonary embolism and infarction,Congestive heart failure, unspecified,Alkalosis,Obstructive sleep apnea (adult)(pediatric),Myalgia and myositis, unspecified,Unspecified acquired hypothyroidism,Dysthymic disorder,Other bipolar disorders'}
