CHIEF COMPLAINT: s/p fall, w/ GI bleed, MI, DKA

PRESENT ILLNESS: 62 y/o F with PMH of HTN, HL, DMII, CVA, CAD s/p MI and stent
'[**86**] and '[**89**], on Plavix (no ASA), who presented to ER s/p fall,
with coffee ground emesis x 2 days. She reports that she was at
home in her wheelchair 1 day PTA when she became
lightheaded/dizzy and fell. Unwitnessed. Apparently lost
consciousness and awoke the next day. Called paramedics and
brought to [**Hospital1 18**]. Reports no preceding chest pain, palpitations,
shortness of breath. +nausea and dark emesis over last couple
days. denies black stools or BRBPR.
.
In ER, BP 203/106, HR 103, T97.4, FSBG >500. NG lavage coffee
ground cleared w/ 200 cc, rectal brown strongly G+, Hct 37
baseline. EKG with STEMI (1mm III/aVF, CK/Tn neg x1) and DKA
(Glu 800's, HCO3 18, AG 33, BUN/Cr 40/1.7). Seen by GI in ER. No
scope given MI. Seen by Cards. No cath given GI bleed. Given
Anzemet 12.5 IV, Protonix, Regular Insulin 10 IV x 1, followed
by Insulin drip at 7U/hr. 3L NS IVF. Lopressor 5mg IV x 1.

MEDICAL HISTORY: HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

MEDICATION ON ADMISSION: prilosec 40mg/day
plavix 75mg/day
albuterol inh
insulin 40NPH/20Reg qam, 20NPH qpm
atenolol 25mg/day
lisinopril 20mg/day
sl Ntg prn
neurontin 600mg TID

ALLERGIES: Aspirin / Nifedipine / Premarin / Morphine / Crestor /
Atorvastatin / Codeine

PHYSICAL EXAM: vitals- 96.3, 90, 156/90, 23, 100% RA
gen- nauseated, no acute distress, chest pain free
neck- b/l EJ lines, no noticeable JVD
heent- EOMI. non-icteric sclera. MM dry
pulm- CTA b/l. no r/r/w
cv- RRR. no m/r/g
abd- soft, NT/ND. mild RUQ tenderness w/o rebound or guarding
ext- cool LE's. 1+ pulses b/l. no edema
neuro- sleepy but arousable, oriented x 3. LUE/LLE 0/5; RLE/RUE
[**4-17**] motor strength
rect- dark brown, guaiac +; no bright red blood.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives alone at home [**Location (un) 6409**]; wheelchair bound s/p CVA; no
h/o ETOH or tobacco use
Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Nonspecific abnormal electrocardiogram [ECG] [EKG],Percutaneous transluminal coronary angioplasty status,Surgical or other procedure not carried out because of contraindication,Esophageal reflux,Old myocardial infarction,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Candidal esophagitis,Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Hyperosmolality and/or hypernatremia,Iron deficiency anemia secondary to blood loss (chronic),Acute kidney failure, unspecified,Accidental fall from bed,Long-term (current) use of insulin
Hypertension NOS,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Abnorm electrocardiogram,Status-post ptca,No proc/contraindication,Esophageal reflux,Old myocardial infarct,Late ef-hemplga side NOS,Candidal esophagitis,DMII ketoacd uncontrold,Urin tract infection NOS,Hyperosmolality,Chr blood loss anemia,Acute kidney failure NOS,Fall from bed,Long-term use of insulin
Admission Date:  [**2195-9-2**]              Discharge Date:   [**2195-9-10**]

Date of Birth:  [**2132-11-18**]             Sex:   F

Service: MEDICINE

Allergies:
Aspirin / Nifedipine / Premarin / Morphine / Crestor /
Atorvastatin / Codeine

Attending:[**First Name3 (LF) 7934**]
Chief Complaint:
s/p fall, w/ GI bleed, MI, DKA

Major Surgical or Invasive Procedure:
EGD

History of Present Illness:
62 y/o F with PMH of HTN, HL, DMII, CVA, CAD s/p MI and stent
'[**86**] and '[**89**], on Plavix (no ASA), who presented to ER s/p fall,
with coffee ground emesis x 2 days. She reports that she was at
home in her wheelchair 1 day PTA when she became
lightheaded/dizzy and fell. Unwitnessed. Apparently lost
consciousness and awoke the next day. Called paramedics and
brought to [**Hospital1 18**]. Reports no preceding chest pain, palpitations,
shortness of breath. +nausea and dark emesis over last couple
days. denies black stools or BRBPR.
.
In ER, BP 203/106, HR 103, T97.4, FSBG >500. NG lavage coffee
ground cleared w/ 200 cc, rectal brown strongly G+, Hct 37
baseline. EKG with STEMI (1mm III/aVF, CK/Tn neg x1) and DKA
(Glu 800's, HCO3 18, AG 33, BUN/Cr 40/1.7). Seen by GI in ER. No
scope given MI. Seen by Cards. No cath given GI bleed. Given
Anzemet 12.5 IV, Protonix, Regular Insulin 10 IV x 1, followed
by Insulin drip at 7U/hr. 3L NS IVF. Lopressor 5mg IV x 1.


Past Medical History:
HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

Social History:
lives alone at home [**Location (un) 6409**]; wheelchair bound s/p CVA; no
h/o ETOH or tobacco use

Family History:
non-contributory

Physical Exam:
vitals- 96.3, 90, 156/90, 23, 100% RA
gen- nauseated, no acute distress, chest pain free
neck- b/l EJ lines, no noticeable JVD
heent- EOMI. non-icteric sclera. MM dry
pulm- CTA b/l. no r/r/w
cv- RRR. no m/r/g
abd- soft, NT/ND. mild RUQ tenderness w/o rebound or guarding
ext- cool LE's. 1+ pulses b/l. no edema
neuro- sleepy but arousable, oriented x 3. LUE/LLE 0/5; RLE/RUE
[**4-17**] motor strength
rect- dark brown, guaiac +; no bright red blood.

Pertinent Results:
ADMIT EKG:
=========
NSR. borderline left axis. 1mm ST elev III, 0.5mm AVF, w/ 1mm ST
dep I, 1mm AVL. QIII, AVF (old) , TWI anterolaterally
.
ADMIT Labs:
==========
[**2195-9-2**] 06:00PM   WBC-10.1# RBC-4.28 HGB-12.6 HCT-36.6 MCV-86
[**2195-9-2**] 06:00PM   NEUTS-88.1* LYMPHS-8.5* MONOS-3.2 EOS-0.2
BASOS-0
[**2195-9-2**] 06:00PM   ALBUMIN-3.6
[**2195-9-2**] 06:00PM   ALT(SGPT)-11 AST(SGOT)-17 CK(CPK)-49 ALK
PHOS-120* AMYLASE-42 TOT BILI-0.5
[**2195-9-2**] 06:00PM   LIPASE-25
[**2195-9-2**] 06:00PM   GLUCOSE-883* UREA N-40* CREAT-1.7* SODIUM-140
POTASSIUM-4.1 CHLORIDE-93* TOTAL CO2-18* ANION GAP-33*
[**2195-9-2**] 06:00PM   PT-11.0 PTT-20.8* INR(PT)-0.9
.
Cardiac Enzymes:
===============
[**2195-9-2**] 09:41PM BLOOD CK(CPK)-48
[**2195-9-3**] 04:10AM BLOOD CK(CPK)-62
[**2195-9-3**] 12:00PM BLOOD CK(CPK)-86
[**2195-9-2**] 09:41PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2195-9-3**] 04:10AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2195-9-3**] 12:00PM BLOOD CK-MB-NotDone cTropnT-<0.01
.
ECHO [**2195-9-3**]:
============
Conclusions:
The left atrium is normal in size. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Overall left ventricular systolic function is low normal
(LVEF 50%) secondary to hypokinesis of the inferior septum and
inferior free wall (basal segments). No masses or thrombi are
seen in the left ventricle. There is no ventricular septal
defect. Right ventricular chamber size and free wall motion are
normal. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. Trace aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. There is
no mitral valve prolapse. Mild (1+) mitral regurgitation is
seen. The estimated pulmonary artery systolic pressure is
normal. There is no pericardial effusion
.
Compared with the findings of the prior study (images reviewed)
of [**2191-12-23**], inferior hypokinesis is now present
.
ABDOMINAL U/S [**2195-9-3**]:
=====================
COMPLETE ABDOMINAL ULTRASOUND:
.
The liver is normal in echotexture with no focal lesions
identified. There is appropriate forward portal venous flow.
There is no intra- or extra-hepatic ductal dilatation. There are
a few small gallstones with no evidence of cholecystitis. The
spleen is small measuring 8 cm. The right kidney measures 9.0
cm. The left kidney measures 9.1 cm. There is no hydronephrosis
or stones. There is no ascites.
.
IMPRESSION:
1. Cholelithiasis with no evidence for cholecystitis.
2. Patent portal veins with appropriate forward flow.
.
EGD [**2195-9-4**]:
============
Esophagus:
Mucosa: Esophagitis with contact bleeding was seen in the lower
third of the esophagus, most likely associated with [**Female First Name (un) **].
Diffuse candidiasis was seen in the upper third of the
esophagus, middle third of the esophagus and lower third of the
esophagus. Samples were obtained for microbiology using a brush.

Stomach: Excavated Lesions Multiple erosions were noted in the
stomach body, antrum and fundus. Most were in a linear
distribution. [**Month (only) 116**] or may not be related to NG tube (if placed
earlier).
Duodenum: Normal duodenum.
.
Colonoscopy [**2195-9-10**]: aborted secondary to inadequate preparation


Brief Hospital Course:
62 yo female with h/o DMII, CAD, CVA, who presents with GI
bleed, found to be in DKA, c/b UGIB likely [**1-15**] esophageal
candidiasis, currently stable.
.
# ? SEIZURE- Had question of hypoglycemic seizure [**9-6**] with BG
38 and confusion, aphasia. CT of the head was negative for
bleed. EEG performed [**9-6**] showed diffusely slow and disorganized
background and bursts of frequent slowing suggestive of moderate
to severe encephalopathy. Also occasional delta frequency
slowing in temporal region bilaterally suggestive of subcortical
dysfunction. No clear epileptiform seizures were seen. She
continued to have brief intermittent episodes of agitation. She
always quickly returned back to her alert, oriented, pleasant
baseline on each occasion. These episodes lasted for 2 days and
then resolved. Toxic metabolic workup was unremarkable.
Non-motor seizures were still on the differential so a
sphenoidal EEG was performed which was also unremarkable. At the
time of discharge, patient had been alert, oriented, and
pleasant for the 48 hours prior to discharge.  She was set up
with follow up in the neurology epilepsy clinic on discharge.
.
# Diabetes - Her DKA resolved and gap closed with IVF and
insulin. Unclear precipitating factor of DKA but thought
possibly due to UTI or esophageal candidiasis. She had
relatively well controlled BGs during admission with only
occasional late evening elevations thought likely secondary to
overeating at dinner. She was changed from NPH to lantus with
the help of [**Last Name (un) **] recommendations.  At the time of discharge,
the majority of her fingersticks were in the low 100s and she
was sent out on lantus and humalog insulin sliding scale [**First Name8 (NamePattern2) **]
[**Last Name (un) **] recommendations.
.
# GIB - She was initially seen by GI with coffee ground emesis
and a positive NG lavage in ER. She initially recieved 1 unit of
pRBCs for hct of 28.9 with concern for STEMI which was
eventually ruled out. EGD performed on HD# 3 which demonstrated
esophagitis with contact bleeding in the lower third of the
esophagus, most likely associated with [**Female First Name (un) **]. Diffuse
candidiasis was seen in the upper third of the esophagus, middle
third of the esophagus and lower third of the esophagus. She was
treated with fluconazole, to complete a 14 day course.
Esophageal candidiasis believed likely secondary to poorly
controlled diabetes. Her HIV test was negative. Her hematocrit
fluctuated over course of admission but remained relatively
stable. She required no further transfusions.  However, given
concern for a possible lower GI source with stable hematocrit
significantly below prior baseline, she was prepped for a
colonoscopy. However, at colonoscopy, her bowel preparation was
inadequate and the procedure was aborted.  There was urgent need
for acute colonoscopy so she was discharged for outpatient
colonoscopy per GI recommendations.
.
# hypernatremia- The etiology of her hypernatremia was unclear.
It slowly responded to 1/2 NS but then quickly rebounded to 150
after her bowel preparation. Seemed to be euvolemic
hypernatremia on exam. It was as high as 152 on admission. Serum
osmolality and urine osmolality was normal. BGs were not high
enough to suggest an osmotic diuresis. DI was not suggested by
urine osmolality.  Patient has had excellent po intake but
unclear whether thirst and osmoreceptor function was intact.
With history of CVA, there was some question of hypothalamic
dysfunction. However, there was no evidence of new changes on
head CT, which would have been expected as patient presented
with hypernatremia. Also possible that when volume recessated
for her DKA she was treated with hypertonic sodium bicarbonate
to treat her metabolic acidosis which can cause hypernatremia
but should have resolved after resusitation was stopped.  She
had no neurologic symptoms of her hypernatremia at the time of
discharge and was encouraged to take in free water. She was
scheduled for follow up wiht her PCP to have labs drawn prior to
her visit.
.
# hypertension- Patient had elevated BPs, especially overnight,
without clear cause. Her beta blocker was increased to 50 mg TID
of metoprolol.  Her lisinopril was increased to 30 mg QD. At the
time of discharge, her metoprolol was changed to 150 mg QD of
atenolol.
.
# CAD- Initial EKG with inferior ST elevations (1mm III, 0.5mm
AVF), w/ reciprocal ST depressions in I,AVL. Cardiac enzymes
cycled and were negative x 3.  Patient remained chest pain free
throughout. Cardiology reviewed EKGs and did not feel that
changes were consistent with a STEMI. Recommended [**Hospital **] medical
management only. Was continued on her clopedigrel, lisinopril,
and beta blocker.  She was not given aspirin or a statin given
her documented allergy.
.
# UTI - Culture [**2195-9-2**] grew a pansensitive E-coli. Unclear
whether this was the cause of her DKA.  She was started on Cipro
and was treated for a 7 day course to be completed as an
outpatient.
.

Medications on Admission:
prilosec 40mg/day
plavix 75mg/day
albuterol inh
insulin 40NPH/20Reg qam, 20NPH qpm
atenolol 25mg/day
lisinopril 20mg/day
sl Ntg prn
neurontin 600mg TID

Discharge Medications:
1. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 2 days.
Disp:*4 Tablet(s)* Refills:*0*
2. Fluconazole 100 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 8 days.
Disp:*8 Tablet(s)* Refills:*0*
3. Prilosec 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation
four times a day as needed for shortness of breath or wheezing.

6. Lantus 100 unit/mL Solution Sig: Thirty (30) units
Subcutaneous at bedtime.
Disp:*qs * Refills:*2*
7. Humalog 100 unit/mL Solution Sig: One (1) injection
Subcutaneous asdir: For BG<80, no insulin.
For BG 81-120 mg/dL give 4 Units.
For BG 121-160 mg/dL give 5 Units. For BG 161-200 mg/dL give 6
Units For BG 201-240 mg/dL, give 7 Units For BG 241-280 mg/dL
give 8 Units.
For BG 281-320 mg/dL, give 9 units
For BG 321-360 mg/dL give 10 Units For BG 361-400 mg/dL, give 11
Units .
8. Neurontin 600 mg Tablet Sig: One (1) Tablet PO three times a
day.
9. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tab
Sublingual Q5minutes as needed for chest pain: x 4 doses.  If
chest pain persistent after 4 doses, [**Name8 (MD) 138**] MD or go to Emergency
Room.
10. Lisinopril 30 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Atenolol 100 mg Tablet Sig: 1.5 Tablets PO once a day.
Disp:*45 Tablet(s)* Refills:*2*
12. Outpatient Lab Work
Please have bloodwork done in 1 week and have the results faxed
to your PCP [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at fax: [**Telephone/Fax (1) 16587**].
Check CBC, SMA-7


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary:
1. Diabetic Ketoacidosis
2. esophageal candidiasis
3. urinary tract infection
.
Secondary:
1. Diabetes Mellitus
2. hypertension
3. hyperlipidemia
4. coronary artery disease
5. gastroesophageal reflux disease


Discharge Condition:
stable


Discharge Instructions:
Please continue to take all medications as prescribed.  Please
note that you must continue to take your Cipro to complete a 7
day course for a urinary tract infection. You will also need to
continue to take fluconazole for your esophageal yeast infection
to complete a 14 day course. Please note that your atenolol and
lisinopril doses have been increased.  Your NPH insulin has been
changed to Lantus (insulin glargine) which you will now only
have to take once a day.
.
Please try to drink water as much as possible as your lab
results suggest that you are dehydrated.
.
Please follow up with Nurse [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] as below.
You should have blood work drawn in 1 week and have the results
faxed to Dr. [**Last Name (STitle) **].  You have been given a prescription for
bloodwork.
.
Your colonoscopy could not be performed while in the hospital
because your bowel preparation was inadequate.  You will need to
follow up as an outpatient to repeat the colonscopy. See below.
.
Please call your doctor or return to the hospital if you
experience chest pain, shortness of breath, fever, chills,
nausea, vomiting, abdominal pain, bloody stools, dark tarry
stools, or any other concerns.

Followup Instructions:
Please follow up with Nurse [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] on
[**2195-9-25**] at 10 am at [**Hospital3 **].  Phone [**Telephone/Fax (1) 1247**]
.
Please follow up with Neurology with Dr. [**First Name (STitle) **] [**Name (STitle) 4253**]. The
office will be calling you to let you know the date and time of
your appointment.
.
Please follow up with Gastroenterology to repeat your
colonoscopy on [**2195-9-23**] at 8am with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 572**]. Phone: [**Telephone/Fax (1) 97842**].  You will need to complete a bowel preparation the day
prior to your procedure.  This will be mailed to you prior to
that date.  If you have not received your preparation before
[**2195-9-18**], please call [**Telephone/Fax (1) 9557**].
.
Provider: [**First Name11 (Name Pattern1) 354**] [**Last Name (NamePattern4) 3013**], M.D. Date/Time:[**2195-11-18**] 1:00
.
Provider: [**Name10 (NameIs) **] PROCEDURE Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2195-11-18**]
1:00
{'Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Nonspecific abnormal electrocardiogram [ECG] [EKG],Percutaneous transluminal coronary angioplasty status,Surgical or other procedure not carried out because of contraindication,Esophageal reflux,Old myocardial infarction,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Candidal esophagitis,Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Hyperosmolality and/or hypernatremia,Iron deficiency anemia secondary to blood loss (chronic),Acute kidney failure, unspecified,Accidental fall from bed,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: s/p fall, w/ GI bleed, MI, DKA

PRESENT ILLNESS: 62 y/o F with PMH of HTN, HL, DMII, CVA, CAD s/p MI and stent
'[**86**] and '[**89**], on Plavix (no ASA), who presented to ER s/p fall,
with coffee ground emesis x 2 days. She reports that she was at
home in her wheelchair 1 day PTA when she became
lightheaded/dizzy and fell. Unwitnessed. Apparently lost
consciousness and awoke the next day. Called paramedics and
brought to [**Hospital1 18**]. Reports no preceding chest pain, palpitations,
shortness of breath. +nausea and dark emesis over last couple
days. denies black stools or BRBPR.
.
In ER, BP 203/106, HR 103, T97.4, FSBG >500. NG lavage coffee
ground cleared w/ 200 cc, rectal brown strongly G+, Hct 37
baseline. EKG with STEMI (1mm III/aVF, CK/Tn neg x1) and DKA
(Glu 800's, HCO3 18, AG 33, BUN/Cr 40/1.7). Seen by GI in ER. No
scope given MI. Seen by Cards. No cath given GI bleed. Given
Anzemet 12.5 IV, Protonix, Regular Insulin 10 IV x 1, followed
by Insulin drip at 7U/hr. 3L NS IVF. Lopressor 5mg IV x 1.

MEDICAL HISTORY: HTN
DMII
Hyperlipidemia
h/o CVA w/ residual L sided hemiparesis
CAD- w/ stent '[**86**] and '[**89**]
Asthma
Rheumatic fever
Femoral Bypass - [**1-15**] complication of most recent cath
Asthma - last hospitalization mult years ago, uses rescue
albuterol inhaler 1-2 times per week
migraine headaches - tx with vicodin or tylenol
Breast Cancer - node negative (surgery only, no chemo, no rad)
Degenerative Disk Disease
Osteoarthritis
Osteoporosis
GERD

MEDICATION ON ADMISSION: prilosec 40mg/day
plavix 75mg/day
albuterol inh
insulin 40NPH/20Reg qam, 20NPH qpm
atenolol 25mg/day
lisinopril 20mg/day
sl Ntg prn
neurontin 600mg TID

ALLERGIES: Aspirin / Nifedipine / Premarin / Morphine / Crestor /
Atorvastatin / Codeine

PHYSICAL EXAM: vitals- 96.3, 90, 156/90, 23, 100% RA
gen- nauseated, no acute distress, chest pain free
neck- b/l EJ lines, no noticeable JVD
heent- EOMI. non-icteric sclera. MM dry
pulm- CTA b/l. no r/r/w
cv- RRR. no m/r/g
abd- soft, NT/ND. mild RUQ tenderness w/o rebound or guarding
ext- cool LE's. 1+ pulses b/l. no edema
neuro- sleepy but arousable, oriented x 3. LUE/LLE 0/5; RLE/RUE
[**4-17**] motor strength
rect- dark brown, guaiac +; no bright red blood.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives alone at home [**Location (un) 6409**]; wheelchair bound s/p CVA; no
h/o ETOH or tobacco use 

### Response:
{'Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Nonspecific abnormal electrocardiogram [ECG] [EKG],Percutaneous transluminal coronary angioplasty status,Surgical or other procedure not carried out because of contraindication,Esophageal reflux,Old myocardial infarction,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Candidal esophagitis,Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Hyperosmolality and/or hypernatremia,Iron deficiency anemia secondary to blood loss (chronic),Acute kidney failure, unspecified,Accidental fall from bed,Long-term (current) use of insulin'}
