CHIEF COMPLAINT: Watery diarrhea for two weeks

PRESENT ILLNESS: Patient is a 69yo AAF with a PMHx significant for ESRD, COPD,
HIV+, CAD, CHF, PEA arrest, MR, PE, GI bleeds, Anemia, and
Vulvar squamous cell carcinoma that was recently discharged from
[**Hospital1 18**] for pneumonia and treated with a complete dose of
antibiotics, that began to have watery diarrhea for five days,
developed fevers, chills, and abdominal pain. Pain is diffuse,
nonfocal, [**7-28**], and not associated with nausea or vomiting.
.
CC: Transfer from surgery service with diarrhea
.
HPI: 69 female with MMP including ESRD on HD, HIV (cd4 940
[**7-23**], on HAART), CAD s/p MI, CHF, COPD presents to our service
for continued treatment of medical conditions and diarrhea.
Briefly, she was admitted on [**12-12**] with fever chills and
abdominal pain one week after being discharged on
vanco/levo/flagyl for pneumonia.  She reports increasing
frequency of BM and worsening abdominal pain.  She had F/C at
home, but was free of them since being in hospital.  She also
had episodes of chest pain while at rest at hemodialysis.
Cardiology was consulted twice. THe first episode was associated
with a troponin elevation, thought to be due to demand ischemia
in the setting of going into AF.  The second episode of
substernal burning was releived with maalox, and felt to be very
atypical for ischemic chest pain.  She has also been followed by
infectious disesase for a fairly resistant diarrhea, with the
only positive micro data being positive c.dif.  The diarrhea was
watery, and is slowly improving.
.
She currently is feeling well, with much less abdominal pain and
slowing frequency of bowel movements.  She had 3 BM two days
ago, 2 BM yesterday, and 1 BM thus far today (more formed).  She
has been treated with flagyl, PO vanco, and cholestyramine.  She
was admitted with a WBC of 23K, and now is 11K.  Her hematocrit
has remained stable in mid 30s.  She has been persistently
elevated.  Her INR was supratherapeutic on admission (on
warfarin for h/o DVT with PE) at 10.  Her warfarin was restarted
now.  She currently denies F/C/NS, occasional cough, no
abdominal pain. SHe has occasional nausea that responds to
anzemet.

MEDICAL HISTORY: Past Medical History:
1. CAD s/p NSTEMI [**5-19**], s/p PTCA/stent LCX [**2113**]. Latest
catheterization in [**10-21**] with 2-vessel disease. Persantine MIBI
[**4-22**] without symptoms or EKG changes. MIBI images significant
for severe fixed inferior defect, EF 58%.
2. DM type 2, on NPH.
3. HIV, last CD4 count 940 in [**7-/2115**]
4. ESRD on HD since '[**10**] (M, W, F)
5. CHF, with mixed systolic (EF 45-50%) and diastolic
dysfunction.
6. Severe mitral regurgitation [**2115-6-20**]
7. History of RUL segmental PE in [**11/2114**], on coumadin
([**2114-12-5**]) D/C'd in 06/[**2115**].
8. Recently diagnosed right popliteal DVT [**7-/2115**], restarted on
Coumadin
9. H/o multiple AVF clots, s/p thrombectomies, last in [**2115-1-8**]
9. H/o GIB in the setting of coagulopathy and NSAIDs
10. Eosinophilic pneumonia diagnosed [**4-22**], on chronic
prednisone therapy.
11. Anemia [**2-20**] CRF
12. Vulvar intraepithelial neoplasia diagnosed in [**2113-4-18**].
13. COPD with PFTs with FVC 0.69 (27%), FEV1 0.46 (24%),
FEV1/FVC 92%.
14. History of positive Galactomannan antigen
15. RUL nodules on CT, not FDG avid on PET on [**8-20**]. Etiology
unclear.
16. Vulvar squamous cell carcinoma in situ.

MEDICATION ON ADMISSION: Bactrim 80-400, Prednisone 20', B-Complex, Zidovidine 200,
Nevirapine 200, Lamuvidine, colace, protonix, albuterol,
dilaudid, oxycontin, senna, spogen, coumadin, isordil,
metoprolol 25, ASA, lisinopril

ALLERGIES: Motrin / Lipitor

PHYSICAL EXAM: At admission:
VS - T-100.4, HR-80, BP-95/60, RR-16, Sat 99%RA
GEN: A&O x 3, in NAD
ABD: Soft, diffusely tender, minimal guarding without
localization. Patient has guiac positive stools
.
on transfer
.
VS-  afebrile  110/80  80s comfortable on room air
GEN- sitting in chair, talking to daughter.  NAD.
[**Name2 (NI) 4459**]- no pallor, MMM, OP clear, poor dentition
NECK- supple, no JVP appreciated
CV- RRR, soft II/VI HSM at apex, distant heart sounds.
CHEST- Wheezes bilaterally, otherwise clear
ABD- obese, soft, NT, pos normoactive BS
EXT- dry skin, no edema.  Open sore on left shin.
NEURO- AAOx3, MAEW, no focal findings
SKIN- Dry on extremities

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Recently was at the [**Hospital **] rehab. Lives in [**Location 686**] with her
daughter. [**Name (NI) **] EtOH. Ex-smoker (60 pack-year smoking history)
Intestinal infection due to Clostridium difficile,Chronic combined systolic and diastolic heart failure,Chronic airway obstruction, not elsewhere classified,End stage renal disease,Mitral valve disorders,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Asymptomatic human immunodeficiency virus [HIV] infection status,Anemia in chronic kidney disease,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pulmonary eosinophilia
Int inf clstrdium dfcile,Chr syst/diastl hrt fail,Chr airway obstruct NEC,End stage renal disease,Mitral valve disorder,Hyp kid NOS w cr kid V,Asymp hiv infectn status,Anemia in chr kidney dis,Old myocardial infarct,DMII wo cmp nt st uncntr,Pulmonary eosinophilia
Admission Date:  [**2115-12-12**]              Discharge Date:   [**2115-12-24**]

Date of Birth:  [**2046-6-27**]             Sex:   F

Service: MEDICINE

Allergies:
Motrin / Lipitor

Attending:[**First Name3 (LF) 562**]
Chief Complaint:
Watery diarrhea for two weeks

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Patient is a 69yo AAF with a PMHx significant for ESRD, COPD,
HIV+, CAD, CHF, PEA arrest, MR, PE, GI bleeds, Anemia, and
Vulvar squamous cell carcinoma that was recently discharged from
[**Hospital1 18**] for pneumonia and treated with a complete dose of
antibiotics, that began to have watery diarrhea for five days,
developed fevers, chills, and abdominal pain. Pain is diffuse,
nonfocal, [**7-28**], and not associated with nausea or vomiting.
.
CC: Transfer from surgery service with diarrhea
.
HPI: 69 female with MMP including ESRD on HD, HIV (cd4 940
[**7-23**], on HAART), CAD s/p MI, CHF, COPD presents to our service
for continued treatment of medical conditions and diarrhea.
Briefly, she was admitted on [**12-12**] with fever chills and
abdominal pain one week after being discharged on
vanco/levo/flagyl for pneumonia.  She reports increasing
frequency of BM and worsening abdominal pain.  She had F/C at
home, but was free of them since being in hospital.  She also
had episodes of chest pain while at rest at hemodialysis.
Cardiology was consulted twice. THe first episode was associated
with a troponin elevation, thought to be due to demand ischemia
in the setting of going into AF.  The second episode of
substernal burning was releived with maalox, and felt to be very
atypical for ischemic chest pain.  She has also been followed by
infectious disesase for a fairly resistant diarrhea, with the
only positive micro data being positive c.dif.  The diarrhea was
watery, and is slowly improving.
.
She currently is feeling well, with much less abdominal pain and
slowing frequency of bowel movements.  She had 3 BM two days
ago, 2 BM yesterday, and 1 BM thus far today (more formed).  She
has been treated with flagyl, PO vanco, and cholestyramine.  She
was admitted with a WBC of 23K, and now is 11K.  Her hematocrit
has remained stable in mid 30s.  She has been persistently
elevated.  Her INR was supratherapeutic on admission (on
warfarin for h/o DVT with PE) at 10.  Her warfarin was restarted
now.  She currently denies F/C/NS, occasional cough, no
abdominal pain. SHe has occasional nausea that responds to
anzemet.


Past Medical History:
Past Medical History:
1. CAD s/p NSTEMI [**5-19**], s/p PTCA/stent LCX [**2113**]. Latest
catheterization in [**10-21**] with 2-vessel disease. Persantine MIBI
[**4-22**] without symptoms or EKG changes. MIBI images significant
for severe fixed inferior defect, EF 58%.
2. DM type 2, on NPH.
3. HIV, last CD4 count 940 in [**7-/2115**]
4. ESRD on HD since '[**10**] (M, W, F)
5. CHF, with mixed systolic (EF 45-50%) and diastolic
dysfunction.
6. Severe mitral regurgitation [**2115-6-20**]
7. History of RUL segmental PE in [**11/2114**], on coumadin
([**2114-12-5**]) D/C'd in 06/[**2115**].
8. Recently diagnosed right popliteal DVT [**7-/2115**], restarted on
Coumadin
9. H/o multiple AVF clots, s/p thrombectomies, last in [**2115-1-8**]
9. H/o GIB in the setting of coagulopathy and NSAIDs
10. Eosinophilic pneumonia diagnosed [**4-22**], on chronic
prednisone therapy.
11. Anemia [**2-20**] CRF
12. Vulvar intraepithelial neoplasia diagnosed in [**2113-4-18**].
13. COPD with PFTs with FVC 0.69 (27%), FEV1 0.46 (24%),
FEV1/FVC 92%.
14. History of positive Galactomannan antigen
15. RUL nodules on CT, not FDG avid on PET on [**8-20**]. Etiology
unclear.
16. Vulvar squamous cell carcinoma in situ.

Social History:
Recently was at the [**Hospital **] rehab. Lives in [**Location 686**] with her
daughter. [**Name (NI) **] EtOH. Ex-smoker (60 pack-year smoking history)


Family History:
Non-contributory

Physical Exam:
At admission:
VS - T-100.4, HR-80, BP-95/60, RR-16, Sat 99%RA
GEN: A&O x 3, in NAD
ABD: Soft, diffusely tender, minimal guarding without
localization. Patient has guiac positive stools
.
on transfer
.
VS-  afebrile  110/80  80s comfortable on room air
GEN- sitting in chair, talking to daughter.  NAD.
[**Name2 (NI) 4459**]- no pallor, MMM, OP clear, poor dentition
NECK- supple, no JVP appreciated
CV- RRR, soft II/VI HSM at apex, distant heart sounds.
CHEST- Wheezes bilaterally, otherwise clear
ABD- obese, soft, NT, pos normoactive BS
EXT- dry skin, no edema.  Open sore on left shin.
NEURO- AAOx3, MAEW, no focal findings
SKIN- Dry on extremities


Pertinent Results:
[**2115-12-12**] 02:00PM   PLT COUNT-220
[**2115-12-12**] 02:00PM   NEUTS-81* BANDS-0 LYMPHS-13* MONOS-6 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2115-12-12**] 02:00PM   WBC-23.9*# RBC-2.96* HGB-11.3* HCT-36.0
MCV-122* MCH-38.2* MCHC-31.4 RDW-20.1*
[**2115-12-12**] 02:00PM   TOT PROT-5.9*
[**2115-12-12**] 02:00PM   LIPASE-9
[**2115-12-12**] 02:00PM   ALT(SGPT)-11 AST(SGOT)-12 ALK PHOS-92
AMYLASE-47 TOT BILI-0.3
[**2115-12-12**] 02:00PM   GLUCOSE-111* UREA N-39* CREAT-7.4*#
SODIUM-144 POTASSIUM-3.3 CHLORIDE-96 TOTAL CO2-29 ANION GAP-22*
[**2115-12-12**] 02:12PM   LACTATE-2.2*
[**2115-12-12**] 06:30PM URINE  WBCCLUMP-OCC
[**2115-12-12**] 06:30PM URINE  RBC-[**6-28**]* WBC-[**12-8**]* BACTERIA-RARE
YEAST-NONE EPI-0-2
[**2115-12-12**] 06:30PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-500
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-MOD
[**2115-12-12**] 06:30PM URINE  COLOR-Yellow APPEAR-Cloudy SP [**Last Name (un) 155**]-1.013
[**2115-12-12**] 11:15PM   PLT COUNT-202
[**2115-12-12**] 11:15PM   WBC-24.9* RBC-2.60* HGB-10.1* HCT-30.6*
MCV-117* MCH-38.6* MCHC-32.9 RDW-20.2*
[**2115-12-12**] 11:42PM   freeCa-1.03*
[**2115-12-12**] 11:42PM   O2 SAT-98
[**2115-12-12**] 11:42PM   GLUCOSE-341* K+-3.7
[**2115-12-12**] 11:42PM   TYPE-ART PO2-105 PCO2-45 PH-7.40 TOTAL CO2-29
BASE XS-1

CT C/A/P [**12-13**] - 1. Interval development of bowel wall edema
affecting the entire length of the colon with peri-colic
stranding consistent with pan-colitis. In the setting of
prolonged antibiotic use, this is suspicious for Clostridium
difficile / pseudomembranous colitis. No pneumatosis or portal
venous gas is seen. No extraluminal air or free air is seen.
2. Interval improvement with residual opacity in previously
demonstrated multilobar patchy opacities.3. Persistent
spiculated right upper lobe focus that measures smaller in size
compared to the previous exam.
4. Intrahepatic biliary ductal dilatation. 5. Bilateral
low-attenuation renal lesions that are too small to
characterize.6. Possible tiny low-attenuation lesion in the
uncinate process of the pancreas that is probably unchanged
compared to the previous exam

CXR [**12-12**] - Right perihilar ill defined paranchymal opacity; ?
infectious, ? neoplastic

Brief Hospital Course:
Patient admitted to hospital electively on [**12-12**] for watery
diarrhea and possible operative intervention based on patient's
prednisone usage. Patient was started on empiric flagyl and
serial abdominal exams, while obtaining a CT scan whose results
are mentioned above. Patient was admitted to the ICU for her h/o
PEA, and WBC of 24.9 concerning for possible bowel/colitis
rupture. Renal was consulted to manage the patients dialysis
needs, ID was consulted to manage her colitis, and cardiology to
r/o possible MI.  Patient felt much improved by HD2, cardiology
supported her beta blockade administration and felt no
antiarrhythmic was warranted. ID recommended vancomycin
empirically while sending three stool studies for c.diff toxin
and stool cultures.  By HD4, patient's abdomen was soft and
nontender, but etiology not yet determined, and diarrhea
episodes continued.  ID recommended oral vancomycin
administration and no flagyl.  Cardiology felt patient's
elevated Troponins were the result of demand ischemia and not an
acute coronary event.  Patient was allowed to advance diet as
tolerated but maintained on PO vanco for 14 day total course.
Patient continued to have numerous, nonbloody bowel movements.
On HD 7 while obtaining HD, the patient had episode of CP for
which and EKG was obtained and reviewed by cardiology and did
not reveal st changes, and did not warrant a change in
management.  Patient was restarted on her coumadin on HD7, as
well as flagyl to synergistically cure the c.diff colitis.
Patient began to note some interval improvement on the dual
regimen, with more formed stools beginning to pass.  On [**12-20**] the
surgical team started cholestyramine as a third [**Doctor Last Name 360**], and
consulted medicine to take over care of the patient, as she was
no longer a surgical candidate and instead needed outpatient
follow-up. She was transferred to the medicine service on [**12-21**]
with their addendum to follow
.
DIARRHEA: On medicine her diarrhea continue to improve. The
flagyl, vancomycin, and cholestyramine were continued.  IV
fluids were assessed daily and given to keep up with her stool
output.  The BMs began to be more infrequent and more formed.
She had LLQ pain on transfer, but that quickly got better
without any intervention.  It was felt much of the pain and
leukocytosis was in part due to the c.dif colitis.  She was
discharged to complete two more weeks of flagyla and PO
vancomycin.  The cholestyramine was stopped.
.
CAD: Has had sevearl episodes of chest pain during admission,
and given history these are a bit concerning. Will continue to
treat her heartburn with PPI (watch in case this is contributing
to diarrhea).  Continued her cardiac regimen of ASA, statin, BB.
 Will get another set of enzymes in the morning and ECG to
follow trend.  Even though she is ESRD, she still had an
elevation, likely in the stting of a rapid rate while she was on
surgical service.  Continued to monitor.  She had one episode of
CP while on medical service, which was accompanied with bitter
taste in mouth and felt to be likely [**2-20**] gerd.  PPI was
continued, and maalox was given (and then held [**2-20**] ESRD).  She
did have one episode of hypotension, which was transient to
78/38, and quickly improved to 92/48 without any intervention.
.
DM2: Continued RSSI, NPH [**Hospital1 **].
.
CHF: Appears euvolemic on exam.  Will continue BB and monitor
i/o's very closely with hemodialysis.
.
HIV/AIDS: Will continue current OP regimen of prednisone,
zidovudine, neviarapine, lamivudine, with PCP [**Name Initial (PRE) 1102**].
.
COPD: COntinued nebs.  Slight wheezing on exam.
-no wheezing [**12-23**] in AM
.
ESRD: On HD MWF.
.
PPX: Bactrim, PPI, ambulating, eating, neutrophos.
.
DISPO: pending resolution of diarrhea and nausea.
.
CODE: full


Medications on Admission:
Bactrim 80-400, Prednisone 20', B-Complex, Zidovidine 200,
Nevirapine 200, Lamuvidine, colace, protonix, albuterol,
dilaudid, oxycontin, senna, spogen, coumadin, isordil,
metoprolol 25, ASA, lisinopril

Discharge Medications:
1. Prednisone 10 mg Tablet [**Month/Day (1) **]: One (1) Tablet PO DAILY (Daily).

2. Zidovudine 100 mg Capsule [**Month/Day (1) **]: Two (2) Capsule PO BID (2
times a day).
3. Nevirapine 200 mg Tablet [**Month/Day (1) **]: One (1) Tablet PO BID (2 times
a day).
4. Vancomycin 250 mg Capsule [**Month/Day (1) **]: One (1) Capsule PO Q6H (every
6 hours) for 14 days.
Disp:*56 Capsule(s)* Refills:*0*
5. Lamivudine 100 mg Tablet [**Month/Day (1) **]: 0.5 Tablet PO DAILY (Daily).
6. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet [**Month/Day (1) **]: One (1)
Tablet PO QHD (each hemodialysis).
7. Aspirin 81 mg Tablet, Chewable [**Month/Day (1) **]: One (1) Tablet, Chewable
PO DAILY (Daily).
8. Metoprolol Tartrate 25 mg Tablet [**Month/Day (1) **]: 0.5 Tablet PO TID (3
times a day).
Disp:*15 Tablet(s)* Refills:*2*
9. Simvastatin 40 mg Tablet [**Month/Day (1) **]: One (1) Tablet PO DAILY
(Daily).
10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) [**Month/Day (1) **]: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
11. Albuterol 90 mcg/Actuation Aerosol [**Month/Day (1) **]: Two (2) Puff
Inhalation Q 12H (Every 12 Hours).
12. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device [**Month/Day (1) **]:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
13. Folic Acid 1 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

14. Potassium & Sodium Phosphates [**Telephone/Fax (3) 4228**] mg Packet [**Telephone/Fax (3) **]: One
(1) Packet PO BID (2 times a day).
15. Warfarin 5 mg Tablet [**Telephone/Fax (3) **]: One (1) Tablet PO DAILY (Daily).
16. Flagyl 500 mg Tablet [**Telephone/Fax (3) **]: One (1) Tablet PO three times a
day for 14 days.
Disp:*42 Tablet(s)* Refills:*0*
17. Insulin Regular Human 300 unit/3 mL Insulin Pen [**Telephone/Fax (3) **]: One (1)
 Subcutaneous as directed: sliding scale.


Discharge Disposition:
Home With Service

Facility:
Uphams Corner Home Care

Discharge Diagnosis:
Clostridium dificile colitis
End stage renal disease
Coronary artery disease
hypertension
HIV / AIDS


Discharge Condition:
Stable, ambulating, tolerating PO diet, afebrile


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
.
Continue to take all meications as prescribed.
.
If you experience worsening diarrhea, chest pain, difficulty
breathing, passing out, or any other concerning symptom, please
seek immediate medical attention.
.
Continue with your hemodialysis

Followup Instructions:
Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 252**], M.D. Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2116-9-17**] 1:15

Dr. [**Last Name (STitle) **] on Tuesday [**2115-12-31**] at 2:50pm
{'Intestinal infection due to Clostridium difficile,Chronic combined systolic and diastolic heart failure,Chronic airway obstruction, not elsewhere classified,End stage renal disease,Mitral valve disorders,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Asymptomatic human immunodeficiency virus [HIV] infection status,Anemia in chronic kidney disease,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pulmonary eosinophilia'}


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: Watery diarrhea for two weeks

PRESENT ILLNESS: Patient is a 69yo AAF with a PMHx significant for ESRD, COPD,
HIV+, CAD, CHF, PEA arrest, MR, PE, GI bleeds, Anemia, and
Vulvar squamous cell carcinoma that was recently discharged from
[**Hospital1 18**] for pneumonia and treated with a complete dose of
antibiotics, that began to have watery diarrhea for five days,
developed fevers, chills, and abdominal pain. Pain is diffuse,
nonfocal, [**7-28**], and not associated with nausea or vomiting.
.
CC: Transfer from surgery service with diarrhea
.
HPI: 69 female with MMP including ESRD on HD, HIV (cd4 940
[**7-23**], on HAART), CAD s/p MI, CHF, COPD presents to our service
for continued treatment of medical conditions and diarrhea.
Briefly, she was admitted on [**12-12**] with fever chills and
abdominal pain one week after being discharged on
vanco/levo/flagyl for pneumonia.  She reports increasing
frequency of BM and worsening abdominal pain.  She had F/C at
home, but was free of them since being in hospital.  She also
had episodes of chest pain while at rest at hemodialysis.
Cardiology was consulted twice. THe first episode was associated
with a troponin elevation, thought to be due to demand ischemia
in the setting of going into AF.  The second episode of
substernal burning was releived with maalox, and felt to be very
atypical for ischemic chest pain.  She has also been followed by
infectious disesase for a fairly resistant diarrhea, with the
only positive micro data being positive c.dif.  The diarrhea was
watery, and is slowly improving.
.
She currently is feeling well, with much less abdominal pain and
slowing frequency of bowel movements.  She had 3 BM two days
ago, 2 BM yesterday, and 1 BM thus far today (more formed).  She
has been treated with flagyl, PO vanco, and cholestyramine.  She
was admitted with a WBC of 23K, and now is 11K.  Her hematocrit
has remained stable in mid 30s.  She has been persistently
elevated.  Her INR was supratherapeutic on admission (on
warfarin for h/o DVT with PE) at 10.  Her warfarin was restarted
now.  She currently denies F/C/NS, occasional cough, no
abdominal pain. SHe has occasional nausea that responds to
anzemet.

MEDICAL HISTORY: Past Medical History:
1. CAD s/p NSTEMI [**5-19**], s/p PTCA/stent LCX [**2113**]. Latest
catheterization in [**10-21**] with 2-vessel disease. Persantine MIBI
[**4-22**] without symptoms or EKG changes. MIBI images significant
for severe fixed inferior defect, EF 58%.
2. DM type 2, on NPH.
3. HIV, last CD4 count 940 in [**7-/2115**]
4. ESRD on HD since '[**10**] (M, W, F)
5. CHF, with mixed systolic (EF 45-50%) and diastolic
dysfunction.
6. Severe mitral regurgitation [**2115-6-20**]
7. History of RUL segmental PE in [**11/2114**], on coumadin
([**2114-12-5**]) D/C'd in 06/[**2115**].
8. Recently diagnosed right popliteal DVT [**7-/2115**], restarted on
Coumadin
9. H/o multiple AVF clots, s/p thrombectomies, last in [**2115-1-8**]
9. H/o GIB in the setting of coagulopathy and NSAIDs
10. Eosinophilic pneumonia diagnosed [**4-22**], on chronic
prednisone therapy.
11. Anemia [**2-20**] CRF
12. Vulvar intraepithelial neoplasia diagnosed in [**2113-4-18**].
13. COPD with PFTs with FVC 0.69 (27%), FEV1 0.46 (24%),
FEV1/FVC 92%.
14. History of positive Galactomannan antigen
15. RUL nodules on CT, not FDG avid on PET on [**8-20**]. Etiology
unclear.
16. Vulvar squamous cell carcinoma in situ.

MEDICATION ON ADMISSION: Bactrim 80-400, Prednisone 20', B-Complex, Zidovidine 200,
Nevirapine 200, Lamuvidine, colace, protonix, albuterol,
dilaudid, oxycontin, senna, spogen, coumadin, isordil,
metoprolol 25, ASA, lisinopril

ALLERGIES: Motrin / Lipitor

PHYSICAL EXAM: At admission:
VS - T-100.4, HR-80, BP-95/60, RR-16, Sat 99%RA
GEN: A&O x 3, in NAD
ABD: Soft, diffusely tender, minimal guarding without
localization. Patient has guiac positive stools
.
on transfer
.
VS-  afebrile  110/80  80s comfortable on room air
GEN- sitting in chair, talking to daughter.  NAD.
[**Name2 (NI) 4459**]- no pallor, MMM, OP clear, poor dentition
NECK- supple, no JVP appreciated
CV- RRR, soft II/VI HSM at apex, distant heart sounds.
CHEST- Wheezes bilaterally, otherwise clear
ABD- obese, soft, NT, pos normoactive BS
EXT- dry skin, no edema.  Open sore on left shin.
NEURO- AAOx3, MAEW, no focal findings
SKIN- Dry on extremities

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Recently was at the [**Hospital **] rehab. Lives in [**Location 686**] with her
daughter. [**Name (NI) **] EtOH. Ex-smoker (60 pack-year smoking history) 

### Response:
{'Intestinal infection due to Clostridium difficile,Chronic combined systolic and diastolic heart failure,Chronic airway obstruction, not elsewhere classified,End stage renal disease,Mitral valve disorders,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Asymptomatic human immunodeficiency virus [HIV] infection status,Anemia in chronic kidney disease,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pulmonary eosinophilia'}
