CHIEF COMPLAINT: Chest/epigastric pain, shortness of breath

PRESENT ILLNESS: 65F with history of PE, little routine medical care, presents to
ED with indigestion and severe chest pain and shortness of
breath. She reports her dinner on [**9-4**] did not sit well and has
had belching and general nausea since then. She ate breakfast on
[**9-5**] and felt worse. Felt like a "ball of grapefruit" was
sitting in her chest. Not truly burning or stabbing sensation,
but felt this same discomfort radiate to back. Remarks that she
thought she was going to die. Felt like she couldn't breathe at
the same time and felt like she was hyperventilating. No cough.
No fever. No palpitations. +nausea without vomiting. No
diarrhea.
.
In the ED, initial vs were: T98.4, P77, BP130/61, R30, O2 sat
92% on RA or 2L. HRs ranged up to 101-125. SBP up to 175 but
initially in ?90s systolic. Per notes and report, O2 sat
decreased with lying down (not clear how low in notes; by report
was low 90s on NRB). Weaned to 4 L NC with sats in high 90s, but
continued to have RRs in 20s. Patient was given SLNTG x2, ASA
325 mg, morphine, zofran, 1.5 L IVFs and levofloxacin ad
ceftriaxone for ?infiltrate. CXR with atelectasis; CTA without
dissection or PE, also showed atelectasis. RUQ US and CT abdomen
without explaining pathology; fatty liver and cholelithiasis
only. LFTs significant for transaminitis. Ruled out for MI with
troponins negative x 3. ECG with LBBB (old per notes).
.
On the floor, she currently appears in slight distress,
complains of a pain in her upper abdomen that radiates to her
back.  Feels slightly nauseous but is able to keep down water.
Has not had a formal diagnosis of GERD made in the past, has
just been taking peptol bismol for what she thought was
heartburn at home.  Still continues to have some belching
currently.  Breathing comfortably on 2L, satting 95.
.
Review of systems:
(+) Per HPI . + HA last week. + sneezing and allergic rhinitis
symptoms. +constipation. +dysuria thought ?[**1-20**] yeast infection.
+GERD type symptoms. +intermittent LE edema.
(-) Denies fever, chills, recent weight loss or gain. Denies
cough, palpitations, diarrhea, arthralgias or myalgias.

MEDICAL HISTORY: Past Medical History: little medical care in several years.
- Presentation to [**Hospital3 **] where had stress test (full
results not available) but did have LBBB in [**2141**].
- History of PE at age 21 while on OCPs. On coumadin x 6 months.

MEDICATION ON ADMISSION: None regularly. Was taking AZO, a probiotic for yeast
infections, up until 4 days ago (2-3 times per day).  Colace
prn.

ALLERGIES: Codeine

PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION:
Vitals: T: 97.6 BP: 142/76 P: 91 R: 18 O2: 95% 2L
General: Appears in mild pain. Not tachypneic. Speaking in full
sentences.
HEENT: Sclera anicteric, PERRL, EOMI. MMM, oropharynx clear
Neck: supple, no LAD, JVD elevated to 5 cm ASA.
Lungs: + soft bibasilar crackles. No wheezes, rhonchi.
CV: S1S2, RRR, [**1-24**] SM at RUSB and LUSB
Abdomen: soft, obese, ND, +BS, + epigastric TTP (mild), no
rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no e/c/c.
Neuro: CN II-XII intact. strength 5/5 in UEs and LEs.

FAMILY HISTORY: No blood clots or liver disease. Brother with hypertension and
heart disease of some type.

SOCIAL HISTORY: Takes care of an elderly woman for work. Walks up and down
stairs during work, sometimes feels shortness of breath. Notes
that she has been anxious related to a disagreement with her
boss lately. No EtOH or drug use ever. Smoked up until age 30.
Not sexually active.
Poisoning by sulfonamides,Bacteremia,Hepatitis, unspecified,Hypoxemia,Other chronic nonalcoholic liver disease,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of venous thrombosis and embolism,Personal history of tobacco use,Accidental poisoning by other anti-infectives,Dehydration,Constipation, unspecified,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted
Poisoning-sulfonamides,Bacteremia,Hepatitis NOS,Hypoxemia,Chronic liver dis NEC,Esophageal reflux,DMII wo cmp nt st uncntr,Hx-ven thrombosis/embols,History of tobacco use,Acc pois-oth anti-infect,Dehydration,Constipation NOS,Cholelithiasis NOS,Undet pois-med agnt NEC
Admission Date:  [**2144-9-4**]              Discharge Date:   [**2144-9-10**]

Date of Birth:  [**2078-12-12**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
Chest/epigastric pain, shortness of breath

Major Surgical or Invasive Procedure:
None


History of Present Illness:
65F with history of PE, little routine medical care, presents to
ED with indigestion and severe chest pain and shortness of
breath. She reports her dinner on [**9-4**] did not sit well and has
had belching and general nausea since then. She ate breakfast on
[**9-5**] and felt worse. Felt like a "ball of grapefruit" was
sitting in her chest. Not truly burning or stabbing sensation,
but felt this same discomfort radiate to back. Remarks that she
thought she was going to die. Felt like she couldn't breathe at
the same time and felt like she was hyperventilating. No cough.
No fever. No palpitations. +nausea without vomiting. No
diarrhea.
.
In the ED, initial vs were: T98.4, P77, BP130/61, R30, O2 sat
92% on RA or 2L. HRs ranged up to 101-125. SBP up to 175 but
initially in ?90s systolic. Per notes and report, O2 sat
decreased with lying down (not clear how low in notes; by report
was low 90s on NRB). Weaned to 4 L NC with sats in high 90s, but
continued to have RRs in 20s. Patient was given SLNTG x2, ASA
325 mg, morphine, zofran, 1.5 L IVFs and levofloxacin ad
ceftriaxone for ?infiltrate. CXR with atelectasis; CTA without
dissection or PE, also showed atelectasis. RUQ US and CT abdomen
without explaining pathology; fatty liver and cholelithiasis
only. LFTs significant for transaminitis. Ruled out for MI with
troponins negative x 3. ECG with LBBB (old per notes).
.
On the floor, she currently appears in slight distress,
complains of a pain in her upper abdomen that radiates to her
back.  Feels slightly nauseous but is able to keep down water.
Has not had a formal diagnosis of GERD made in the past, has
just been taking peptol bismol for what she thought was
heartburn at home.  Still continues to have some belching
currently.  Breathing comfortably on 2L, satting 95.
.
Review of systems:
(+) Per HPI . + HA last week. + sneezing and allergic rhinitis
symptoms. +constipation. +dysuria thought ?[**1-20**] yeast infection.
+GERD type symptoms. +intermittent LE edema.
(-) Denies fever, chills, recent weight loss or gain. Denies
cough, palpitations, diarrhea, arthralgias or myalgias.

Past Medical History:
Past Medical History: little medical care in several years.
- Presentation to [**Hospital3 **] where had stress test (full
results not available) but did have LBBB in [**2141**].
- History of PE at age 21 while on OCPs. On coumadin x 6 months.

- Denies known history of DM, hyperlipidemia, hypertension.
- History of T&A.
- History of panic attacks.
- "Congenital [**Last Name **] problem in which blood was flowing the wrong
way"

Social History:
Takes care of an elderly woman for work. Walks up and down
stairs during work, sometimes feels shortness of breath. Notes
that she has been anxious related to a disagreement with her
boss lately. No EtOH or drug use ever. Smoked up until age 30.
Not sexually active.

Family History:
No blood clots or liver disease. Brother with hypertension and
heart disease of some type.

Physical Exam:
PHYSICAL EXAM ON ADMISSION:
Vitals: T: 97.6 BP: 142/76 P: 91 R: 18 O2: 95% 2L
General: Appears in mild pain. Not tachypneic. Speaking in full
sentences.
HEENT: Sclera anicteric, PERRL, EOMI. MMM, oropharynx clear
Neck: supple, no LAD, JVD elevated to 5 cm ASA.
Lungs: + soft bibasilar crackles. No wheezes, rhonchi.
CV: S1S2, RRR, [**1-24**] SM at RUSB and LUSB
Abdomen: soft, obese, ND, +BS, + epigastric TTP (mild), no
rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no e/c/c.
Neuro: CN II-XII intact. strength 5/5 in UEs and LEs.

Pertinent Results:
LABS:
[**2144-9-4**] 03:10PM BLOOD WBC-9.9 RBC-5.71* Hgb-14.3 Hct-43.7
MCV-77* MCH
                 25.1* MCHC-32.8 RDW-14.5 Plt Ct-356
[**2144-9-4**] 03:10PM BLOOD Neuts-85.3* Lymphs-11.9* Monos-1.4*
Eos-0.9 Baso-0.4
[**2144-9-4**] 03:10PM BLOOD PT-12.4 PTT-19.4* INR(PT)-1.0
[**2144-9-4**] 03:10PM BLOOD Glucose-345* UreaN-15 Creat-0.7 Na-140
K-3.7 Cl-103
                 HCO3-24 AnGap-17
[**2144-9-4**] 03:10PM BLOOD ALT-280* AST-523* LD(LDH)-596* CK(CPK)-48
AlkPhos
                 144* TotBili-1.1
[**2144-9-4**] 03:10PM BLOOD Lipase-47
[**2144-9-5**] 03:36AM BLOOD GGT-906*
[**2144-9-4**] 09:33PM BLOOD calTIBC-260 Ferritn-GREATER TH TRF-200
[**2144-9-4**] 04:43PM BLOOD Lactate-2.4*

[**2144-9-7**] 07:55AM BLOOD WBC-5.7 RBC-5.26 Hgb-13.1 Hct-40.0
MCV-76* MCH
                 24.8* MCHC-32.7 RDW-14.6 Plt Ct-264
[**2144-9-7**] 07:55AM BLOOD Glucose-134* UreaN-7 Creat-0.7 Na-136
K-3.8 Cl-101
                 HCO3-23 AnGap-16
[**2144-9-7**] 07:55AM BLOOD ALT-704* AST-673* AlkPhos-195*
TotBili-4.9*
[**2144-9-6**] 05:55AM BLOOD Lipase-29
[**2144-9-5**] 03:36AM BLOOD Albumin-4.0 Calcium-9.1 Phos-3.1 Mg-1.9
[**2144-9-5**] 03:52AM BLOOD Lactate-1.9

[**2144-9-10**] 07:30AM BLOOD WBC-6.3 RBC-6.13* Hgb-15.1 Hct-46.9
MCV-77* MCH
                 24.7* MCHC-32.3 RDW-15.2 Plt Ct-337
[**2144-9-10**] 07:30AM BLOOD Glucose-155* UreaN-8 Creat-0.6 Na-138
K-3.6 Cl-101
                 HCO3-26 AnGap-15
[**2144-9-10**] 07:30AM BLOOD ALT-541* AST-395* AlkPhos-280*
TotBili-2.7*

[**2144-9-4**] 11:08PM BLOOD Smooth-NEGATIVE
[**2144-9-4**] 11:08PM BLOOD [**Doctor First Name **]-NEGATIVE
[**2144-9-9**] 07:45AM BLOOD IgG-846
[**2144-9-4**] 09:33PM BLOOD Acetmnp-NEG
[**2144-9-5**] 12:27PM BLOOD HBcAb-NEGATIVE
[**2144-9-4**] 09:33PM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE HAV
Ab-NEGATIVE
[**2144-9-4**] 09:33PM BLOOD HCV Ab-NEGATIVE

[**2144-9-4**] 11:08PM BLOOD %HbA1c-12.0*
[**2144-9-4**] 09:33PM BLOOD Triglyc-80 HDL-61 CHOL/HD-4.7
LDLcalc-210*
[**2144-9-4**] 09:33PM BLOOD TSH-1.5
.
MICROBIOLOGY:
Blood Culture ([**9-4**]): Escherichia coli
                             |
AMPICILLIN------------  =>32 R
AMPICILLIN/SULBACTAM--  =>32 R
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------     4 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN---------- =>128 R
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S
.
EBV ([**9-5**]): IgG (+), IgM (-)
CMV ([**9-5**]): IgG (-), IgM (-)
.
IMAGING/STUDIES:
RUQ U/S ([**9-8**]): 1. No portal vein thrombosis. 2. Echogenic liver
consistent with fatty infiltration. 3. Cholelithiasis with no
cholecystitis.
.
MRCP ([**2144-9-6**]): 1. Normal appearance of the intra- and
extra-hepatic bile ducts without evidence of dilatation,
stenosis, irregularity, or filling defect. 2. Diffuse fatty
infiltration of the liver. 3. Cholelithiasis.
.
ECHO ([**2144-9-7**]): Suboptimal image quality. Minimal aortic valve
stenosis. Normal left ventricular cavity size with low normal
systolic function (LVEF 50-55%). Mild aortic regurgitation. No
right-to-left intracardiac flow identified. Mild mitral
regurgitation. Dilated thoracic aorta.
.
CXR ([**9-5**]): Lung volumes remain low. Slight improvement in areas
of patchy and linear atelectasis at the bases. Mild cardiac
enlargement is unchanged.
.
CTA chest/CT abdomen: extensive atherosclerosis, no aortic
dissection, no PE identified. Patchy opacities in lower lobes -
?atelectasis. Fatty liver. Left kidney lesion incompletely
characterized. Mildly distended loops of small bowel.
.
EKG: ST at 110, LBBB, ST segment deviations c/w LBBB

Brief Hospital Course:
# Chest/epigastric pain: Pt presented with focal pain in the
epigastrium, tender to palpation. Pain was associated with
belching/reflux-like symptoms, radiating to the back.  Pain
improved day by day. ACS, PE, dissection ruled out with cardiac
enzymes and chest CTA. No abdominal pathology to explain
symptoms. Most likely etiologies considered were GERD,
esophageal spasm, or ulcer disease. Pt also very anxious and
hyperaware of her symptoms.  We treated with bowel rest, IVF,
slowly advanced her diet as tolerated, gave a PPI for reflux and
simethicone for gas, and the pt improved by time of discharge.
.
# Elevated LFTs: Pt presented with ALT of 920, AST of 1185, Alk
Phos of 163, and Tbili of 3.3.  This did not seem like a
cholestatic picture given only mild elevation in Alk Phos with
relation to the transaminases.  RUQ U/S showed fatty liver and
cholelithiasis, with no evidence of a portal vein thrombosis.
MRCP was also unremarkable, and only confirmed findings on U/S.
It showed no stones in the CBD. Pt's serum was negative for
Tylenol and pt denies use.  All hepatitis and herpes serologies
were negative and [**Doctor First Name **] and [**Last Name (un) 15412**] were negative as well. Pt reports
use of AZO, a probiotic, that is a known hepatotoxin.  Her
elevations were likely [**1-20**] AZO use vs a stone in the CBD that
subsequently passed. We gave her IVF and bowel rest and trended
her LFTs, which continued to decline during her admission.
.
# Bacteremia: Pt was found to have E. coli, sensitive to a
number of agents.  We initially treated with Ceftriaxone and
later switched to Cipro given the potential for LFT elevations
as a result of Ceftriaxone.  The pt improved clinically over the
course of admission and subsequent blood cultures did not show
any growth.
.
# Hypoxia and tachypnea: Pt had O2 sats in the high 90s on 1L
and low to mid 90s on RA. Differential included atelectasis
(splinting from pain vs. obesity compressing lungs), pulmonary
edema (EF is low normal at 50%), anxiety, and bronchospasm.
Patient was troponin negative x 3. She received an echo, which
showed an EF of 50-55%. Pt did not appear to be volume up on
exam. O2 sats improved during admission and pt was breathing
comfortably on RA at time of discharge.
.
# Hyperglycemia: Pt presented with glucose levels in the 200s.
She has not received medical care for several years and has
likely had DMII for some time.  Her HbA1c is 12.0. Her lipid
profile shows LDL of 210 and total cholesterol of 287.  [**Last Name (un) **]
saw her [**9-8**], educated her about diabetes, gave her a
glucometer, determined an appropriate outpatient regiment of
Glyburide 10mg [**Hospital1 **], and set up outpatient follow-up for her at
[**Last Name (un) **].

Medications on Admission:
None regularly. Was taking AZO, a probiotic for yeast
infections, up until 4 days ago (2-3 times per day).  Colace
prn.

Discharge Medications:
1. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
2. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 2 days.
Disp:*4 Tablet(s)* Refills:*0*
3. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO twice a day.
Disp:*120 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
hepatotoxicity attributed to AZO
GERD
Diabetes Mellitus Type 2, newly diagnosed


Discharge Condition:
Good, afebrile, minimal pain


Discharge Instructions:
You were admitted to [**Hospital1 69**] for
chest pain and SOB.  During your stay in the ICU, you were ruled
out for myocardial infarction.  We found that your liver enzymes
were elevated, which is likely due to over the counter
medication that you were taking.  You received two liver
ultrasounds and an MRI of your liver that showed that you have
stones in your gall bladder, but no evidence of gall bladder
infection or stones obstructing your bile ducts.  We found
bacterial growth in your blood cultures for which you were put
on antibiotics.  During your stay you were diagnosed with
diabetes and seen by the diabetes specialists.  You will need to
take medication for management of diabetes from now on and
follow up in clinic.

Please make note of the following changes to your medication:
- new medication: glyburide 10 mg twice a day
- new medication: omeprazole 20 mg daily
- new medication: cipro 500 mg twice a day for 2 days

Please keep all your medical appointments

If you experience worsening chest pains, shortness of breath, or
any other worrisome symptoms, please return to the emergency
room.

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **] [**Name12 (NameIs) **], MD (PCP)
SC [**Hospital Ward Name **] CLINICAL CTR, [**Location (un) **]
Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2144-9-22**] 1:45

Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD (Liver)
LM [**Hospital Ward Name **] BLDG ([**Doctor First Name **]), [**Location (un) **]
LIVER CENTER (SB)
Phone:[**Telephone/Fax (1) 2422**]
Date/Time:[**2144-10-6**] 11:40

Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 14591**] ([**Last Name (un) **]/Diabetes)
[**Hospital **] Clinic - [**Last Name (un) 3911**], [**Location (un) 86**], [**Numeric Identifier 718**]
Date: [**2144-10-6**] at 1:00 PM

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 9973**], [**Name12 (NameIs) **] Educator ([**Last Name (un) **]/Diabetes)
[**Hospital **] Clinic - [**Last Name (un) 3911**], [**Location (un) 86**], [**Numeric Identifier 718**]
Date: [**2144-10-6**] at 2:00 PM


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Poisoning by sulfonamides,Bacteremia,Hepatitis, unspecified,Hypoxemia,Other chronic nonalcoholic liver disease,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of venous thrombosis and embolism,Personal history of tobacco use,Accidental poisoning by other anti-infectives,Dehydration,Constipation, unspecified,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted'}


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: Chest/epigastric pain, shortness of breath

PRESENT ILLNESS: 65F with history of PE, little routine medical care, presents to
ED with indigestion and severe chest pain and shortness of
breath. She reports her dinner on [**9-4**] did not sit well and has
had belching and general nausea since then. She ate breakfast on
[**9-5**] and felt worse. Felt like a "ball of grapefruit" was
sitting in her chest. Not truly burning or stabbing sensation,
but felt this same discomfort radiate to back. Remarks that she
thought she was going to die. Felt like she couldn't breathe at
the same time and felt like she was hyperventilating. No cough.
No fever. No palpitations. +nausea without vomiting. No
diarrhea.
.
In the ED, initial vs were: T98.4, P77, BP130/61, R30, O2 sat
92% on RA or 2L. HRs ranged up to 101-125. SBP up to 175 but
initially in ?90s systolic. Per notes and report, O2 sat
decreased with lying down (not clear how low in notes; by report
was low 90s on NRB). Weaned to 4 L NC with sats in high 90s, but
continued to have RRs in 20s. Patient was given SLNTG x2, ASA
325 mg, morphine, zofran, 1.5 L IVFs and levofloxacin ad
ceftriaxone for ?infiltrate. CXR with atelectasis; CTA without
dissection or PE, also showed atelectasis. RUQ US and CT abdomen
without explaining pathology; fatty liver and cholelithiasis
only. LFTs significant for transaminitis. Ruled out for MI with
troponins negative x 3. ECG with LBBB (old per notes).
.
On the floor, she currently appears in slight distress,
complains of a pain in her upper abdomen that radiates to her
back.  Feels slightly nauseous but is able to keep down water.
Has not had a formal diagnosis of GERD made in the past, has
just been taking peptol bismol for what she thought was
heartburn at home.  Still continues to have some belching
currently.  Breathing comfortably on 2L, satting 95.
.
Review of systems:
(+) Per HPI . + HA last week. + sneezing and allergic rhinitis
symptoms. +constipation. +dysuria thought ?[**1-20**] yeast infection.
+GERD type symptoms. +intermittent LE edema.
(-) Denies fever, chills, recent weight loss or gain. Denies
cough, palpitations, diarrhea, arthralgias or myalgias.

MEDICAL HISTORY: Past Medical History: little medical care in several years.
- Presentation to [**Hospital3 **] where had stress test (full
results not available) but did have LBBB in [**2141**].
- History of PE at age 21 while on OCPs. On coumadin x 6 months.

MEDICATION ON ADMISSION: None regularly. Was taking AZO, a probiotic for yeast
infections, up until 4 days ago (2-3 times per day).  Colace
prn.

ALLERGIES: Codeine

PHYSICAL EXAM: PHYSICAL EXAM ON ADMISSION:
Vitals: T: 97.6 BP: 142/76 P: 91 R: 18 O2: 95% 2L
General: Appears in mild pain. Not tachypneic. Speaking in full
sentences.
HEENT: Sclera anicteric, PERRL, EOMI. MMM, oropharynx clear
Neck: supple, no LAD, JVD elevated to 5 cm ASA.
Lungs: + soft bibasilar crackles. No wheezes, rhonchi.
CV: S1S2, RRR, [**1-24**] SM at RUSB and LUSB
Abdomen: soft, obese, ND, +BS, + epigastric TTP (mild), no
rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no e/c/c.
Neuro: CN II-XII intact. strength 5/5 in UEs and LEs.

FAMILY HISTORY: No blood clots or liver disease. Brother with hypertension and
heart disease of some type.

SOCIAL HISTORY: Takes care of an elderly woman for work. Walks up and down
stairs during work, sometimes feels shortness of breath. Notes
that she has been anxious related to a disagreement with her
boss lately. No EtOH or drug use ever. Smoked up until age 30.
Not sexually active. 

### Response:
{'Poisoning by sulfonamides,Bacteremia,Hepatitis, unspecified,Hypoxemia,Other chronic nonalcoholic liver disease,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of venous thrombosis and embolism,Personal history of tobacco use,Accidental poisoning by other anti-infectives,Dehydration,Constipation, unspecified,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted'}
