CHIEF COMPLAINT: 61 year-old female diagnosed with primary amyloidosis in [**Month (only) 880**]
[**2163**], recently harvested after Cytoxan chemotherapy, being
admitted for melphalan therapy followed by auto-BMT as a
palliative measure.

PRESENT ILLNESS: Ms. [**Known lastname **] is a 61 year-old woman diagnosed with primary
amyloidosis in [**2162-3-6**]. At that time, she presented with
progressive lower extremity edema. Work-up revealed significant
proteinuria. A renal biopsy was then performed and showed lambda
light chain deposits. She was also found to have lambda light
chain in her urine. A diagnosis of primary [**Doctor Last Name **] amyloidosis was
subsequently made. She was recently harvested after Cytoxan
therapy and is now being admitted for melphalan chemotherapy
followed by autologous stem cell transplant. Her screening
evaluation revealed normal pulmonary function and no significant
cardiac dysfunction. Except for the proteinuria, her renal
function is normal.

MEDICAL HISTORY: 1) Primary amyloidosis diagnosed in [**3-10**] following clinical
proteinuria. Renal biopsy demonstrated a predominance of lambda
light chains. Bone marrow biopsy in [**5-10**] showed low level (5-10%
of the cellularity) monoclonal lambda plasmacytosis.
2) Multiple bilateral breast cysts: Biopsies negative for
cancer.
3) History of premature ventricular complexes
4) History of duodenal ulcer
5) Surgery to right leg ligamentin [**2139**]'s

MEDICATION ON ADMISSION: ASA 81 mg PO once daily
Ranitidine 150 mg PO once daily
Lipitor 20 mg PO once daily
Toprol 20 mg PO once daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: Pleasant woman in NAD.
VITAL SIGNS: Temp 97, HR 104, BP 110/64, RR 20, oxygen
saturation 96% on RA
HEENT: PERRL, EOMI. no sinus tenderness. Clear oropharynx.
NECK: No JVD. No carotid bruit.
RESP: Clear to auscultation bilaterally
CVS: Normal S1, S2. No murmur/rub or gallop. Left subclavian
triple lumen in place.
GI: Normal BS. Soft and non-tender. No hepatosplenomegaly.
EXt: 3+ pitting edema to thighs. No clubbing, no cyanosis.
NEURO: AAO X3. CN II-XII intact. Strenght [**5-11**] thoughout.

FAMILY HISTORY: Significant for [**Name (NI) 1932**] disease in her son. She ahd a brother
with renal cell carcinoma. Her mother is alive at the age of 93.
Her father died at the age of 84 of "old age".

SOCIAL HISTORY: She currently lives with her husband and has three children. Her
younger son had [**Name (NI) 1932**] disease approximately 3-4 years ago.
She has a 20 pack-year smoking history and reports occasional
alcohol consumption, no drugs.
Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Cerebral artery occlusion, unspecified with cerebral infarction,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Other complications due to other vascular device, implant, and graft
Chr stomach ulc w hem,Chr blood loss anemia,Crbl art ocl NOS w infrc,Surg compl-heart,Parox ventric tachycard,Comp-oth vasc dev/graft
Name:  [**Known lastname 10161**],[**Known firstname 3989**] A                    Unit No:   [**Numeric Identifier 10162**]

Admission Date:  [**2163-7-25**]              Discharge Date:   [**2163-8-25**]

Date of Birth:  [**2102-6-12**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6234**]
Chief Complaint:
61 year-old female diagnosed with primary amyloidosis in [**Month (only) 880**]
[**2163**], recently harvested after Cytoxan chemotherapy, being
admitted for melphalan therapy followed by auto-BMT as a
palliative measure.

Major Surgical or Invasive Procedure:
Triple lumen catheter placement ([**2163-7-25**])
Esophagogastroduodenoscopy ([**2163-7-26**] and [**2163-8-13**])
Right femoral line cordis placement ([**2163-8-4**])
Endotracheal intubation ([**2163-8-4**] to [**2163-8-5**])


Brief Hospital Course:
Prior to D/C, Ms. [**Known lastname **] had a repeat CXR to better characterize
RUL and RLL opacities visualized on CXR on [**2163-8-24**] initially
done after she complained of a self-limited episode of
right-sided chest pain. Repeat CXR revealed a RUL opacity
concerning for possible pneumonia. Patient clinically stable and
afebrile, off oxygen with saturation of 93% on room air, but
noted to have an elevated WBC count (18.1 on [**2163-8-24**] down to
14.0 today). Given high WBC and CXR picture, will cover with
Levofloxacin for 1 week. She will be reevaluated in 1 week on
[**Hospital Ward Name 1836**] 7, with repeat CBC and CXR.



Discharge Medications:
1. Lipitor 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
2. Carafate 1 g Tablet Sig: One (1) Tablet PO every six (6)
hours: Please take on an empty stomach.
Disp:*120 Tablet(s)* Refills:*0*
3. Metoprolol Tartrate 25 mg Tablet Sig: Half Tablet PO twice a
day: Take 12.5 mg PO twice daily.
Disp:*30 Tablet(s)* Refills:*2*
4. Acyclovir 400 mg Tablet Sig: One (1) Tablet PO three times a
day.
Disp:*90 Tablet(s)* Refills:*2*
5. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
7. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
Life Care Facilities

Discharge Diagnosis:
1) Primary amyloidosis
2) Gastric ulcer


Discharge Condition:
Patient discharged to skilled nursing facility Life Care
Facility in stable condition.

Discharge Instructions:
Please call your primary oncologist or return to the clinic if
you develop fever or chills, or if you experience worsening
shortness of breath or increased leg swelling.

Please follow-up with Dr [**Last Name (STitle) 1653**], Dr [**Last Name (STitle) 223**], Dr [**Last Name (STitle) 8818**]
(gastroenterology) and psychiatry as indicated below.

Followup Instructions:
1) PLease come back to [**Hospital Ward Name 1836**] 7 next Wednesday for follow-up
cell counts and CXR.

2) Please follow-up with Dr [**Last Name (STitle) 223**] on [**2163-9-7**] at
13:30. His office # is [**Telephone/Fax (1) 10163**].

3) Please follow-up with gastroenterology for your stomach
ulcer. Your appointment is scheduled for [**2163-9-16**] at
0900 with Dr [**Last Name (STitle) 8818**] as indicated below:
Provider: [**Name10 (NameIs) **] [**Last Name (NamePattern4) 10164**], MD Where: [**Hospital6 189**] MEDICAL
SPECIALTIES Phone:[**Telephone/Fax (1) 1368**] Date/Time:[**2163-9-16**] 9:00

4) Please call your cardiologist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1653**] and schedule an
appointment to see him in the next 1 month.

5) You may call the psychiatry [**Hospital 10165**] clinic to schedule an
appointment at [**Telephone/Fax (1) 10166**].

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 6235**] MD [**MD Number(1) 6236**]

Completed by:[**2163-8-25**]

Admission Date:  [**2163-7-25**]              Discharge Date:   [**2163-8-25**]

Date of Birth:  [**2102-6-12**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7591**]
Chief Complaint:
61 year-old female diagnosed with primary amyloidosis in [**Month (only) 958**]
[**2163**], recently harvested after Cytoxan chemotherapy, being
admitted for melphalan therapy followed by auto-BMT as a
palliative measure.

Major Surgical or Invasive Procedure:
Triple lumen catheter placement ([**2163-7-25**])
Esophagogastroduodenoscopy ([**2163-7-26**] and [**2163-8-13**])
Right femoral line cordis placement ([**2163-8-4**])
Endotracheal intubation ([**2163-8-4**] to [**2163-8-5**])


History of Present Illness:
Ms. [**Known lastname **] is a 61 year-old woman diagnosed with primary
amyloidosis in [**2162-3-6**]. At that time, she presented with
progressive lower extremity edema. Work-up revealed significant
proteinuria. A renal biopsy was then performed and showed lambda
light chain deposits. She was also found to have lambda light
chain in her urine. A diagnosis of primary [**Doctor Last Name **] amyloidosis was
subsequently made. She was recently harvested after Cytoxan
therapy and is now being admitted for melphalan chemotherapy
followed by autologous stem cell transplant. Her screening
evaluation revealed normal pulmonary function and no significant
cardiac dysfunction. Except for the proteinuria, her renal
function is normal.

Other than her leg edema, Ms. [**Known lastname **] complains of increasing
weakness and fatigue. She denies SOB, cough, headache, syncope,
chest pain or palpitation, abdominal pain or dysuria. She also
denies any recent febrile illness.

Past Medical History:
1) Primary amyloidosis diagnosed in [**3-10**] following clinical
proteinuria. Renal biopsy demonstrated a predominance of lambda
light chains. Bone marrow biopsy in [**5-10**] showed low level (5-10%
of the cellularity) monoclonal lambda plasmacytosis.
2) Multiple bilateral breast cysts: Biopsies negative for
cancer.
3) History of premature ventricular complexes
4) History of duodenal ulcer
5) Surgery to right leg ligamentin [**2139**]'s

Social History:
She currently lives with her husband and has three children. Her
younger son had [**Name (NI) 1932**] disease approximately 3-4 years ago.
She has a 20 pack-year smoking history and reports occasional
alcohol consumption, no drugs.

Family History:
Significant for [**Name (NI) 1932**] disease in her son. She ahd a brother
with renal cell carcinoma. Her mother is alive at the age of 93.
Her father died at the age of 84 of "old age".

Physical Exam:
GENERAL: Pleasant woman in NAD.
VITAL SIGNS: Temp 97, HR 104, BP 110/64, RR 20, oxygen
saturation 96% on RA
HEENT: PERRL, EOMI. no sinus tenderness. Clear oropharynx.
NECK: No JVD. No carotid bruit.
RESP: Clear to auscultation bilaterally
CVS: Normal S1, S2. No murmur/rub or gallop. Left subclavian
triple lumen in place.
GI: Normal BS. Soft and non-tender. No hepatosplenomegaly.
EXt: 3+ pitting edema to thighs. No clubbing, no cyanosis.
NEURO: AAO X3. CN II-XII intact. Strenght [**5-11**] thoughout.

Pertinent Results:
Pertinent laboratory results on admission include WBC-12.5*
(NEUTS-82.6* LYMPHS-11.5* MONOS-4.0 EOS-0.7 BASOS-1.2),
HGB-12.0, HCT-34.5*, PLT 588*. Chemistry reveals GLUCOSE-153*,
UREA N-21*, CREAT-0.6, SODIUM-141, POTASSIUM-3.8, CHLORIDE-106,
HCO3-25, CALCIUM-8.5, PHOSPHATE-3.8, MAGNESIUM-1.6, URIC
ACID-9.5*, ALBUMIN-2.8*. Liver enzymes show ALT-16, AST-18,
ALP-115 with normal bilirubin profile. LDH 276.

Imaging:
CXR ([**2163-6-3**]): Normal
Skeletal survey ([**2163-5-26**]): Normal
Echo ([**2163-6-14**]): LVH with low normal LVEF (50-55%), 1+ MR.


Brief Hospital Course:
Her hospital course will be reviewed by problems:

1) Primary amyloidosis: Ms [**Known lastname **] was treated with 2 days of high
dose Melphalan, followed by one rest day. Stem cells were
reinfused on [**2163-7-29**]. Her ANC reached a nadir on [**2163-8-3**],
then was above 500 on [**2163-8-9**]. She was given Neupogen from
[**2163-8-2**] until [**2163-8-11**]. She tolerated the chemo well.

2) CNS: On [**2163-7-30**] (day +1), the patient developed a transient
right visual field defect which resolved spontaneously after one
hour with no recurrence. Neurology was consulted. MRI head on
[**7-30**] revealed a hyperintense region in the left temporal lobe
consistent with acute infarction. Work-up for an embolic focus
was initiated and was negative. EKG revealed NSR. Echo (TTE)
showed no evidence of a thrombus, moderate symmetric LVH and
LVEF low-normal 50-55%. TEE was not performed given low ANC and
low platelets. Carotid doppler ([**2163-8-2**]) showed no stenosing
lesion. She was also placed on telemetry for evaluation of
arrhythmia (see CVS). Decision was taken not to administer ASA
given thrombocytopenia post reinfusion. Heparin was also not
indicated in her case, given negative embolic work-up and high
risk of heparinization. She was IV hydrated to maintain her BP
at a higher level, and continued on Lipitor. Her CVA was
subsequently felt to be possibly related to hypercoagulability
secondary to her nephrotic syndrome.

During her hospital stay, Ms [**Known lastname **] was also found to have a
fluctuating mental status, mostly at night, starting around day
+18. Infectious and metabolic work-ups were negative, including
TSH, B12, and RPR. Psychiatry was consulted, with an impression
of delirium. All BDZ, anticholinergics and cognitive depressant
medications were held. Patient's mental status subsequently
improved. She will follow-up with psychiatry as an out-patient
to evaluate for underlying depression in setting of her medical
condition.

3) GI: On day 6 post BMT, patient developped some hematuria,
followed by a small volume of hematemesis. This was followed by
massive hematochezia and hematemesis ~450cc total. Platelets
were 37. With each episode, she became more fatigued and
hypotensive, with SBP decreasing to 70's (baseline 100's) and
decreased mentation. Agressive IVF and blood product support
were initiated. She was transferred to the [**Hospital Unit Name 153**] for hemodynamic
instability. GI was consulted emergently. The patient was
electively intubated for endoscopy. EGD revealed a smooth,
non-bleeding, 12 cm mass in the mid-body of the greater
curvature, but no evidence of active bleeding. She was started
on Protonix IV. She overall received 2L NS, 1L LR, 4U PRBC's, 2U
FFP, 6hr pressor support with levophed over initial
stabilization. HCT initially dropped from 25-->16, then
increased to 29 after 4U PRBC's. A repeat CT head showed no
bleed. She returned to the floor on [**2163-8-7**].

On [**2163-8-13**], a repeat EGD was performed to assess
prognostication prior to anticoagulation for a subclavian
catheter-related thrombosis. It revealed Grade 2 esophagitis in
the lower third of the esophagus and a segment suspicious for
Barrett's esophagus. More importantly, it showed a 10 cm X 1,5
cm cratered ulcer in the stomach body. Given high-risk of
rebleeding, decision was taken not to anticoagulate. The line
was pulled out with no complications. High dose Protonix was
started along with Carafate. Her hematocrit remained stable
while on the floor. She was last transfused on [**2163-8-11**].
Helicobacter pylori serology negative. She will follow-up with
GI as an out-patient and will need a repeat EGD.

4) Respiratory: After extubation, Ms. [**Known lastname **] required supplemental
oxygen up to 4L via NP to maintain her oxygen saturation above
92 %. She was gradually weaned off oxygen on the floor and
supplemental oxygen was discontinued on [**2163-8-24**]. At discharge,
her oxygen saturation is 92-94 % on room air. Serial CXRs
revealed fairly stable bilateral pleural effusions and vascular
congestion consistent with pulmonary edema. No evidence of
pneumonia or pulmonary infiltrate.

5) CVS: As mentionned, patient was placed on telemetry following
CVA/TIA. She had a few asymptomatic episodes of NSVT, up to 12
beats, without hemodynamic instability. Her primary cardiologist
was contact[**Name (NI) **] (Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 11493**]) and an EP consult was obtained.
As per EP, she was started on Metoprolol 12.5 mg PO BID. We were
unable to increase the dose to a target of 25 mg PO BID given
patient's borderline low BP (SBP in 90s-100s). A repeat cardiac
echo on [**2163-8-15**] showed mild [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 1915**], mild symmetric LVH
with low normal LVEF (55%) and a small pericardial effusion was
seen.
EKGs revealed sinus tachycardia, probable prior anterior and
inferior MI and non-specific lateral ST-T changes were noted. Of
note, her QTc is slightly prolonged and should be followed. She
will follow-up with her primary cardiologist at D/C.

6) GU: Patient's volume status remained a major issue during her
hospital stay. She has anasarca secondary to her primary
condition, proteinuria and hypoalbuminemia. She was gently
diuresed with Lasix with good results. Her creatinine remained
normal throughout. Her electrolytes were repleted as needed. A
24-hour urine collection revealed a total protein of 232 mg/dL,
Ucreat of 25. Her albumin remains low at 2.3 at discharge. She
will be discharged on Lasix 20 mg PO BID and should have
biweekly Chem 10 with electrolyte repletion as necessary.

She experienced multiple episodes of incontinence while on the
floor, both of urine and feces, felt secondary to reduced
mobility and access. She reports a history consistent with
stress incontinence prior to her admission. On the floor, a
foley was inserted for a short period of time. U/A and urine
cultures were negative. She also complained of bladder spasms,
controlled with Ditropan. No further incontinence at D/C. Off
Ditropan.

Nutrition: She was started on TPN upon return from the [**Hospital Unit Name 153**]
status post massive UGI bleed. diet was advanced slowly and TPN
was D/C'd on [**2163-8-13**].

7) ID: Patient had some diarrhea while in hospital. Flagyl was
started on [**8-8**] and D/C'd on [**8-9**] given C.diff negative on 3
occasions. Her diarrhea was felt to be most likely secondary to
erythromycin, started post UGI bleed to increase GI motiliy. She
also had a low-grade temperature starting on [**2163-8-10**] (100.1).
She was continued on her prophylactic Levoquin (started on day
-2). Vancomycin was added. Levo switched to Cefepime. All
antibiotics were D/C'd on [**8-15**] given no longer neutropenic and
negative work-up.

8) Skin: While in hospital, Ms. [**Known lastname **] had a severe candidal rash
involving her groins, genitalia and buttocks. Fluconazole and
Miconazole powder were prescribed. The rash improved on the
above regimen and with a foley catheter which kept the area dry
(patient incontinent at times). She also has 2 groin lesions
from previous femoral sticks/cordis in the ICU. Plastic Surgery
was consulted, who felt that the lesions were superficial and
required no antibiotics. Wound care with wet-to-dry dressings
were recommended.

She was followed by OT and PT in hospital and will benefit from
continued services at D?C. She will be discharged to a skilled
nursing facility. COndition stable at discharge.

Medications on Admission:
ASA 81 mg PO once daily
Ranitidine 150 mg PO once daily
Lipitor 20 mg PO once daily
Toprol 20 mg PO once daily


Discharge Medications:
1. Lipitor 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
2. Carafate 1 g Tablet Sig: One (1) Tablet PO every six (6)
hours: Please take on an empty stomach.
Disp:*120 Tablet(s)* Refills:*0*
3. Metoprolol Tartrate 25 mg Tablet Sig: Half Tablet PO twice a
day: Take 12.5 mg PO twice daily.
Disp:*30 Tablet(s)* Refills:*2*
4. Acyclovir 400 mg Tablet Sig: One (1) Tablet PO three times a
day.
Disp:*90 Tablet(s)* Refills:*2*
5. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
Life Care Facilities

Discharge Diagnosis:
1) Primary amyloidosis
2) Gastric ulcer


Discharge Condition:
Patient discharged to skilled nursing facility in stable
condition.

Discharge Instructions:
Please call your primary oncologist or return to the clinic if
you develop fever or chills, or if you experience worsening
shortness of breath or increased leg swelling.

Please follow-up with Dr [**Last Name (STitle) 11493**], Dr [**Last Name (STitle) 410**], Dr [**Last Name (STitle) 2161**]
(gastroenterology) and psychiatry as indicated below.

Followup Instructions:
1) Please follow-up with Dr [**Last Name (STitle) 410**] in the next 3 weeks. Please
call his office at [**Telephone/Fax (1) 3760**] to schedule an appointment in
early [**Month (only) **].

2) Please follow-up with gastroenterology for your stomach
ulcer. Your appointment is scheduled for [**2163-9-16**] at
0900 with Dr [**Last Name (STitle) 2161**] as indicated below:
Provider: [**Name10 (NameIs) **] [**Last Name (NamePattern4) 2163**], MD Where: [**Hospital6 29**] MEDICAL
SPECIALTIES Phone:[**Telephone/Fax (1) 1954**] Date/Time:[**2163-9-16**] 9:00

3) Please call your cardiologist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 11493**] and schedule an
appointment to see him in the next 1 month.

4) You may call the psychiatry [**Hospital 6669**] clinic to schedule an
appointment at [**Telephone/Fax (1) 1387**].



Completed by:[**2163-8-25**]
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Cerebral artery occlusion, unspecified with cerebral infarction,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Other complications due to other vascular device, implant, and graft'}


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: 61 year-old female diagnosed with primary amyloidosis in [**Month (only) 880**]
[**2163**], recently harvested after Cytoxan chemotherapy, being
admitted for melphalan therapy followed by auto-BMT as a
palliative measure.

PRESENT ILLNESS: Ms. [**Known lastname **] is a 61 year-old woman diagnosed with primary
amyloidosis in [**2162-3-6**]. At that time, she presented with
progressive lower extremity edema. Work-up revealed significant
proteinuria. A renal biopsy was then performed and showed lambda
light chain deposits. She was also found to have lambda light
chain in her urine. A diagnosis of primary [**Doctor Last Name **] amyloidosis was
subsequently made. She was recently harvested after Cytoxan
therapy and is now being admitted for melphalan chemotherapy
followed by autologous stem cell transplant. Her screening
evaluation revealed normal pulmonary function and no significant
cardiac dysfunction. Except for the proteinuria, her renal
function is normal.

MEDICAL HISTORY: 1) Primary amyloidosis diagnosed in [**3-10**] following clinical
proteinuria. Renal biopsy demonstrated a predominance of lambda
light chains. Bone marrow biopsy in [**5-10**] showed low level (5-10%
of the cellularity) monoclonal lambda plasmacytosis.
2) Multiple bilateral breast cysts: Biopsies negative for
cancer.
3) History of premature ventricular complexes
4) History of duodenal ulcer
5) Surgery to right leg ligamentin [**2139**]'s

MEDICATION ON ADMISSION: ASA 81 mg PO once daily
Ranitidine 150 mg PO once daily
Lipitor 20 mg PO once daily
Toprol 20 mg PO once daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: Pleasant woman in NAD.
VITAL SIGNS: Temp 97, HR 104, BP 110/64, RR 20, oxygen
saturation 96% on RA
HEENT: PERRL, EOMI. no sinus tenderness. Clear oropharynx.
NECK: No JVD. No carotid bruit.
RESP: Clear to auscultation bilaterally
CVS: Normal S1, S2. No murmur/rub or gallop. Left subclavian
triple lumen in place.
GI: Normal BS. Soft and non-tender. No hepatosplenomegaly.
EXt: 3+ pitting edema to thighs. No clubbing, no cyanosis.
NEURO: AAO X3. CN II-XII intact. Strenght [**5-11**] thoughout.

FAMILY HISTORY: Significant for [**Name (NI) 1932**] disease in her son. She ahd a brother
with renal cell carcinoma. Her mother is alive at the age of 93.
Her father died at the age of 84 of "old age".

SOCIAL HISTORY: She currently lives with her husband and has three children. Her
younger son had [**Name (NI) 1932**] disease approximately 3-4 years ago.
She has a 20 pack-year smoking history and reports occasional
alcohol consumption, no drugs. 

### Response:
{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Cerebral artery occlusion, unspecified with cerebral infarction,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Other complications due to other vascular device, implant, and graft'}
