CHIEF COMPLAINT: Thoracic wound drainage and hyponatremia

PRESENT ILLNESS: 55 y/o M with PMH of renal cell CA metastatic to T-spine s/p
recent T1-T12 fusion on [**2194-1-28**] on decadron taper presented from
[**Hospital 38**] Rehab with increased serosanguinous drainage from
wound per rehab team and low grade temp of 100.1. Per the
patient, he has been feeling well and denies fever, chills,
increased back pain. He does have bilateral tingling/numbness in
his lower extremities, but able to move his feet/legs. He was
found to have renal cell CA in [**2190**] s/p nephrectomy, then found
to have extradural mass at T5 in [**6-21**] with kyphotic collapse at
T10 when presented with leg weakness with numbness/difficulty
walking. He is s/p recent admission between [**Date range (1) 75880**]
for thoracic instrumented fusion T1-12 on [**2194-1-28**] by Dr. [**Last Name (STitle) 548**]
and was only at his rehab for 2 days when the staff noted
increased serosanguinous drainage from site, without purulence,
odor, but increased WBC.

MEDICAL HISTORY: rheumatoid arthritis x 20 years
renal ca s/p nephrectomy
metastatic spine disease s/p thoracic instrumented fusion T1-12
on [**2194-1-28**] for extradural mass at T5 and kyphotic collapse at
T10
h/o IVDA

MEDICATION ON ADMISSION: Bacitracin ointment
Celexa 20 mg PO DAILY
Cyclobenzaprine 10mg PO BID
Dexamethasone 1mg Q12h (down from PO Q8h x 2 days)
Docusate 100mg [**Hospital1 **]
SC heparin
RISS
Methadone 30 mg PO QHS, 60 mg PO Q 6 AM AND Q 6 PM
Metoprolol Tartrate 12.5 mg PO BID
MVI
Senna 2tabs [**Hospital1 **]
Tylenol 1000mg Q6hr prn
Dulcolax 10mg PR QD prn
Dilaudid 2-4mg PO Q3h prn pain
Sorbitol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - T97.9, BP 114/72, HR 108, RR 20, 96% on RA
General: lying in bed, in NAD
HEENT: NCAT, dry mucous membranes
Neck: supple, no carotid bruits, no LAD
Pulmonary: CTA bilaterally, no w/c/r
Cardiac: tachycardia, regular rate and rhythm, with no m/r/g
Abdomen: +BS soft, nontender, mildly distended,
Extremities: radial deviation of MCP joints of both hands,
slight tremor.
Back: + flowing serosanguinous drainage from wound draining 4
wound covers and chucks in 4 hours. No tenderness to palpation
to paraspinal area. staples intact.
NEURO - awake, A&Ox3, able to name hospital, spell his last name
forwards and backwards. Mildly inattentive. Eyelids heavy. CNs
II-XII grossly intact, slight weakness of right orbicularis. [**4-19**]
strength of right LE, 5/5 strength of LLE. Sensation to light
touch intact. Reflexes 1+

FAMILY HISTORY: Family History: father deceased at 63 yo of heart disease.

SOCIAL HISTORY: Lives with a friend and his wife; tobacco 2 ppd x 30-40 years
but notes has not smoked for the last 2 weeks; recovering
alcoholic but no ETOH recently; history of drug abuse, but none
for last two years, on Methadone.
Other postoperative infection,Pneumonia, organism unspecified,Other disorders of neurohypophysis,Secondary malignant neoplasm of bone and bone marrow,Myelopathy in other diseases classified elsewhere,Bacteremia,Acute osteomyelitis, other specified sites,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hyperpotassemia,Rheumatoid arthritis,Thrombocytopenia, unspecified,Anemia in neoplastic disease,Chronic hepatitis C without mention of hepatic coma,Personal history of malignant neoplasm of kidney
Other postop infection,Pneumonia, organism NOS,Neurohypophysis dis NEC,Secondary malig neo bone,Myelopathy in oth dis,Bacteremia,Ac osteomyelitis NEC,Mth sus Stph aur els/NOS,Abn react-surg proc NEC,Hyperpotassemia,Rheumatoid arthritis,Thrombocytopenia NOS,Anemia in neoplastic dis,Chrnc hpt C wo hpat coma,Hx of kidney malignancy
Name:  [**Known lastname 1799**],[**Known firstname 63**]                Unit No:   [**Numeric Identifier 12405**]

Admission Date:  [**2194-2-7**]              Discharge Date:   [**2194-3-4**]

Date of Birth:  [**2138-6-4**]             Sex:   M

Service: PLASTIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3341**]
Addendum:
Pt remained in hospital 1 additional day to ensure
rehabilitation facility could administer nafcillin as directed.
During additional night pt had increased pain.  CPS recommended
increasing evening dose of methadone as well as dilaudid dose.

Discharge Medications:
1. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl Topical
DAILY (Daily).
4. Sorbitol 70 % Solution Sig: Thirty (30) ML Miscellaneous
DAILY (Daily) as needed for constipation.
5. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day) as needed.
6. Modafinil 100 mg Tablet Sig: Two (2) Tablet PO qAM ().
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
8. Tizanidine 2 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
9. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO QHS (once a day
(at bedtime)).
10. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
11. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
12. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1)  Subcutaneous
DAILY (Daily).
14. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
15. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed.
16. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 5 days.
17. Methadone 10 mg Tablet Sig: Four (4) Tablet PO QAM (once a
day (in the morning)) as needed for pain.
18. Methadone 40 mg Tablet, Soluble Sig: One (1) Tablet, Soluble
PO NOON (At Noon) as needed for pain.
19. Methadone 40 mg Tablet, Soluble Sig: One (1) Tablet, Soluble
PO DAILY16 (Once Daily at 16) as needed for pain.
20. Ondansetron 4 mg IV Q8H:PRN
21. Nafcillin 2 gm IV Q4H
Please administer in NS
22. Methadone 10 mg Tablet Sig: Five (5) Tablet PO QHS (once a
day (at bedtime)).
23. Hydromorphone 4 mg Tablet Sig: 2-3 Tablets PO Q3H (every 3
hours) as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1174**] [**Hospital **] Hospital - [**Location (un) **]

Discharge Diagnosis:
PRIMARY:
- Post-operative wound dehiscense c/b MSSA infection.
- MSSA bacteremia
- Aortic valve Lambl's excresences vs. vegetation
- Thrombocytopenia NOS (NOT HIT).
- Anemia of inflammation
- Hyponatremia secondary to SIADH

SECONDARY:
- Transpedicular resection of the T5 renal cell metastasis.
- T9 vertebrectomy for pathologic fracture.
- Posterior instrumentation segmental T1-T12
- Right lower extremity weakness secondary to cord compression
- Metastatic renal cell carcinoma s/p left nephrectomy, XRT.
- Hepatitis C
- Prior IVDA
- ETOH abuse


Discharge Instructions:
Please return to the hospital if
- you experience fevers greater then 101.4, chills, or other
signs of infection.
- you experience chest pain, shortness of breath, redness,
swelling, or purulent discharge from the incision site.
- you experience worsening pain or any other concerning
symptoms.

Certain pain medications may have side effects such as
drowsiness. Do not operate heavy machinery while on these
medications.
Certain pain medications such as percocet or codeine can cause
constipation. If needed you can take a stool softner such as
Colace (one capsule) or gentle laxative (such as Milk of
Magnesia) once per day.

Restart taking all your regular medications.
Continue to take your antibiotics as prescribed

-Please do not shower until your follow-up visit.
.
Please keep track of JP drain output for your follow-up visit

Followup Instructions:
Please have LFT's, CBC with diff, bun and creatine drawn weekly
and ESR and CRP drawn ever other week.  Please fax weekly
results to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at ([**Telephone/Fax (1) 3790**].

Follow up with Dr. [**Last Name (STitle) **] in [**Hospital **] clinic on [**3-31**] at 11:30 am

Follow up with plastic surgery - Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 735**] next tuesday.
Please call to make an appointment.

Follow up with Dr. [**Last Name (STitle) 752**] from neurosurgery in 2 weeks.  Please
call to make an appointment


                             [**First Name11 (Name Pattern1) 389**] [**Last Name (NamePattern4) 3342**] MD [**MD Number(1) 3343**]

Completed by:[**2194-3-4**]

Admission Date:  [**2194-2-7**]              Discharge Date:   [**2194-3-4**]

Date of Birth:  [**2138-6-4**]             Sex:   M

Service: PLASTIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1430**]
Chief Complaint:
Thoracic wound drainage and hyponatremia

Major Surgical or Invasive Procedure:
- Debridement and evacuation of wound infection
- latissimus and trapezius flap
- removal of porticath


History of Present Illness:
55 y/o M with PMH of renal cell CA metastatic to T-spine s/p
recent T1-T12 fusion on [**2194-1-28**] on decadron taper presented from
[**Hospital 38**] Rehab with increased serosanguinous drainage from
wound per rehab team and low grade temp of 100.1. Per the
patient, he has been feeling well and denies fever, chills,
increased back pain. He does have bilateral tingling/numbness in
his lower extremities, but able to move his feet/legs. He was
found to have renal cell CA in [**2190**] s/p nephrectomy, then found
to have extradural mass at T5 in [**6-21**] with kyphotic collapse at
T10 when presented with leg weakness with numbness/difficulty
walking. He is s/p recent admission between [**Date range (1) 75880**]
for thoracic instrumented fusion T1-12 on [**2194-1-28**] by Dr. [**Last Name (STitle) 548**]
and was only at his rehab for 2 days when the staff noted
increased serosanguinous drainage from site, without purulence,
odor, but increased WBC.

In the ED, his initial vitals were: T98.1, BP 120/67, HR 107, RR
20, 98% on RA. He was given ativan 1mg IV x 1, dilaudid 4mg PO x
1. Neurosurgery was consulted in the ED and did not suspect
wound infection so did not recommend any antibiotics but
recommended CT imaging of T-spine. Labs drawn significant for
hyponatremia with Na 126, hyperkalemia K 5.5, and WBC 19.2
(around his recent baseline) with 9 bands. Ulytes showed FeNa<1
and UNa 102. He was given IV decadron 10mg x 1 and admitted to
medicine for workup of hyponatremia, tachycardia with
neurosurgery following.

On the floor, the patient denies any back pain, increased
numbness or tingling of his legs, or subjective fever, chills,
dysuria, or diarrhea. He notes increased urination recently and
currently is thirsty.


Past Medical History:
rheumatoid arthritis x 20 years
renal ca s/p nephrectomy
metastatic spine disease s/p thoracic instrumented fusion T1-12
on [**2194-1-28**] for extradural mass at T5 and kyphotic collapse at
T10
h/o IVDA

Social History:
Lives with a friend and his wife; tobacco 2 ppd x 30-40 years
but notes has not smoked for the last 2 weeks; recovering
alcoholic but no ETOH recently; history of drug abuse, but none
for last two years, on Methadone.

Family History:
Family History: father deceased at 63 yo of heart disease.


Physical Exam:
VS - T97.9, BP 114/72, HR 108, RR 20, 96% on RA
General: lying in bed, in NAD
HEENT: NCAT, dry mucous membranes
Neck: supple, no carotid bruits, no LAD
Pulmonary: CTA bilaterally, no w/c/r
Cardiac: tachycardia, regular rate and rhythm, with no m/r/g
Abdomen: +BS soft, nontender, mildly distended,
Extremities: radial deviation of MCP joints of both hands,
slight tremor.
Back: + flowing serosanguinous drainage from wound draining 4
wound covers and chucks in 4 hours. No tenderness to palpation
to paraspinal area. staples intact.
NEURO - awake, A&Ox3, able to name hospital, spell his last name
forwards and backwards. Mildly inattentive. Eyelids heavy. CNs
II-XII grossly intact, slight weakness of right orbicularis. [**4-19**]
strength of right LE, 5/5 strength of LLE. Sensation to light
touch intact. Reflexes 1+

Pertinent Results:
Ct spine [**2-8**]
1.  Post-operative changes in the thoracic region with
improvement in thoracic kyphosis since the following surgery and
stabilization.  At T5 level, no evidence of compression of the
thecal sac is visualized on the current study with persistent
lytic abnormality in the left pedicle of L5 and involving the
articular processes.
2.  Fluid collection at the upper end of the laminectomy at
C7-T1 level with small air bubbles without enhancement in the
surrounding soft tissues could be a post-operative fluid
collection.  However, clinical correlation recommended as
infection cannot be excluded entirely on the CT appearances.


Brief Hospital Course:
55 yo M with metastatic renal CA to T spine s/p T1-T12 fusion,
with non-healing wound complicated by MSSA, s/p latissimus and
trapezius flap on [**2194-2-20**].
.
Pt presented with fever, elevated WBC, ESR and CRP, increasing
drainage from surcial wound and signs of infection in C7-T1 area
on CT.  Thoracic wound was debrided on [**2194-2-9**] and [**2194-2-14**].
Wound cx showed MSSA and pt was started on nafcillin.  Blood
cultures remained negative, and ECHO showed no vegetations on
TTE.  Pt had portacath removed to ensure not nidus of infection.
 On [**2194-2-20**] wound was repaired with latissimus and trapezius flap
and pt transfered to plastic surgery.  Pt followed usual post-op
course with adequate healing of spinal wound.  Nafcillin to be
continued for 6 weeks at 2 gm q4hr.
.
#. Hyponatremia - Pt with previous history of hyponatremia, and
is at risk of SIADH given cancer and SSRI use. Improved with
fluid restriction. Nephrology followed throught pt stay
.
# HAP - Pt febrile with RLL infiltrate on CXR on [**2-26**].  Pt
started on Levofloxacin to treat HAP continued for 10 days.  ID
was consulted and followed throughout stay.
.
# Thrombocytopenia - Platelet drop greater than 50% with current
nadir of 58. HIT positive, but OD equivocal, 0.7. Serotonin
release assay negative. Therefore negative for HIT.  Platelets
subsequently improved through hospitalization
.
#. Altered mental status - AAOx3. No change in mental status. No
masses/mets/bleed on CT head.

Medications on Admission:
Bacitracin ointment
Celexa 20 mg PO DAILY
Cyclobenzaprine 10mg PO BID
Dexamethasone 1mg Q12h (down from PO Q8h x 2 days)
Docusate 100mg [**Hospital1 **]
SC heparin
RISS
Methadone 30 mg PO QHS, 60 mg PO Q 6 AM AND Q 6 PM
Metoprolol Tartrate 12.5 mg PO BID
MVI
Senna 2tabs [**Hospital1 **]
Tylenol 1000mg Q6hr prn
Dulcolax 10mg PR QD prn
Dilaudid 2-4mg PO Q3h prn pain
Sorbitol

Discharge Medications:
1. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Methadone 10 mg Tablet Sig: Three (3) Tablet PO QHS (once a
day (at bedtime)).
4. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl Topical
DAILY (Daily).
5. Sorbitol 70 % Solution Sig: Thirty (30) ML Miscellaneous
DAILY (Daily) as needed for constipation.
6. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day) as needed.
7. Modafinil 100 mg Tablet Sig: Two (2) Tablet PO qAM ().
8. Hydromorphone 4 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
9. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
10. Tizanidine 2 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
11. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO QHS (once a day
(at bedtime)).
12. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
13. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day).
14. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

15. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1)  Subcutaneous
DAILY (Daily).
16. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
17. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed.
18. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 5 days.
19. Methadone 10 mg Tablet Sig: Four (4) Tablet PO QAM (once a
day (in the morning)) as needed for pain.
20. Methadone 40 mg Tablet, Soluble Sig: One (1) Tablet, Soluble
PO NOON (At Noon) as needed for pain.
21. Methadone 40 mg Tablet, Soluble Sig: One (1) Tablet, Soluble
PO DAILY16 (Once Daily at 16) as needed for pain.
22. Ondansetron 4 mg IV Q8H:PRN
23. Nafcillin 2 gm IV Q4H
Please administer in NS


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
PRIMARY:
- Post-operative wound dehiscense c/b MSSA infection.
- MSSA bacteremia
- Aortic valve Lambl's excresences vs. vegetation
- Thrombocytopenia NOS (NOT HIT).
- Anemia of inflammation
- Hyponatremia secondary to SIADH

SECONDARY:
- Transpedicular resection of the T5 renal cell metastasis.
- T9 vertebrectomy for pathologic fracture.
- Posterior instrumentation segmental T1-T12
- Right lower extremity weakness secondary to cord compression
- Metastatic renal cell carcinoma s/p left nephrectomy, XRT.
- Hepatitis C
- Prior IVDA
- ETOH abuse

Discharge Condition:
Good


Discharge Instructions:
Please return to the hospital if
- you experience fevers greater then 101.4, chills, or other
signs of infection.
- you experience chest pain, shortness of breath, redness,
swelling, or purulent discharge from the incision site.
- you experience worsening pain or any other concerning
symptoms.

Certain pain medications may have side effects such as
drowsiness. Do not operate heavy machinery while on these
medications.
Certain pain medications such as percocet or codeine can cause
constipation. If needed you can take a stool softner such as
Colace (one capsule) or gentle laxative (such as Milk of
Magnesia) once per day.

Restart taking all your regular medications.
Continue to take your antibiotics as prescribed

-Please do not shower until your follow-up visit.
.
Please keep track of JP drain output for your follow-up visit

Followup Instructions:
Please have LFT's, CBC with diff, bun and creatine drawn weekly
and ESR and CRP drawn ever other week.  Please fax weekly
results to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7443**] at ([**Telephone/Fax (1) 1353**].

Follow up with Dr. [**Last Name (STitle) 7443**] in [**Hospital **] clinic on [**3-31**] at 11:30 am

Follow up with plastic surgery - Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] next tuesday.
Please call to make an appointment.

Follow up with Dr. [**Last Name (STitle) 548**] from neurosurgery in 2 weeks.  Please
call to make an appointment
{'Other postoperative infection,Pneumonia, organism unspecified,Other disorders of neurohypophysis,Secondary malignant neoplasm of bone and bone marrow,Myelopathy in other diseases classified elsewhere,Bacteremia,Acute osteomyelitis, other specified sites,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hyperpotassemia,Rheumatoid arthritis,Thrombocytopenia, unspecified,Anemia in neoplastic disease,Chronic hepatitis C without mention of hepatic coma,Personal history of malignant neoplasm of kidney'}


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: Thoracic wound drainage and hyponatremia

PRESENT ILLNESS: 55 y/o M with PMH of renal cell CA metastatic to T-spine s/p
recent T1-T12 fusion on [**2194-1-28**] on decadron taper presented from
[**Hospital 38**] Rehab with increased serosanguinous drainage from
wound per rehab team and low grade temp of 100.1. Per the
patient, he has been feeling well and denies fever, chills,
increased back pain. He does have bilateral tingling/numbness in
his lower extremities, but able to move his feet/legs. He was
found to have renal cell CA in [**2190**] s/p nephrectomy, then found
to have extradural mass at T5 in [**6-21**] with kyphotic collapse at
T10 when presented with leg weakness with numbness/difficulty
walking. He is s/p recent admission between [**Date range (1) 75880**]
for thoracic instrumented fusion T1-12 on [**2194-1-28**] by Dr. [**Last Name (STitle) 548**]
and was only at his rehab for 2 days when the staff noted
increased serosanguinous drainage from site, without purulence,
odor, but increased WBC.

MEDICAL HISTORY: rheumatoid arthritis x 20 years
renal ca s/p nephrectomy
metastatic spine disease s/p thoracic instrumented fusion T1-12
on [**2194-1-28**] for extradural mass at T5 and kyphotic collapse at
T10
h/o IVDA

MEDICATION ON ADMISSION: Bacitracin ointment
Celexa 20 mg PO DAILY
Cyclobenzaprine 10mg PO BID
Dexamethasone 1mg Q12h (down from PO Q8h x 2 days)
Docusate 100mg [**Hospital1 **]
SC heparin
RISS
Methadone 30 mg PO QHS, 60 mg PO Q 6 AM AND Q 6 PM
Metoprolol Tartrate 12.5 mg PO BID
MVI
Senna 2tabs [**Hospital1 **]
Tylenol 1000mg Q6hr prn
Dulcolax 10mg PR QD prn
Dilaudid 2-4mg PO Q3h prn pain
Sorbitol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - T97.9, BP 114/72, HR 108, RR 20, 96% on RA
General: lying in bed, in NAD
HEENT: NCAT, dry mucous membranes
Neck: supple, no carotid bruits, no LAD
Pulmonary: CTA bilaterally, no w/c/r
Cardiac: tachycardia, regular rate and rhythm, with no m/r/g
Abdomen: +BS soft, nontender, mildly distended,
Extremities: radial deviation of MCP joints of both hands,
slight tremor.
Back: + flowing serosanguinous drainage from wound draining 4
wound covers and chucks in 4 hours. No tenderness to palpation
to paraspinal area. staples intact.
NEURO - awake, A&Ox3, able to name hospital, spell his last name
forwards and backwards. Mildly inattentive. Eyelids heavy. CNs
II-XII grossly intact, slight weakness of right orbicularis. [**4-19**]
strength of right LE, 5/5 strength of LLE. Sensation to light
touch intact. Reflexes 1+

FAMILY HISTORY: Family History: father deceased at 63 yo of heart disease.

SOCIAL HISTORY: Lives with a friend and his wife; tobacco 2 ppd x 30-40 years
but notes has not smoked for the last 2 weeks; recovering
alcoholic but no ETOH recently; history of drug abuse, but none
for last two years, on Methadone. 

### Response:
{'Other postoperative infection,Pneumonia, organism unspecified,Other disorders of neurohypophysis,Secondary malignant neoplasm of bone and bone marrow,Myelopathy in other diseases classified elsewhere,Bacteremia,Acute osteomyelitis, other specified sites,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hyperpotassemia,Rheumatoid arthritis,Thrombocytopenia, unspecified,Anemia in neoplastic disease,Chronic hepatitis C without mention of hepatic coma,Personal history of malignant neoplasm of kidney'}
