CHIEF COMPLAINT: Fever, shortness of breath

PRESENT ILLNESS: 54-year-old gentleman with a history of AML. He is day 508
post-transplant complicated by chronic graft-versus-host disease

MEDICAL HISTORY: -AML-M7 ([**3-23**]) [Diagnosed with AML in 04/[**2142**]. Admitted
[**2143-6-24**] for matched unrelated allogenic transplant with
busulfan and
cyclophosphamide as his conditioning regimen. AB0 mismatch and
requiring periodic blood transfusions. Underwent bone marrow
aspirate and biopsy most recently on [**2143-9-2**] which showed
markedly hypercellular bone marrow with opacity of
erythroblasts. Cytogenetics were normal. FISH was normal.
Chimerism testing showed them to be 100% donor. ]
-Hyperlipidemia, HTN
-Nephrolithiasis, lithotrypsy and previous nephrostomy tube
and emergent surgery to repair ureteral damage
-Basal cell carcinoma, resected
-Multiple back surgeries: Lumbar L5-S1 surgery x 3, and cervical
spine fusion (bone graft, no hardware)
- Chronic numbness, neuropathic pain
-Pericardial effusion s/p [**3-23**] drainage
- C5/C6 and C6/C7 secondary to herniation of nucleus pulposus,
s/p
Anterior cervical discectomy and fusion C5-6 and C6-7

MEDICATION ON ADMISSION: Medications:
acyclovir 400mg TID
cyclosporine 50mg [**Hospital1 **]
Valium 5mg daily prn muscle spasm
folic acid 1mg daily
Lasix 20mg daily
Neurontin 300mg QHS
Insulin Lispro per sliding scale, NPH 12units [**Hospital1 **]
levofloxacin 500mg daily - until f/u with Dr. [**Last Name (STitle) 724**]
metoprolol 50mg [**Hospital1 **]
cxycodone 5mg 1-2 tabs Q4-6hr prn pain
OxyContin 20mg Q12hr
Protonix 40mg daily
prednisone 10mg daily
Actonel 35mg weekly
Androgel 50mg to torso daily
Bactrm SS one tab daily
voriconozole 200mg [**Hospital1 **]

ALLERGIES: Cefepime / Cipro

PHYSICAL EXAM: Tmax: 37.2 ??????C (99 ??????F)
Tcurrent: 37.2 ??????C (99 ??????F)
HR: 71 (71 - 86) bpm
BP: 100/64(73) {100/64(73) - 122/78(88)} mmHg
RR: 12 (11 - 13) insp/min
SpO2: 98%
Heart rhythm: SR (Sinus Rhythm)
Wgt (current): 105 kg (admission): 105 kg
Height: 72 Inch
General Appearance: Well nourished, No acute distress, Sleepy
Eyes / Conjunctiva: PERRL
Head, Ears, Nose, Throat: Normocephalic, neck supple, JVP 10 cm

FAMILY HISTORY: Mother died suddenly in her 70s. Father died of unknown cancer
with tumors visible across body. One sister has thyroid cancer.
One brother has diabetes and kidney stones. One sister has
[**Name (NI) 5895**].

SOCIAL HISTORY: Mr. [**Known lastname 47367**] lives in [**Location 14840**] with his wife and has three
children, used to work as a [**Company 22957**] technician, but recently was
"forced" to retire. Smoked a pack per day
of cigarettes for many years, but does not currently smoke. He
drinks alcohol socially. He does not use drugs. Walks with
walker and has a cat.
Other pulmonary embolism and infarction,Pneumonia due to respiratory syncytial virus,Complications of transplanted bone marrow,Chronic graft-versus-host disease,Acute myeloid leukemia, in remission,Aseptic necrosis of head and neck of femur,Pulmonary collapse,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Edema,Hypovolemia
Pulm embol/infarct NEC,Resp syncyt viral pneum,Compl marrow transplant,Chronc graft-vs-host dis,Act myl leuk w rmsion,Aseptic necrosis femur,Pulmonary collapse,Long-term use of insulin,Hyperlipidemia NEC/NOS,Obstructive sleep apnea,Hypertension NOS,DMII wo cmp nt st uncntr,Edema,Hypovolemia
Admission Date:  [**2144-11-21**]              Discharge Date:   [**2144-12-7**]

Date of Birth:  [**2090-7-16**]             Sex:   M

Service: MEDICINE

Allergies:
Cefepime / Cipro

Attending:[**First Name3 (LF) 3913**]
Chief Complaint:
Fever, shortness of breath

Major Surgical or Invasive Procedure:
none

History of Present Illness:
54-year-old gentleman with a history of AML. He is day 508
post-transplant complicated by chronic graft-versus-host disease

manifesting as skin, liver involvement and edema. Pt was most
recently admitted for right leg cellulitis; discharged [**11-4**]
with chronic levofloxacin that per records finished on [**11-19**].
Today the patient describes waking up this AM with chills and
malaise. He reports not being able to get warm; the wife called
the onc fellow on call took his temp-- 99.6. As the day
progressed, his temperature increase and he came to the ER.
.
In addition to the fever, the patient has been having
siginificant fatigue and increased cough with sputum. This
afternoon he also developed severe headache (as is typical with
his acute illness), feeling very weak, acute onset of shortness
of breath and pleuritic chest pain. Of note, his lower
extremities have been more swollen recently, but he has recently
noticed that his L>R has been swollen since yesterday, but
previously the right was more swollen than the left.
.
On presentation to the ER, initial vitals were T 101, HR 104, RR
18 02 95% RA. While in the ED, he became more hypoxic and
required a NRB to keep sats above 93%. He also became
hypotensive to BPs of 80s/50s. His BP was fluid responsive and
the patient received a total of 3L. Additionally, he was seen by
onc who recommended Vancomycin, Zosyn. He also received
azithromycin. CTA was done for pleuritic CP that showed a
subsegmental PE, thus he was started on heparin gtt and given
dilaudid for pain.
.
On arrival to the floor, the patient is feeling well, but feels
fatigued. As well he has a persistent bifrontal headache with
photophobia.
.
ROS: + photophobia, + bilateral chest pressure (chronic)
hyperesthesia. + sick contacts (daughter who lives with him has
had fever and sore throat) Denies dizziness or lightheadedness,
syncope or presyncope. He has had no dysuria, constipation,
melena, hematochezia, diarrhea. He has no blurry vision, neck
stiffness.


Past Medical History:
-AML-M7 ([**3-23**]) [Diagnosed with AML in 04/[**2142**]. Admitted
[**2143-6-24**] for matched unrelated allogenic transplant with
busulfan and
cyclophosphamide as his conditioning regimen. AB0 mismatch and
requiring periodic blood transfusions. Underwent bone marrow
aspirate and biopsy most recently on [**2143-9-2**] which showed
markedly hypercellular bone marrow with opacity of
erythroblasts. Cytogenetics were normal. FISH was normal.
Chimerism testing showed them to be 100% donor. ]
-Hyperlipidemia, HTN
-Nephrolithiasis, lithotrypsy and previous nephrostomy tube
and emergent surgery to repair ureteral damage
-Basal cell carcinoma, resected
-Multiple back surgeries: Lumbar L5-S1 surgery x 3, and cervical
spine fusion (bone graft, no hardware)
- Chronic numbness, neuropathic pain
-Pericardial effusion s/p [**3-23**] drainage
- C5/C6 and C6/C7 secondary to herniation of nucleus pulposus,
s/p
Anterior cervical discectomy and fusion C5-6 and C6-7


Social History:
Mr. [**Known lastname 47367**] lives in [**Location 14840**] with his wife and has three
children, used to work as a [**Company 22957**] technician, but recently was
"forced" to retire. Smoked a pack per day
of cigarettes for many years, but does not currently smoke. He
drinks alcohol socially. He does not use drugs. Walks with
walker and has a cat.


Family History:
Mother died suddenly in her 70s. Father died of unknown cancer
with tumors visible across body. One sister has thyroid cancer.
One brother has diabetes and kidney stones. One sister has
[**Name (NI) 5895**].

Physical Exam:
Tmax: 37.2 ??????C (99 ??????F)
Tcurrent: 37.2 ??????C (99 ??????F)
HR: 71 (71 - 86) bpm
BP: 100/64(73) {100/64(73) - 122/78(88)} mmHg
RR: 12 (11 - 13) insp/min
SpO2: 98%
Heart rhythm: SR (Sinus Rhythm)
Wgt (current): 105 kg (admission): 105 kg
Height: 72 Inch
General Appearance: Well nourished, No acute distress, Sleepy
Eyes / Conjunctiva: PERRL
Head, Ears, Nose, Throat: Normocephalic, neck supple, JVP 10 cm

Cardiovascular: (S1: Normal), (S2: Normal), No(t) S3, No(t) S4
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Clear : , Crackles : in the left lower base)
Abdominal: Soft, Bowel sounds present, Tender: RUQ and
epigastrium
Extremities: Right: 1+, Left: 1+
Skin: Warm, Rash: Hands, erythema of upper abdomen
Neurologic: Follows simple commands, Responds to: Not assessed,
Oriented (to): x3, Movement: Purposeful, Tone: Normal


Pertinent Results:
Heme:

[**2144-11-21**] 03:00PM   WBC-6.0 RBC-3.18* HGB-12.6* HCT-36.3*
MCV-114* MCH-39.5* MCHC-34.7 RDW-17.6*
[**2144-11-21**] 03:00PM   NEUTS-85.1* LYMPHS-6.9* MONOS-6.8 EOS-0.8
BASOS-0.3
[**2144-11-21**] 03:00PM   PT-14.1* PTT-25.6 INR(PT)-1.2*

Chemistries:

[**2144-11-21**] 03:00PM   GLUCOSE-135* UREA N-14 CREAT-1.3* SODIUM-139
POTASSIUM-4.8 CHLORIDE-99 TOTAL CO2-33* ANION GAP-12
[**2144-11-21**] 03:00PM   ALT(SGPT)-23 AST(SGOT)-32 ALK PHOS-279* TOT
BILI-0.4
[**2144-11-21**] 03:00PM   LIPASE-12

Cultures:
[**2144-11-21**] Blood: No growth
[**2144-11-21**] Urine: < 10,000
[**2144-11-22**] Sputum: contamination

IMAGING:
UPRIGHT AP VIEW OF THE ABDOMEN: No free air is seen under the
diaphragms.
Relative gasless abdomen is present with no air-fluid levels
identified.
Stool and air is seen within the descending colon and sigmoid
colon. No soft tissue calcifications are identified.
IMPRESSION: No air-fluid levels or free intra-abdominal air
identified.
Relative paucity of gas within the abdomen.

UPRIGHT AP VIEW OF THE CHEST: The right PICC has been removed.
Cervical
fusion hardware is present. Cardiac, mediastinal and hilar
contours are
unchanged and within normal limits. The lungs are clear. There
is no
pulmonary vascular congestion. No pleural effusions or
pneumothorax. Osseous structures are unremarkable.
IMPRESSION: No acute cardiopulmonary abnormality.
.
[**2144-11-21**] CTA:
1. Left lower lobe segmental pulmonary embolism.
2. Wedge-shaped peripheral consolidation in the superior segment
of the right lower lobe. Differential considerations include
infectious or inflammatory processes; atelectasis is less
likely.
3. Thoracic vertebral compression fracture, unchanged in
comparison to
[**2144-9-10**].

.
Portable TTE (Complete) Done [**2144-11-23**] at 10:26:48 AM
The left atrium is dilated. Left ventricular wall thicknesses
and cavity size are normal. Left ventricular systolic function
is hyperdynamic (EF>75%). There is no left ventricular outflow
obstruction at rest or with Valsalva. Right ventricular chamber
size and free wall motion are normal. The aortic valve leaflets
(3) are mildly thickened but aortic stenosis is not present. No
aortic regurgitation is seen. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no mitral valve prolapse. The estimated pulmonary artery
systolic pressure is normal. There is no pericardial effusion.
Compared with the prior study (images reviewed) of [**2144-6-8**], LV
function appears hyperdynamic on the current study. The other
findings are similar.
.
BILAT LOWER EXT VEINS Study Date of [**2144-11-23**] 5:05 PM
IMPRESSION: No DVT in the bilateral lower extremities.
.
CHEST (PORTABLE AP) Study Date of [**2144-11-25**] 5:10 AM
IMPRESSION:
1. Worsening right lower lobe opacity over the period of last
five days most likely representing a worsening infectious
process.
2. Given the presence of pulmonary embolism in left lower lobe
the worsening left lower lobe opacity might represent infarction
as well as atelectasis or infection, determination based on the
chest radiograph cannot be made.
.
CHEST (PORTABLE AP) Study Date of [**2144-11-27**] 4:53 AM
Portable AP chest radiograph was compared to [**2144-11-26**].
There is a slightly improved aeration of lung bases due to
resolution of
atelectasis. Cardiomediastinal silhouette is stable. No
appreciable pleural effusion is seen.
.
[**2144-12-4**] CXR: FINDINGS: Comparison study [**12-3**], there is no
interval change. The two vague bilateral upper lobe opacities
are again seen. These could represent areas related to pulmonary
emboli.
.
[**2144-12-7**] CT chest w/o contrast:
1. Findings are most consistent with cryptogenic organizing
pneumonia, although a component of viral pneumonia is possible.
2. Stable centrilobular emphysema.
3. Multilevel compression fractures are similar to [**2144-11-21**].


Brief Hospital Course:
54 yo M with AML s/p allo-BMT with chronic GVHD of liver, skin
now with fever and pulmonary embolism.
.
Fever/RSV: The patient was admitted to the MICU for inital
hypotension, PE, Acute renal insufficency and increased oxygen
requirement.  The patient reported recent sick contacts and due
to his respiratory complaints, a pulmonary process was the most
consistant site of infection. He was treated with Vancomycin and
Zosyn in the ED and this therapy was continued throughout his
ICU course. He was hypotensive in the ED (SBP to 80's), but this
resolved with IV fluids and was felt to be consistant with
pre-septic physiology.  Cultures were obtained.  Nasal swab was
positive for RSV, sputum with gram positive cocci and yeast.
The patient was treated with Synagist/palivizumab in two
7.5mg/kg doses for RSV.  The patient remained febrile over the
first 4 days of hospitalization but defervessed by hospital day
5.  He was transferred to the BMT service on ICU Day 6.  On the
floor patient was treated with scheduled abuterol and ipatropium
nebs and his supplemental oxygen was weaned down to 2L/min.
Patient's shortness of breath resolved. However, his hypoxia
persisted.  Patient was seen by the Pulmonary and physical
therapy. It appears that the RSV infection is primarily an upper
respiratory tract infection as there is no evidence of RSV
pneumonia. There was some concern that his hypoxia may represent
an element of GVHD of the lung so his prednisone dose was
increased to 40mg.  He had slight improvement with increased
steroids and was tapered to 30mg at the time of discharge.  His
steroid dose will continued to be tapered in the outpatient
setting. He is recommended to continue use of supplemental
oxygen after discharge to maintain oxygen saturations greater
than 94%.

.
PE: LLL pulmonary embolism was identified on CTA.  Pt was
started on [**Hospital1 **] lovenox. On the day of discharge he was started
on coumadin 2mg po and instructed to follow up in two days to
have his INR monitored.  He is to continue lovenox injections at
the reduced dose of 80 mg [**Hospital1 **] until his INR becomes therapeutic.

.
Chronic Health Issues:
GHVD: The patient was maintained in his home regimen of
cyclosporin and prednisone. A RUQ ultrasound was performed to
assess pt's chronic complaint of RUQ tenderness. Ultrasound was
without evidence of acute processes consistent with this pain.
Liver function tests were monitored throughout hospitalization.

AML: The patient was maintained in his home regimen of
cyclophosphamide, ACV, Bactrim and Voriconazole

Lower Extremity Edema: Has been an issue for several months.
Increased over his initial hospital course due to fluid
resusitation.  He underwent gentle diuresis with lasix with
moderate improvement.  An Echo was performed which showed
hyperdynamic LVEF.  Pt was restarted on home lasix 20 mg po
prior to discharge.

Diabetes: Continued outpatient dose of NPH, lispro ss.

Avascular necrosis of hips bilateral: Outpatient pain regimen
continued.

Obstructive Sleep Apnea:  The was given CPAP for his OSA.  He
did not tolerate the face mask or nasal mask.  He refused to use
CPAP for the remainder of his hospitalizaiton. He is scheduled
for an outpatient appointment with a sleep clinic in [**Month (only) 404**] to
introduce him to CPAP.


Medications on Admission:
Medications:
acyclovir 400mg TID
cyclosporine 50mg [**Hospital1 **]
Valium 5mg daily prn muscle spasm
folic acid 1mg daily
Lasix 20mg daily
Neurontin 300mg QHS
Insulin Lispro per sliding scale, NPH 12units [**Hospital1 **]
levofloxacin 500mg daily - until f/u with Dr. [**Last Name (STitle) 724**]
metoprolol 50mg [**Hospital1 **]
cxycodone 5mg 1-2 tabs Q4-6hr prn pain
OxyContin 20mg Q12hr
Protonix 40mg daily
prednisone 10mg daily
Actonel 35mg weekly
Androgel 50mg to torso daily
Bactrm SS one tab daily
voriconozole 200mg [**Hospital1 **]


Discharge Medications:
1. Supplemental oxygen
Please provide supplemental oxygen and necessary equipment.
Start at 2L/minute oxygen via nasal cannula and titrate oxygen
up to maintain oxygen saturations of greater than 94%.
2. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
3. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Testosterone 5 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
5. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. Voriconazole 200 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours).
7. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q12H (every 12 hours).
8. Cyclosporine Modified 25 mg Capsule Sig: Two (2) Capsule PO
Q12H (every 12 hours).
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
10. Acyclovir 200 mg Capsule Sig: Two (2) Capsule PO Q8H (every
8 hours).
11. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*0*
12. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
14. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 6-8 hours as
needed for pain.
15. Diazepam 5 mg Tablet Sig: One (1) Tablet PO BID PRN () as
needed for muscle spasm.
16. Insulin
Please resume home insulin regimen:
NPH 12 units [**Hospital1 **]
Lispo per sliding scale
17. Actonel 35 mg Tablet Sig: One (1) Tablet PO once a week.
18. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation
every four (4) hours as needed for shortness of breath or
wheezing.
Disp:*1 inhaler* Refills:*0*
19. Lovenox 80 mg/0.8 mL Syringe Sig: One (1)  Subcutaneous
twice a day for 15 days.
Disp:*15 days supply* Refills:*0*
20. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO once a day.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Community VNA

Discharge Diagnosis:
Respiratory Syncytial Virus (RSV)
Pulmonary Embolism
Chronic Graft Versus Host Disease
Obstructive Sleep Apnea
h/o Acute Myelogenous Leukemia s/p BMT [**2142**]


Discharge Condition:
Stable; Pt requires supplemental oxygen with ambulation.  He is
tolerating po diet and medications well.


Discharge Instructions:
You were admitted to the hospital for fever, low blood pressure,
and difficulty breathing.  You were found to have a blood clot
in your left lung as well as an upper respiratory tract
infection with a virus called RSV.  You were admitted to the ICU
until you were stabilized.  Once you blood pressure returned to
[**Location 213**] and your fever resolved you were transferred to the floor
where you were closely monitored.  Your shortness of breath
improved. However, you still required supplemental oxygen to
maintain adequate oxygen levels.
.
The following changes were made to your medications:
1) START Lovenox SC injections 80mg twice a day
2) START Albuterol inhaler 2 puffs every 4 hours as needed for
shortness of breath
3) START Warfarin (Coumadin) 3mg by mouth daily
4) STOP levofloxacin (levoquin)
5) INCREASE prednisone to 30 mg by mouth daily
.
.
Please continue taking all other home medications as previously
prescribed.
.
Please contact your physician or return to the hospital if you
experience fever, chills, chest pain, worsening cough, increased
difficulty breathing or any other symptom that is concerning to
you.

Followup Instructions:
Please follow up with [**First Name8 (NamePattern2) 3235**] [**Last Name (NamePattern1) 3236**] in [**Hospital 3242**] clinic on Wednesday
[**2144-12-9**] at 10:30 am.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 9574**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 3241**]
Date/Time:[**2144-12-9**] 10:30
{'Other pulmonary embolism and infarction,Pneumonia due to respiratory syncytial virus,Complications of transplanted bone marrow,Chronic graft-versus-host disease,Acute myeloid leukemia, in remission,Aseptic necrosis of head and neck of femur,Pulmonary collapse,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Edema,Hypovolemia'}


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: Fever, shortness of breath

PRESENT ILLNESS: 54-year-old gentleman with a history of AML. He is day 508
post-transplant complicated by chronic graft-versus-host disease

MEDICAL HISTORY: -AML-M7 ([**3-23**]) [Diagnosed with AML in 04/[**2142**]. Admitted
[**2143-6-24**] for matched unrelated allogenic transplant with
busulfan and
cyclophosphamide as his conditioning regimen. AB0 mismatch and
requiring periodic blood transfusions. Underwent bone marrow
aspirate and biopsy most recently on [**2143-9-2**] which showed
markedly hypercellular bone marrow with opacity of
erythroblasts. Cytogenetics were normal. FISH was normal.
Chimerism testing showed them to be 100% donor. ]
-Hyperlipidemia, HTN
-Nephrolithiasis, lithotrypsy and previous nephrostomy tube
and emergent surgery to repair ureteral damage
-Basal cell carcinoma, resected
-Multiple back surgeries: Lumbar L5-S1 surgery x 3, and cervical
spine fusion (bone graft, no hardware)
- Chronic numbness, neuropathic pain
-Pericardial effusion s/p [**3-23**] drainage
- C5/C6 and C6/C7 secondary to herniation of nucleus pulposus,
s/p
Anterior cervical discectomy and fusion C5-6 and C6-7

MEDICATION ON ADMISSION: Medications:
acyclovir 400mg TID
cyclosporine 50mg [**Hospital1 **]
Valium 5mg daily prn muscle spasm
folic acid 1mg daily
Lasix 20mg daily
Neurontin 300mg QHS
Insulin Lispro per sliding scale, NPH 12units [**Hospital1 **]
levofloxacin 500mg daily - until f/u with Dr. [**Last Name (STitle) 724**]
metoprolol 50mg [**Hospital1 **]
cxycodone 5mg 1-2 tabs Q4-6hr prn pain
OxyContin 20mg Q12hr
Protonix 40mg daily
prednisone 10mg daily
Actonel 35mg weekly
Androgel 50mg to torso daily
Bactrm SS one tab daily
voriconozole 200mg [**Hospital1 **]

ALLERGIES: Cefepime / Cipro

PHYSICAL EXAM: Tmax: 37.2 ??????C (99 ??????F)
Tcurrent: 37.2 ??????C (99 ??????F)
HR: 71 (71 - 86) bpm
BP: 100/64(73) {100/64(73) - 122/78(88)} mmHg
RR: 12 (11 - 13) insp/min
SpO2: 98%
Heart rhythm: SR (Sinus Rhythm)
Wgt (current): 105 kg (admission): 105 kg
Height: 72 Inch
General Appearance: Well nourished, No acute distress, Sleepy
Eyes / Conjunctiva: PERRL
Head, Ears, Nose, Throat: Normocephalic, neck supple, JVP 10 cm

FAMILY HISTORY: Mother died suddenly in her 70s. Father died of unknown cancer
with tumors visible across body. One sister has thyroid cancer.
One brother has diabetes and kidney stones. One sister has
[**Name (NI) 5895**].

SOCIAL HISTORY: Mr. [**Known lastname 47367**] lives in [**Location 14840**] with his wife and has three
children, used to work as a [**Company 22957**] technician, but recently was
"forced" to retire. Smoked a pack per day
of cigarettes for many years, but does not currently smoke. He
drinks alcohol socially. He does not use drugs. Walks with
walker and has a cat. 

### Response:
{'Other pulmonary embolism and infarction,Pneumonia due to respiratory syncytial virus,Complications of transplanted bone marrow,Chronic graft-versus-host disease,Acute myeloid leukemia, in remission,Aseptic necrosis of head and neck of femur,Pulmonary collapse,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Edema,Hypovolemia'}
