CHIEF COMPLAINT: melena

PRESENT ILLNESS: [**Age over 90 **] yo M retired internal medicine physician, w/Hx of GIB while
on ASA X2, history of coronary artery disease s/p stent 9 wks
ago, abdominal aortic aneurysm repair and paroxysmal atrial
fibrillation, who presents with a 1d H/o melena. Pt has been on
Plavix and ASA since recent stent ([**7-27**]).  Pt reports that 1d
PTA he had one mahogany colored stool, (guiaic pos per pt) early
in the day, and then after having lunch and juice had a dark,
tarry stool, also guiaic pos per pt report.  No abdominal pain.
No nausea/vomiting.  No lightheadedness/dizziness.  Reports he
had continued to take his plavix, but his last dose of ASA was
[**10-29**].
In the ED, hct 34-->26.7 (recent baseline was 30-32).  He was
given 2L NS and protonix IV.  NGL was positive and cleared after
250cc NS. GI was consulted.  Pt was originally observed O/N and
now transferred to the ICU for an EGD, when hct drop was noted.
Vital signs have remained stable.
.
ROS:  Neg for CP/SOB.  Stable 2 pillow orthopnea.  No PND.  Able
to walk 10 min before developing his angina, which he states is
much less since he has had his stent placement.  No
palpitations.  Reports recent [**8-31**] lb weight loss, stating that
his "clothes are falling off of (him)."

MEDICAL HISTORY: 1.  First, UGI bleed [**2-24**] ASA use, erosive gastritis, H pylori
positive, no treatment.  Second UGIB [**2-24**] ASA use after his CABG
placement 15 years ago.
2.  Lower GI bleed 2 years ago- Found to have an AVM in the
terminal ileum
3.  AAA repair, [**2085**]
4.  Thyroid dysfunction
5.  pacemaker implantation [**2099-10-20**]
6.  paroxysmal atrial fibrillation for 15 years, s/p several
cardioversions, complicated by amiodarone induced thyrotoxicosis
tx with tapazole ([**2098-10-22**]), continues to take amiodarone,
stable on 100mg po qd
7.  PUD
8.  CAD s/p CABG in [**2080**], status post cardiac cath with stent
placement in [**2100-7-23**], on ASA and plavix with Dr. [**First Name8 (NamePattern2) **]
[**Name (STitle) **] following as his cardiologist.
9.  valvular heart disease, mitral and aortic regurgitation
10. pacemaker placement in [**9-26**]
11. CHF with last Echo [**2100-10-28**] EF 25%, severe regional left
ventricular systolic dysfunction with severe
hypokinesis/akinesis of the distal anterior septum, apex, and
distal anterior wall, [**1-24**]+AR, 2+MR, 2+TR, significant pulmonic
regurgitation
12. TURP
13. Right renal artery stenosis
14. chronic renal insufficiency, with baseline Cr 1.6
15. gun shot wound to right chest [**2039**]
16. fractured metatarsal
17. fractured wrist
18. Hyperuricemia
19. Hiatal hernia
20. Positive Coombs test
21. Constipation
22. Multinodular goiter
23. Anemia
24. Secondary hyperparathyroidism

MEDICATION ON ADMISSION: 1.  Amiodarone 100mg po qd
2.  ASA
3.  Plavix 75mg po qd
4.  Captopril 12.5mg po qd
5.  CoReg 12.5mg po qAM and qPM
6.  Lipitor 20mg po qd
7.  Omeprazole 20mg po qPM
8.  Bumex 100mg po qAM
9.  Vit B12 1000mcg po qd
10. Vit B6 100mg po qd
11. Ferrous gluconate
12. Ambien 5mg po prn
13. Folic acid 1mg po qd
14. Vit D
15. Aranesp
16. Tapazole 5mg po qMon, Wed, Fri
.
Allergies: Sensitive to asa-GI bleed
morphine-vomiting
Levaquin muscle pain, bleeding into muscle

ALLERGIES: Morphine Sulfate / Aspirin / Metoprolol / Levaquin

PHYSICAL EXAM: Temp:  BP: 123/52 P: 65 RR: 14  Oxygen sat: 100% on RA
General:  [**Age over 90 **] y/o Caucasian man in NAD.  Breathing comfortably on
room air.  Pleasant, cooperative.  Well-spoken.  WNWD.
HEENT:  PERRL, EOMI.  Sclerae anicteric.  MMM.  Neck supple, no
LAD.
JVP to mid-jaw.
Lungs:  With bibasilar crackles.  Scar midline over sternum.
CV:  RRR With a diastolic murmur at the RUSB, loud holosystolic
murmur at LLSB, rad to apex. Pacer in place.
Abd: Soft, ND, NT. Normoactive bowel sounds.  no masses felt.
With midline abdominal scar.  No HSM.
Peripheral ext: 2+ DP pulses bilaterally.  Ext warm and
well-perfused.  No edema BLE.
Neuro:  No focal deficits.  Appropriate.

FAMILY HISTORY: Mother died at age [**Age over 90 **].  Father died PAF.  Sister died,
[**Name (NI) 5895**] ds.  Son died [**Name2 (NI) **] climbing- Mt. [**Doctor Last Name **] in
[**Location (un) 24402**], Or.  One living son.

SOCIAL HISTORY: Smoker from the age of 17-27, quit.  No alcohol or IVDA.  Worked
as an Internist for several years here at [**Hospital1 18**], then worked for
BU in Occupational Medicine.  Retired several years ago.
Unspecified gastritis and gastroduodenitis, with hemorrhage,Acute kidney failure, unspecified,Volume depletion, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified disorder of kidney and ureter,Iron deficiency anemia, unspecified,Benign neoplasm of stomach
Gstr/ddnts NOS w hmrhg,Acute kidney failure NOS,Volume depletion NOS,Atrial fibrillation,CHF NOS,Diaphragmatic hernia,Crnry athrscl natve vssl,Status-post ptca,Renal & ureteral dis NOS,Iron defic anemia NOS,Benign neoplasm stomach
Admission Date:  [**2100-10-29**]              Discharge Date:   [**2100-11-3**]


Service: MEDICINE

Allergies:
Morphine Sulfate / Aspirin / Metoprolol / Levaquin

Attending:[**First Name3 (LF) 317**]
Chief Complaint:
melena

Major Surgical or Invasive Procedure:
Upper endoscopy with biopsy on [**2100-11-1**]


History of Present Illness:
[**Age over 90 **] yo M retired internal medicine physician, w/Hx of GIB while
on ASA X2, history of coronary artery disease s/p stent 9 wks
ago, abdominal aortic aneurysm repair and paroxysmal atrial
fibrillation, who presents with a 1d H/o melena. Pt has been on
Plavix and ASA since recent stent ([**7-27**]).  Pt reports that 1d
PTA he had one mahogany colored stool, (guiaic pos per pt) early
in the day, and then after having lunch and juice had a dark,
tarry stool, also guiaic pos per pt report.  No abdominal pain.
No nausea/vomiting.  No lightheadedness/dizziness.  Reports he
had continued to take his plavix, but his last dose of ASA was
[**10-29**].
In the ED, hct 34-->26.7 (recent baseline was 30-32).  He was
given 2L NS and protonix IV.  NGL was positive and cleared after
250cc NS. GI was consulted.  Pt was originally observed O/N and
now transferred to the ICU for an EGD, when hct drop was noted.
Vital signs have remained stable.
.
ROS:  Neg for CP/SOB.  Stable 2 pillow orthopnea.  No PND.  Able
to walk 10 min before developing his angina, which he states is
much less since he has had his stent placement.  No
palpitations.  Reports recent [**8-31**] lb weight loss, stating that
his "clothes are falling off of (him)."


Past Medical History:
1.  First, UGI bleed [**2-24**] ASA use, erosive gastritis, H pylori
positive, no treatment.  Second UGIB [**2-24**] ASA use after his CABG
placement 15 years ago.
2.  Lower GI bleed 2 years ago- Found to have an AVM in the
terminal ileum
3.  AAA repair, [**2085**]
4.  Thyroid dysfunction
5.  pacemaker implantation [**2099-10-20**]
6.  paroxysmal atrial fibrillation for 15 years, s/p several
cardioversions, complicated by amiodarone induced thyrotoxicosis
tx with tapazole ([**2098-10-22**]), continues to take amiodarone,
stable on 100mg po qd
7.  PUD
8.  CAD s/p CABG in [**2080**], status post cardiac cath with stent
placement in [**2100-7-23**], on ASA and plavix with Dr. [**First Name8 (NamePattern2) **]
[**Name (STitle) **] following as his cardiologist.
9.  valvular heart disease, mitral and aortic regurgitation
10. pacemaker placement in [**9-26**]
11. CHF with last Echo [**2100-10-28**] EF 25%, severe regional left
ventricular systolic dysfunction with severe
hypokinesis/akinesis of the distal anterior septum, apex, and
distal anterior wall, [**1-24**]+AR, 2+MR, 2+TR, significant pulmonic
regurgitation
12. TURP
13. Right renal artery stenosis
14. chronic renal insufficiency, with baseline Cr 1.6
15. gun shot wound to right chest [**2039**]
16. fractured metatarsal
17. fractured wrist
18. Hyperuricemia
19. Hiatal hernia
20. Positive Coombs test
21. Constipation
22. Multinodular goiter
23. Anemia
24. Secondary hyperparathyroidism

Social History:
Smoker from the age of 17-27, quit.  No alcohol or IVDA.  Worked
as an Internist for several years here at [**Hospital1 18**], then worked for
BU in Occupational Medicine.  Retired several years ago.


Family History:
Mother died at age [**Age over 90 **].  Father died PAF.  Sister died,
[**Name (NI) 5895**] ds.  Son died [**Name2 (NI) **] climbing- Mt. [**Doctor Last Name **] in
[**Location (un) 24402**], Or.  One living son.


Physical Exam:
Temp:  BP: 123/52 P: 65 RR: 14  Oxygen sat: 100% on RA
General:  [**Age over 90 **] y/o Caucasian man in NAD.  Breathing comfortably on
room air.  Pleasant, cooperative.  Well-spoken.  WNWD.
HEENT:  PERRL, EOMI.  Sclerae anicteric.  MMM.  Neck supple, no
LAD.
JVP to mid-jaw.
Lungs:  With bibasilar crackles.  Scar midline over sternum.
CV:  RRR With a diastolic murmur at the RUSB, loud holosystolic
murmur at LLSB, rad to apex. Pacer in place.
Abd: Soft, ND, NT. Normoactive bowel sounds.  no masses felt.
With midline abdominal scar.  No HSM.
Peripheral ext: 2+ DP pulses bilaterally.  Ext warm and
well-perfused.  No edema BLE.
Neuro:  No focal deficits.  Appropriate.


Pertinent Results:
[**2100-10-28**] 04:17PM BLOOD WBC-5.7 RBC-3.44* Hgb-10.4* Hct-32.0*
MCV-93 MCH-30.2 MCHC-32.4 RDW-15.5 Plt Ct-202
[**2100-10-29**] 07:30PM BLOOD PT-13.2 PTT-24.3 INR(PT)-1.2
[**2100-10-29**] 07:30PM BLOOD Glucose-98 UreaN-51* Creat-2.3* Na-140
K-4.3 Cl-101 HCO3-27 AnGap-16
[**2100-10-30**] 03:41PM BLOOD Calcium-8.6 Phos-3.2 Mg-2.0
[**2100-10-30**] 03:41PM BLOOD TSH-2.5
[**2100-10-31**] 02:56AM URINE Hours-RANDOM Creat-79 Na-84

ECHO [**2100-10-28**]
The left atrium is mildly dilated. The right atrium is
moderately dilated. There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity size is top
normal/borderline dilated. There is severe regional left
ventricular systolic dysfunction with severe
hypokinesis/akinesis of the distal anterior septum, apex and
distal anterior wall. Right ventricular chamber size and free
wall motion are normal. The aortic root is moderately dilated.
The ascending aorta is moderately dilated. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. There is no aortic valve stenosis.
Mild to moderate ([**1-24**]+) aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Moderate (2+)
mitral
regurgitation is seen. Moderate [2+] tricuspid regurgitation is
seen. There is borderline pulmonary artery systolic
hypertension. Significant pulmonic regurgitation is seen. There
is no pericardial effusion.
Compared with the report of the prior study (tape unavailable
for review) of [**2100-2-5**], left ventricular function has
deteriorated

CHEST (PORTABLE AP)  [**2100-10-30**] 1:45 PM
There is slight prominence of the pulmonary vasculature with
cardiomegaly, indicating mild congestive heart failure. The
patient has prior CABG and median sternotomy. Pacemaker leads
remain in place. No pneumothorax is seen. A nasogastric tube
terminates in the gastric antrum.


[**2100-11-1**] report date [**2100-11-3**] "Esophageal" polyp, biopsy:
Gastric-type hyperplastic polyp with focal ulceration.


Brief Hospital Course:
This is a [**Age over 90 **] year old male physician with past medical history
significant for two upper gastrointestinal bleeds in past
secondary to aspirin use presents after two dark stools, both
guiaic positive, hemodynamically stable, repeat hematocrit near
baseline. Currently on ASA and Plavix.
.
1. Gastrointestinal bleed- In the ED, hct 34-->26.7 (recent
baseline was 30-32). Pt was transferred to the ICU, when
hematocrit drop was noted. INR, platelets appropriate. He was
given 2L NS and protonix IV. NGL was positive and cleared after
250cc NS. GI was consulted. Vital signs remained stable so
patient was transferred to floor. On [**11-1**], GI performed an EGD
showing gastritis, large gastric polyp s/p bx. Bleeding was
thought to be most likely from gastritis and/or polyps. Probably
exacerbated by recent anticoagulation with ASA and plavix.
Serial hematocrits were fairly stable within range. Pt was
restarted on the plavix following his EGD. After discussion with
attending, patient was also started back on ASA 81 mg daily as
pt had stent in left main only nine weeks ago. Continued on
protonix [**Hospital1 **].
.
2. [**Name (NI) 4964**] Pt's last echo was significant for a LVEF of 25%.
Monitored closely for fluid overload. Euvolemic on exam with no
evidence of symptomatic HF. Lungs clear and no edma. Admission
CXR clear.
.
3. [**Name (NI) **] Pt is s/p LM stent nine weeks ago. Doing well since that
time in sense that he has not had any more angina. Patient was
restarted on plavix after EGD and restarted on ASA prior to
discharge. While on the floor, patient was on tele and continued
on beta blocker and ACEi as he was well compensated and not
actively bleeding.
.
4. Acute on chronic renal insufficiency. Baseline creatinine per
pt between 1.6 and 2.9. Was elevated to 2.3 on admission most
likely from prerenal state. Down to 2.0 prior to discharge.
.
5. Paroxysmal atrial fib- Stable with good rate control.
Continued on amiodarone and on tele. Pt with pacemaker.
.
6. FEN- Heart healthy. Electrolyte replacement as needed.
.
7. Proph- Pneumoboots; PPI
.
8. Access- Two large bore peripheral IVs.
.
9. Code status: Full
.
10. Communication: With the pt.

Medications on Admission:
1.  Amiodarone 100mg po qd
2.  ASA
3.  Plavix 75mg po qd
4.  Captopril 12.5mg po qd
5.  CoReg 12.5mg po qAM and qPM
6.  Lipitor 20mg po qd
7.  Omeprazole 20mg po qPM
8.  Bumex 100mg po qAM
9.  Vit B12 1000mcg po qd
10. Vit B6 100mg po qd
11. Ferrous gluconate
12. Ambien 5mg po prn
13. Folic acid 1mg po qd
14. Vit D
15. Aranesp
16. Tapazole 5mg po qMon, Wed, Fri
.
Allergies: Sensitive to asa-GI bleed
morphine-vomiting
Levaquin muscle pain, bleeding into muscle

Discharge Medications:
1. Amiodarone 200 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Carvedilol 6.25 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
4. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
5. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. Captopril 12.5 mg Tablet Sig: One (1) Tablet PO once a day.
9. Bumex 1 mg Tablet Sig: One (1) Tablet PO once a day.
10. Vitamin B-12 1,000 mcg Tablet Sig: One (1) Tablet PO once a
day.
11. Vitamin B-6 100 mg Tablet Sig: One (1) Tablet PO once a day.

12. Ambien 5 mg Tablet Sig: One (1) Tablet PO QHS PRN.
13. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
14. Vitamin D 400 unit Capsule Sig: Two (2) Capsule PO once a
day.
15. Tapazole 5 mg Tablet Sig: One (1) Tablet PO Every Mon, Wed,
and Fri.
16. Aranesp 40 mcg/mL Solution Sig: Forty (40) mcg Injection As
previously prescribed.
17. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO QAM.
18. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO at bedtime.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
GI bleed
Polyps in cardia and stomach body
Gastritis
Small Hiatal Hernia

Secondary Diagnosis:
Coronary Artery Disease s/p stent [**7-/2100**]
Chronic Renal Insufficiency


Discharge Condition:
Stable. Pt's last stool was guiac negative and his Hct was
stable.


Discharge Instructions:
1. Please take medications as prescribed.

2. Please call your PCP or return to the emergency room if you
have any chest pain, bright blood per rectum, melena, shortness
of breath or any other concerning symptoms.

3. Please keep all follow up appointments.

4. You had a biopsy of a polyp during your EGD. The GI doctors
[**Name5 (PTitle) **] [**Name5 (PTitle) 138**] [**Name5 (PTitle) **] at home with the results of this biopsy as they
are not yet available.

5. Please resume your aranesp as you were taking it at home.

Followup Instructions:
1. Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 10012**]  Call to schedule
appointment within one week of discharge. The office will be
expecting your call.

2. Provider: [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) 3972**] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 1803**]
Date/Time:[**2101-1-6**] 2:30

3. Provider:  [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**]
Date/Time:[**2101-1-6**] 3:30



Completed by:[**2101-2-7**]
{'Unspecified gastritis and gastroduodenitis, with hemorrhage,Acute kidney failure, unspecified,Volume depletion, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified disorder of kidney and ureter,Iron deficiency anemia, unspecified,Benign neoplasm of stomach'}


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: melena

PRESENT ILLNESS: [**Age over 90 **] yo M retired internal medicine physician, w/Hx of GIB while
on ASA X2, history of coronary artery disease s/p stent 9 wks
ago, abdominal aortic aneurysm repair and paroxysmal atrial
fibrillation, who presents with a 1d H/o melena. Pt has been on
Plavix and ASA since recent stent ([**7-27**]).  Pt reports that 1d
PTA he had one mahogany colored stool, (guiaic pos per pt) early
in the day, and then after having lunch and juice had a dark,
tarry stool, also guiaic pos per pt report.  No abdominal pain.
No nausea/vomiting.  No lightheadedness/dizziness.  Reports he
had continued to take his plavix, but his last dose of ASA was
[**10-29**].
In the ED, hct 34-->26.7 (recent baseline was 30-32).  He was
given 2L NS and protonix IV.  NGL was positive and cleared after
250cc NS. GI was consulted.  Pt was originally observed O/N and
now transferred to the ICU for an EGD, when hct drop was noted.
Vital signs have remained stable.
.
ROS:  Neg for CP/SOB.  Stable 2 pillow orthopnea.  No PND.  Able
to walk 10 min before developing his angina, which he states is
much less since he has had his stent placement.  No
palpitations.  Reports recent [**8-31**] lb weight loss, stating that
his "clothes are falling off of (him)."

MEDICAL HISTORY: 1.  First, UGI bleed [**2-24**] ASA use, erosive gastritis, H pylori
positive, no treatment.  Second UGIB [**2-24**] ASA use after his CABG
placement 15 years ago.
2.  Lower GI bleed 2 years ago- Found to have an AVM in the
terminal ileum
3.  AAA repair, [**2085**]
4.  Thyroid dysfunction
5.  pacemaker implantation [**2099-10-20**]
6.  paroxysmal atrial fibrillation for 15 years, s/p several
cardioversions, complicated by amiodarone induced thyrotoxicosis
tx with tapazole ([**2098-10-22**]), continues to take amiodarone,
stable on 100mg po qd
7.  PUD
8.  CAD s/p CABG in [**2080**], status post cardiac cath with stent
placement in [**2100-7-23**], on ASA and plavix with Dr. [**First Name8 (NamePattern2) **]
[**Name (STitle) **] following as his cardiologist.
9.  valvular heart disease, mitral and aortic regurgitation
10. pacemaker placement in [**9-26**]
11. CHF with last Echo [**2100-10-28**] EF 25%, severe regional left
ventricular systolic dysfunction with severe
hypokinesis/akinesis of the distal anterior septum, apex, and
distal anterior wall, [**1-24**]+AR, 2+MR, 2+TR, significant pulmonic
regurgitation
12. TURP
13. Right renal artery stenosis
14. chronic renal insufficiency, with baseline Cr 1.6
15. gun shot wound to right chest [**2039**]
16. fractured metatarsal
17. fractured wrist
18. Hyperuricemia
19. Hiatal hernia
20. Positive Coombs test
21. Constipation
22. Multinodular goiter
23. Anemia
24. Secondary hyperparathyroidism

MEDICATION ON ADMISSION: 1.  Amiodarone 100mg po qd
2.  ASA
3.  Plavix 75mg po qd
4.  Captopril 12.5mg po qd
5.  CoReg 12.5mg po qAM and qPM
6.  Lipitor 20mg po qd
7.  Omeprazole 20mg po qPM
8.  Bumex 100mg po qAM
9.  Vit B12 1000mcg po qd
10. Vit B6 100mg po qd
11. Ferrous gluconate
12. Ambien 5mg po prn
13. Folic acid 1mg po qd
14. Vit D
15. Aranesp
16. Tapazole 5mg po qMon, Wed, Fri
.
Allergies: Sensitive to asa-GI bleed
morphine-vomiting
Levaquin muscle pain, bleeding into muscle

ALLERGIES: Morphine Sulfate / Aspirin / Metoprolol / Levaquin

PHYSICAL EXAM: Temp:  BP: 123/52 P: 65 RR: 14  Oxygen sat: 100% on RA
General:  [**Age over 90 **] y/o Caucasian man in NAD.  Breathing comfortably on
room air.  Pleasant, cooperative.  Well-spoken.  WNWD.
HEENT:  PERRL, EOMI.  Sclerae anicteric.  MMM.  Neck supple, no
LAD.
JVP to mid-jaw.
Lungs:  With bibasilar crackles.  Scar midline over sternum.
CV:  RRR With a diastolic murmur at the RUSB, loud holosystolic
murmur at LLSB, rad to apex. Pacer in place.
Abd: Soft, ND, NT. Normoactive bowel sounds.  no masses felt.
With midline abdominal scar.  No HSM.
Peripheral ext: 2+ DP pulses bilaterally.  Ext warm and
well-perfused.  No edema BLE.
Neuro:  No focal deficits.  Appropriate.

FAMILY HISTORY: Mother died at age [**Age over 90 **].  Father died PAF.  Sister died,
[**Name (NI) 5895**] ds.  Son died [**Name2 (NI) **] climbing- Mt. [**Doctor Last Name **] in
[**Location (un) 24402**], Or.  One living son.

SOCIAL HISTORY: Smoker from the age of 17-27, quit.  No alcohol or IVDA.  Worked
as an Internist for several years here at [**Hospital1 18**], then worked for
BU in Occupational Medicine.  Retired several years ago. 

### Response:
{'Unspecified gastritis and gastroduodenitis, with hemorrhage,Acute kidney failure, unspecified,Volume depletion, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified disorder of kidney and ureter,Iron deficiency anemia, unspecified,Benign neoplasm of stomach'}
